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Introduction Trigeminal schwannoma surgery has shown a remarkable improvement in functional recovery and tumor resection. In the era of radiosurgery, these outcomes need to be characterized for tumors which are outside the realm of being treated with radiosurgery. We present a series of trigeminal schwannomas larger than 3 cm, surgical approaches used, and outcomes with an emphasis on functional recovery in a high-volume center with radiosurgery facilities. Method All consecutive cases of trigeminal schwannoma from January 2012 to May 2021 which were more than 3 cm in size and underwent microsurgery were included in this series. The surgical approach, neurological outcomes, and extent of resection were defined objectively with pre/postoperative magnetic resonance imaging. Results A total of 83 such cases (>3 cm) were found, with cranial nerve symptoms (5th most common) being the commonest. Twenty three percent cases had blindness due to secondary optic atrophy and eighteen percent had long tract motor symptoms signifying the tumor burden in our series. Radiological gross total excision was achieved in 75.9% cases. Conclusion Large-volume schwannomas present with cranial nerve involvement and may need extensive skull base approaches. Functional outcomes need to be prioritized and can be achieved albeit with lesser gross resection rates. Hearing and facial preservation in addition to relief of trigeminal symptoms should be the goal of resection with minimal additional morbidity. [ABSTRACT FROM AUTHOR]

Malignant Triton Tumors (MTTs) are a rare and aggressive subtype of malignant peripheral nerve sheath tumors (MPNSTs), often associated with neurofibromatosis type 1. This case report describes a unique instance of recurrent sporadic MTT within the carotid sheath in a 33-year-old male without any personal or familial history of neurofibromatosis. The patient initially presented with a biopsy-confirmed MTT in the right neck, involving the carotid body and brachial plexus, and underwent partial resection, radiation therapy, and chemotherapy. Six months later, the patient presented with recurrent MTT, and subsequently underwent radical tumor resection, segmental right carotid artery resection, and deep femoral vein interposition. Recovery was complicated by hematoma formation, and the patient developed vocal fold paralysis and a left vocal fold cyst, necessitating further surgeries. Yearly follow-ups for 8 years revealed no recurrence. This case emphasizes the importance of comprehensive patient evaluation, including clinical history, imaging, and biopsy findings, for accurate diagnosis and prompt surgical intervention in managing such rare and aggressive tumors. Further research is needed to identify novel therapies and improve survival rates for patients with MTTs. [ABSTRACT FROM AUTHOR]

We report a case of paravertebral retroperitoneal ancient schwannoma (RPAS) with symptoms suggestive of irritable bowel syndrome that was relieved after resection. Very few cases have been reported of RPAS with gastrointestinal symptoms. Increased bowel activity associated with RPAS has not been reported. Our case report suggests that RPAS may present with increased bowel frequency that could be relieved after surgical resection. [ABSTRACT FROM AUTHOR]

Intramedullary schwanommas are rare, and most cases are reported in cervical region. Less than 20 dorsal intramedullary schwanommas have been reported till date in literature. This is due to their cell of origin, the Schwann cell, which is not normally found within the parenchyma of the brain and spinal cord; therefore it is not surprising that these lesions are rare. We report a rare solitary dorsal intramedullary schwanomma in a young adult patient who presented with paraplegia.

En dehors de l'oncopédiatrie, et des indications dites « indiscutables » de protonthérapie, validées par l'Institut national du cancer (INCa) et de la Haute autorité de santé (HAS) (chordome, chondrosarcome, et mélanome oculaires), les indications potentielles de protonthérapie en population adulte restent très débattues. L'objectif de cet article de synthèse est donc de décrire le rationnel de la protonthérapie pour les indications intracrâniennes « en dehors de celles validées par l'INCa et la HAS », de rapporter les résultats thérapeutiques pour ces indications, s'ils existent, et d'informer l'oncologue-radiothérapeute si des études cliniques sont ouvertes ou en cours d'ouverture. Cet article de synthèse se limite aux indications pour la population adulte. Considering intracranial tumours, only few indications of protontherapy, such as chordoma, chondrosarcoma or uveal melanoma, are uniformly approved in the world. Other indications, excluding paediatric pathologies, are still debated. The aim of this article is to describe the rationale for the use of protonbeam irradiation for meningioma, pituitary adenoma, craniopharyngioma, paraganglioma, glioma, and schwannoma, and to inform the radiation oncologists if prospective studies or randomized studies are opened for inclusions. This article deals only with indications for adults. [ABSTRACT FROM AUTHOR]

