J Rhinol.  2024 Nov;31(3):184-188. 10.18787/jr.2024.00028.

Vidian Nerve Schwannoma Extending Into the Foramen Rotundum in a Female Patient: A Case Report

• Bang JH
• Jin SH
• Kim SJ
• Lee KH

• KMID: 2561503
• DOI: http://doi.org/10.18787/jr.2024.00028

Abstract

Schwannomas are benign tumors that can develop in any part of a nerve containing Schwann cells. Skull base schwannomas are rare, representing approximately 4% of extracranial schwannomas. Among these, vidian nerve schwannomas are particularly uncommon, with only a few documented cases. In this report, we describe the case of a 58-year-old female patient who presented with an incidental finding of a skull base mass. The patient’s only symptoms were intermittent headaches and dry eyes. No mass was detected during the physical examination. Radiographic evaluation revealed a neoplasm within the vidian canal, and the lesion’s characteristics suggested a schwannoma. The patient underwent endoscopic resection, and subsequent histopathological analysis confirmed the diagnosis of schwannoma. Follow-up imaging and physical examination showed no evidence of recurrence. This case report highlights a schwannoma located in the vidian canal and extending into the foramen rotundum, which was successfully managed with endoscopic surgery.

Keyword

Neurilemmoma; Nerve sheath neoplasms; Transnasal endoscopic surgery; Foramen rotundum

Figure

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  Fig. 1. Axial and coronal views of a computed tomography scan of the paranasal sinus. A: A round mass is observed within the vidian canal, extending into the left sphenoid sinus. The pterygopalatine fossa remains intact. B: A soft tissue density mass-like lesion (asterisk) occupies the vidian canal, extending into the sphenoid sinus and foramen rotundum. The medial wall of the foramen rotundum’s bony canal is partially eroded. White arrowhead: right vidian canal. Black arrowhead: right foramen rotundum. White arrow: left foramen rotundum, showing destruction of the bony canal.

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  Fig. 2. Preoperative axial and coronal magnetic resonance image. A: A hypermetabolic lesion exhibiting a heterogeneously enhanced “salt and pepper” sign is observed on a T1-weighted axial image. B: The left maxillary nerve is not observed on the T1-weighted coronal image, in contrast to the foramen rotundum on the right side (white arrowhead).

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  Fig. 3. Intraoperative image of schwannoma. A: A round mass containing yellowish tissue (asterisk) is visible. Intracapsular piecemeal resection was performed using the appropriate equipment. B: All intracapsular components were removed and confirmed with a 30° endoscope.

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  Fig. 4. Histopathologic findings of the mass. A: Verocay body arranged in a palisading pattern with compact areas of spindle cells, representing the Antoni A area, alongside loosely arranged hypocellular foci in the Antoni B area (hematoxylin & eosin stain, ×100). B: Immunohistochemical staining yielded a strongly positive reaction for S-100 protein, a useful marker for schwannoma (S-100 stain, ×100).

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  Fig. 5. Postoperative magnetic resonance T1-weighted image showing no evidence of recurrence in the area of the vidian canal, with associated mucosal swelling.

Reference

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