Endoscopic Endonasal Transsphenoidal Removal of an Intra-Suprasellar Schwannoma Mimicking a Pituitary Adenoma

Abstract

Intracranial schwannomas, accounting for 8 to 10 % of all primary brain neoplasms, are relatively frequent intracranial tumors, but a “pure” intrasellar localization is exceptional. We report the case of an intra-suprasellar schwannoma mimicking a non-functioning pituitary macroadenoma both radiographically and clinically. A 73-year-old man presented with an episode of lipothymia followed by episodes of mental confusion. The neurological investigations revealed a bitemporal hemianopia and a hypopituitaric status. The neuroradiological investigations showed an intra-suprasellar mass resembling a pituitary adenoma. The patient underwent surgery performed by means of an endoscopic endonasal transsphenoidal approach, with a subtotal excision of the tumor. The histopathological studies revealed a cellular schwannoma. The review of the literature disclosed another 8 cases of intrasellar schwannomas. The possibility of an intrasellar schwannoma has to be considered in the differential diagnoses of neoplastic and non-neoplastic lesions of the sellar area.

Key words

Transsphenoidal surgery - endoscopic approach - schwannoma - pituitary

References

• 1 Chadduck W M. Unusual lesions involving the sella turcica.  South Med J. 1973;  66 948-955
• 2 Civit T, Pinelli C, Klein M, Auque J, Baylac F, Hepner H. Intrasellar schwannoma.  Acta Neurochir (Wien). 1997;  139 160-161
• 3 Goebel H H, Shimokawa K, Schaake T, Kremp A. Schwannoma of the sellar region.  Acta Neurochir (Wien). 1979;  48 191-197
• 4 Guenot M, Bataille B, Wager M. Intrasellar neurinoma.  Neurochirurgie. 1994;  40 263-266
• 5 Ishige N, Ito C, Saeki N, Oka N. Neurinoma with intrasellar extension.  No Shinkei Geka. 1985;  13 79-84
• 6 Kasantikul V, Shuangshoti S, Preechayudh P, Wangsuphachart S. A combined neurilemmoma and angioma of the parasellar region.  J Neurosurg. 1987;  67 307-311
• 7 Perone T P, Robinson B, Holmes S M. Intrasellar schwannoma.  Neurosurgery. 1984;  14 71-73
• 8 Wilberger J E. Primary intrasellar schwannoma: case report.  Surg Neurol. 1989;  32 156-158
• 9 Hardy J. Comment to the article: Maartens NF, Ellegala DB, Vance ML, Lopes MBS, Laws ER. Intrasellar schwannomas: report of two cases.  Neurosurgery. 2003;  52 1205
• 10 Maartens N F, Ellegala D B, Vance M L, Lopes M BS, Laws E R. Intrasellar schwannomas: report of two cases.  Neurosurgery. 2003;  52 1200-1206
• 11 Whee S M, Lee J, Kim J H. Intrasellar schwannoma mimicking pituitary adenoma: a case report.  J Korean Med Sci. 2002;  17 147-150
• 12 Cappabianca P, Alfieri A, Divitiis E de. Endoscopic endonasal transsphenoidal approach to the sella: towards functional endoscopic pituitary surgery (FEPS).  Minim Invasive Neurosurg. 1998;  41 66-73
• 13 Cappabianca P, Cavallo L M, Colao A, Del Basso De Caro M, Esposito F, Cirillo S, Lombardi G, Divitiis E de. Endoscopic endonasal transsphenoidal approach: outcome analysis of 100 consecutive procedures.  Minim Invasive Neurosurg. 2002;  45 1-8
• 14 Cappabianca P, Cavallo L M, Esposito F, Valente V, Divitiis E de. Sellar repair in endoscopic endonasal transsphenoidal surgery: results of 170 cases.  Neurosurgery. 2002;  51 1365-1372
• 15 Carrau R L, Jho H D, Ko Y. Transnasal-transsphenoidal endoscopic surgery of the pituitary gland.  Laryngoscope. 1996;  106 914-918
• 16 Divitiis E de, Cappabianca P. Endoscopic endonasal transsphenoidal surgery. In: Pickard JD (eds.). Advances and Technical Standards in Neurosurgery. Berlin, Heidelberg: Springer Verlag 2002 Vol. 27: 137-177
• 17 Divitiis E de, Cappabianca P, Cavallo L M. Endoscopic transsphenoidal approach: adaptability of the procedure to different sellar lesions.  Neurosurgery. 2002;  51 699-707
• 18 Jho H D, Carrau R L, Ko Y. Endoscopic pituitary surgery. In: Wilkins RH, Rengachary SS (eds.). Neurosurgical Operative Atlas. Park Ridge III: American Association of Neurological Surgeons 1996 5: 1-12
• 19 Gray M H, Rosenberg A E, Dickersin G R, Bahn A K. Glial fibrillary acidic protein and keratin expression by benign and malignant nerve sheath tumors.  Hum Pathol. 1989;  20 1089-1096
• 20 Deruaz J P, Janzer R C, Costa J. Cellular schwannomas of the intracranial and intraspinal compartment: morphological and immunological characteristics compared with classical benign schwannomas.  J Neuropathol Exp Neurol. 1993;  52 114-118
• 21 Scheithauer B W, Casadei G P, Manfrini M, Wood M B. Cellular schwannoma: a clinicopathological study of 56 cases.  J Neuropathol Exp Neurol. 1993;  52 329
• 22 Seppälä M T, Haltia M J. Spinal malignant nerve sheath tumor or cellular schwannoma? A striking difference in prognosis.  J Neurosurg. 1993;  79 528-532
• 23 Woodruff J M, Kourea H P, Louis D N, Scheithauer B W. Schwannoma. In: Kleihues P, Cavenee WK (eds.). WHO Classification of Tumors, Pathology and Genetics: Tumors of the Central Nervous System. Lyon: IARC Press 2000: 164-166
• 24 Stefansson K, Wollmann R, Jerkovic M. S-100 protein in soft-tissue tumors derived from Schwann cells and melanocytes.  Am J Pathol. 1982;  106 261-268