Intraoral schwannomas account for 1% of head and neck schwannoma, with tongue base schwannoma being reported rarely. In an English literature search from 1988 to 2014, not more than 38 cases of tongue base schwannoma have been reported. Large tongue base schwannomas pose a significant risk to airway, thereby calling for an early intervention. We report a rare case of tongue base schwannoma in a 25 year old female managed surgically by lateral pharyngotomy approach. [ABSTRACT FROM AUTHOR]

Highlights • Pancreatic schwannoma arise from sympathetic and Para sympathetic fibers that cross pancreas. • Macroscopically they are well circumscribed, encapsulated lesions, homogenous lesions. • Microscopically they show Antoni A & B areas. • They demonstrate S100, vimentin, CD56 positivity. • Malignant transformation is extremely rare with only 8 reported cases till now. • Treatment is simple enucleation, but a accurate pre-operative diagnosis is difficult to make hence a oncollogically margin negative resection is done. Abstract Introduction: Nerve sheath tumors are tumors arising from nerve sheaths or which show nerve sheath differentiation. They are divided as benign and malignant. They are associated with Von Recklinghausen syndrome. Characterised by café-au-lait spots, lisch nodules, acoustic neuromas, pheochromocytomas. Presentation of case: A 62 year old gentleman came with complaints of Abdominal discomfort for 1month. He also had Left sided abdominal pain, Anorexia, Vomiting, No history of dyspepsia, fever, bowel disturbance. Patient is a known case of diabetes mellitus II. On abdominal examination a large mass of 10*8 cms was palpated in the left hypochondrium, left lumbar, and umbilical region. It had restricted mobility, not moving with respiration, firm in consistency. On palpation of neck, the thyroid gland was found to be enlarged with palpable right lobe. Contrast enhanced computed tomography showed large lobulated heterogenously enhancing mass with internal necrosis and calcifications in the left hypochondrium, in the region of distal body and tail of pancreas. There were no other foci of metastasis in abdomen or chest. Chest X-ray of patient was normal. Ultrasound of neck revealed a suspicious nodule in right lobe of thyroid measuring 1*1 cms with no nodal enlargement. Fnac of thyroid nodule was done under image guidance which was suggestive of papillary carcinoma of thyroid. As image guided biopsy of abdominal tumour could not be done patient was planned for laparotomy. The tumor was resected en bloc - distal pancreatectomy and splenectomy. Post opereative biopsy showed irregular spindle shaped cells with nuclei exhibiting "a wavy, buckled appearance" malignant peripheral nerve sheath tumor. Patient was reviewed after a period of 2 months. Positron emission tomography was done which revealed para aortic nodes and 2 mesenteric nodes. It also revealed a metabolically active nodule in thyroid with cervical nodal metastasis. Patient was taken up for total thyroidectomy with functional neck dissection. Histopathology confirmed papillary carcinoma of thyroid with positive lymph nodes. Patient was advised to undergo a radioactive iodine scan showed 0.3% uptake. Patient was started on chemotherapy for para aortic nodes with a regimen of paclitaxel, adriamycin, ifosumide and mesma. Discussion: Pancreatic schwannoma arise from sympathetic and Para sympathetic fibers that cross over pancreas. Patients Present with abdominal pain and weight loss commonly. Macroscopically they are well circumscribed, encapsulated lesions, homogenous lesions. Microscopically they show Antoni A & B areas. They demonstrate S100, vimentin, CD56 positivity. Most common differential diagnosis are cystic mucinous / serous neoplasms of pancreas. Malignant transformation is extremely rare with only 8 reported cases till now. Treatment is simple enucleation, but a accurate pre-operative diagnosis is difficult to make hence a oncollogically margin negative resection is done. Adjuvant radiotherapy can be given to reduce the tumor load. Chemotherapy can be given with ifosumide and doxorubicin. Conclusion: Malignant pancreatic nerve sheath tumours are very rare to be found, but have very poor prognosis, hence in cases of pancreatic tumour its better to keep the diagnosis of nerve sheath tumour also a differential diagnosis. In conclusion pancreatic tumours are to be identified at the earliest and surgery should be done for those cases [ABSTRACT FROM AUTHOR]

Schwannoma or neurilemmomas are benign, encapsulated, slow growing nerve sheath tumors of ectodermal origin derived from schwann cells of the nerve sheath. It is commonly seen in the head and neck region. It mainly arises from vestibulocochlear nerve (80%) and rarely in oral cavity (1%), tongue being the most common site in the oral cavity. Palate is a rare site for schwannoma. Herein, we report a rare case of schwannoma of the hard palate in a 21-year-old male. It was excised intraorally. A histopathological diagnosis of schwannoma was made. Immunohistochemistry with S-100 and vimentin were positive which confirmed the diagnosis of schwannoma.

