Brain Tumor Res Treat.  2014 Apr;2(1):43-47. 10.14791/btrt.2014.2.1.43.

Oculomotor Nerve Schwannoma: A Case Report

• Cho YH
• Sung KS
• Song YJ
• Kim DC
• Choi S
• Kim KU

• KMID: 1734668
• DOI: http://doi.org/10.14791/btrt.2014.2.1.43

Abstract

Schwannomas account for about 8% of intracranial tumors and 90% are vestibular schwannomas. Oculomotor schwannoma without neurofibromatosis is extremely rare. A 41-year-old female presented with complaints of blurred vision, and the neurologic examination revealed afferent pupillary defect and decreased visual acuity of the left side. Brain magnetic resonance image showed an extra axial mass in the left superior orbital fissure. The patient underwent major surgery via the fronto-temporal approach. The tumor originated from the oculomotor nerve and was subtotally removed under microscopic surgery. The pathological findings confirmed the tumor as a schwannoma. After surgery, ptosis and medial gaze limitation of the left eye was detected, but the symptoms improved gradually.

Keyword

Schwannoma; Oculomotor nerve; Surgery

MeSH Terms

Adult
Brain
Female
Humans
Neurilemmoma*
Neurofibromatosis 1
Neurologic Examination
Neuroma, Acoustic
Oculomotor Nerve*
Orbit
Pupil Disorders
Visual Acuity

Figure

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  Fig. 1 A T1-weighted magnetic resonance imaging (MRI) with gadolinium enhancement is showing an avoid mass in the superior orbital fissure, and the mass was extended from cavernous sinus to the intraorbital resion (A-C). There is no evidence of re-growth on one year-following MRI (D-F).

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  Fig. 2 Intaoperative photogram showing the tumor originated from ventral part of oculomotor nerve. V1: ophthalmic branch of trigeminal nerve, III: oculomotor nerve, II: optic nerve, arrows: the tumor.

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  Fig. 3 The tumor showed whorling or wavy pattern of elongated spindle cells with nuclear palisading, alternating cellular and loose areas (H&E, ×200).

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  Fig. 4 Photograph demonstrating post-surgical function of oculomotor nerve. A: There were medial and down gaze limitation and ptosis of left eye. B: The nerve function was improved after four months.

Reference

1. Choi YS, Sung KS, Song YJ, Kim HD. Olfactory schwannoma-case report-. J Korean Neurosurg Soc. 2009; 45:103–106. PMID: 19274121.

2. Ohata K, Takami T, Goto T, Ishibashi K. Schwannoma of the oculomotor nerve. Neurol India. 2006; 54:437–439. PMID: 17114862.

3. Netuka D, Benes V. Oculomotor nerve schwannoma. Br J Neurosurg. 2003; 17:168–173. PMID: 12820761.

4. Asaoka K, Sawamura Y, Murai H, Satoh M. Schwannoma of the oculomotor nerve: a case report with consideration of the surgical treatment. Neurosurgery. 1999; 45:630–633. discussion 633-4. PMID: 10493384.

5. Katoh M, Kawamoto T, Ohnishi K, Sawamura Y, Abe H. Asymptomatic schwannoma of the oculomotor nerve: case report. J Clin Neurosci. 2000; 7:458–460. PMID: 10942674.

6. Mehta VS, Singh RV, Misra NK, Choudhary C. Schwannoma of the oculomotor nerve. Br J Neurosurg. 1990; 4:69–72. PMID: 2185790.

7. Lunardi P, Rocchi G, Rizzo A, Missori P. Neurinoma of the oculomotor nerve. Clin Neurol Neurosurg. 1990; 92:333–335. PMID: 1963824.

8. Kim IY, Kondziolka D, Niranjan A, Flickinger JC, Lunsford LD. Gamma Knife surgery for schwannomas originating from cranial nerves III, IV, and VI. J Neurosurg. 2008; 109(Suppl):149–153. PMID: 19123902.

9. Schultheiss R, Kristof R, Schramm J. Complete removal of an oculomotor nerve neurinoma without permanent functional deficit. Case report. Ger J Ophthalmol. 1993; 2:228–233. PMID: 8220104.

10. Tanriover N, Kemerdere R, Kafadar AM, Muhammedrezai S, Akar Z. Oculomotor nerve schwannoma located in the oculomotor cistern. Surg Neurol. 2007; 67:83–88. discussion 88. PMID: 17210311.