Schwannomas are well encapsulated mesenchymal tumors of peripheral nerves, with slow growth. The laryngeal schwanomma is exceptional, we present a case not described in the literature of shwannoma in the pre epiglottic space. A 50-year-old woman, who had a history of foreign body sensation for 4 years ago, progressing to high dysphagia and hoarseness. Direct laryngoscopy in suspension demonstrated a regular submucosal mass in the supraglottic space, reducing pharyngo-laryngeal space. CT and MRI concluded with a benign tumor of the preepiglottic space. External surgical excision was performed and a primary tracheotomy was required. The histological examination with an immunochemical study confirmed a benign schwannoma. There was no complication postoperatively. The outcome was excellent after 2 years of follow-up. [ABSTRACT FROM AUTHOR]

The increase in benign spinal tumors among adults over the last decade has been a major cause of concern. This worrisome trend has been attributed to many factors, including improved detection techniques, enhanced access to medical care, and the aging population. The research primarily focuses on Schwannoma, which is a rare type of tumor that arises from Schwann cells, which are responsible for producing the myelin sheath that surrounds and protects nerves. Although the majority of schwannomas are benign, there have been instances where they have transformed into malignant tumors, potentially leading to significant morbidity and mortality. We report a case of a 68-year-old woman who presented with progressive back pain and weakness in both lower limbs over the past months. The pain was initially localized to the lower back but gradually intensified and radiated down to the legs. The patient reported difficulty walking and a sensation of tingling and numbness in the feet. She denied any recent trauma or significant medical history. On physical examination, there was reduced muscle strength (3/5) in both lower limbs. The patient exhibited hyporeflexia in the knees and ankle. A magnetic resonance imaging (MRI) of the spine was performed, revealing a well-defined mass lesion located in the lumbar region, compressing the spinal cord from L2 to L5. The patient was counseled and prepared for surgical resection of the tumor. Histopathological findings revealed features of peripheral nerve sheath tumors and cellular schwannomas. The patient recovered well postoperatively. The surgeon operating should be mindful of the potential presence of a mobile schwannoma, even though it is rarely mentioned in the literature. Being aware of this possibility can help prevent unnecessary surgical dissection, which can lead to higher rates of complications and morbidity. Although it is plausible that this case could have involved a mobile schwannoma, there was not enough evidence to support it as we performed a laminectomy on multiple levels due to the tumor's size., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Ekhator et al.)

Introduction: Neurofibromatosis Type 2 (NF2) is a genetic condition associated with the presence of bilateral vestibular schwannoma and progressive sensorineural hearing loss. Treatment options include observation, stereotactic radiosurgery (SRS) or surgical resection. Historically, retrocochlear pathology was a contraindication to cochlear implantation (CI). However it is now recognized as viable, in an attempt to restore hearing and improve communication. Thus, the aim of this study was to contrast auditory function in CI recipients with NF2 whose tumors were either observed versus initially treated with SRS. Methods: A local review of hearing outcomes in 2 CI patients (3 ears total) with NF2 was undertaken and then pooled with the existing medical literature. Comparative post-implant outcome data, including pure-tone average and aided speech perception measurements was analyzed and compared between 8 subjects whose tumors were observed and 11 subjects who received preimplantation SRS. Results: Mean tumor size in the observation cohort was 0.81cm (.13cm to 1.50cm), and 2.34cm in the SRS group (0.10cm to 3.7cm). The mean reported duration of deafness was 22 months as compared to 71 months in the SRS cohort. Both groups demonstrated similar pre-implant candidacy criteria, average age and open-set speech recognition. Although disparate outcome measurements were utilized across studies, an analysis of post-implant open-set speech perception found no significant differences between groups. Conclusion: Despite a small sample size and highly variable post implantation testing methods, patients who undergo SRS for NF2 associated Schwannoma prior to CI have similar hearing performance and benefit by having already completed definitive tumor management. [ABSTRACT FROM AUTHOR]

Objective: To review all the mediastinal tumors and cysts operated upon at Department of Thoracic Surgery, OICD, DUHS over a 2.5 year period. Study design: Retrospective descriptive study. Place and duration of study: Ojha Institute of Chest Diseases, Dow University of Health Sciences, Karachi, Pakistan from November 2012-April 2015. Material and methods: 50 patients with mediastinal masses of either sex were included in the study. Tumors were categorized as arising from the anterior, middle and posterior mediastinum on the basis of CT scan chest. Tumors were classified into various type based on the results of histopathology. Data was obtained from hospital medical records and proformas were filled for each patient. Results: A total of 50 patients with mediastinal masses were seen at the Department of Thoracic Surgery, Ojha Institute of Chest Diseases between Nov 2012-April 2015. There were 30 males and 20 females (ratio 1.5:1). Most of the patients were between 11-70 years of age, with mean age of 32 years. The most common location for mediastinal tumors was found to be the anterior mediastinum which comprised of 40% of all tumors, followed by posterior (32%) and middle mediastinum respectively (28.0%). Shwanomma (18%) was the most common type of tumor observed, followed by lymphoma (12%) and germ cell tumors (10%). Conclusion: Mediastinal tumors are relatively uncommon in clinical setting. These tumors represent a group of heterogeneous masses present between two pleural cavities. A definitive early diagnosis is the key in management and prognosis of the patient. We present our 5 year experience of patterns of mediastinal tumors. [ABSTRACT FROM AUTHOR]

Tumors of the chorda tympani are extremely rare. To date only 15 cases have been reported in the literature. Slow growing rate and nonspecific clinical features allow these lesions to reach a large size and resemble more common otological entities such as cholesteatoma. Diagnosis is usually established after surgical resection. However, lack of specifity of conventional pathological studies emphasizes the importance of im-munohistochemical studies for final diagnosis. It is advisable to use the correct terms when reporting the histology of chorda tympani tumors in literature. [ABSTRACT FROM AUTHOR]

Lower cranial nerve schwanommas are rare tumours. We present a 35 year old female patient who had a lower cranial nerve schwanomma with both intracranial and extracranial components. The internal jugular vein was injured during the dissection of the extracranial portion of the tumour. Ligation of the internal jugular vein is not associated with significant post-operative complications. Our patient however, developed retrograde cortical venous thrombosis on the 14th post-operative day resulting in multiple areas of haemorrhagic venous infarction with raised intracranial pressure. Such a delayed contiguous cortical venous thrombosis has not been reported. We present this report to highlight this event and to outline the probable causes for the same. [ABSTRACT FROM AUTHOR]

Owing to their scarcity, location, and intricate neurovascular associations, jugular fossa tumors are among the most challenging pathologies encountered by the neurosurgeon.1 While paragangliomas originate within and often occlude the jugular bulb, schwannomas and meningiomas are extra-bulbar and typically do not impede venous flow.2 Schwannomas typically arise from an extradural origin, expanding the jugular foramen.3-5 Meningiomas are intradural and cause hyperostosis of the jugular tubercle.6 We described and have been exposing and resecting jugular fossa tumors through a presigmoid suprabulbar infralabyrinthine window6 that has been detailed in cadaveric studies.7,8 This approach maintains the patency of the jugular bulb without breaching the labyrinths or manipulating the facial nerve. It is applicable to cases with partially impaired hearing and intact lower cranial nerves. The carotid artery can be identified by neuronavigation and micro-Doppler ultrasonography. This approach provides a direct lateral trajectory with a short distance to the jugular fossa and cerebellopontine angle. Early exposure and central debulking of the tumor minimize manipulation of the exquisitely sensitive lower cranial nerves. The distal aspect of these tumors can be removed with endoscopic assisted techniques.9 The first patient is a 49-yr-old woman with a previously irradiated schwannoma who presented with worsening neurologic deficits-an extradural suprabulbar approach was used to resect this tumor. The second patient is a 27-yr-old woman with an enlarging meningioma and associated neurological dysfunction; this tumor was resected using the suprabulbar approach with opening of the presigmoid dura. Both patients have consented to surgery and publication of images. Image at 2:27 and 6:38 reprinted from Arnautović et al, with permission from JNSPG. Image at 2:50 and 6:45 ©Ossama Al-Mefty 1997, reused with permission., (© Congress of Neurological Surgeons 2021.)

The most common genetic predisposition to multiple schwannoma growth is mutation of the neurofibromatosis type 2 gene. We describe a patient with multiple schwannomas and mutation in the recently described INI1 gene, which also predisposes to the disease. We explore the implications for prognosis and outcome. [ABSTRACT FROM AUTHOR]

Renal schwannomas are an extremely rare renal tumor with possibility for malignant conversion. Although reports are scant, most reports have been presented from academic institutions. We report on a case of a renal schwannoma that was removed via robotic assisted laparoscopic nephrectomy in a community-based specialty practice under the suspicion of a renal malignancy.