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Case Reports
. 2014 Oct-Dec;9(4):514-6.
doi: 10.4103/2008-322X.150833.

Orbital oculomotor nerve schwannoma extending to the cavernous sinus: a rare cause of proptosis

Hina Kauser  1 , Omar Rashid  1 , Waseem Anwar  1 , Sabina Khan  2
Affiliations
Case Reports

Orbital oculomotor nerve schwannoma extending to the cavernous sinus: a rare cause of proptosis

Hina Kauser et al. J Ophthalmic Vis Res. 2014 Oct-Dec.

Abstract

Purpose: To report a case of orbital oculomotor nerve schwannoma extending to the cavernous sinus through the superior orbital fissure presenting with proptosis, but without any neurological sign.

Case report: A 32-year-old man presented with axial proptosis of his left eye. Visual acuity and other ocular examinations were normal. Orbital magnetic resonance imaging revealed a well-defined fusiform retrobulbar lesion in the left orbit extending into the superior orbital fissure and left cavernous sinus measuring 43 mm × 21 mm × 19 mm and causing superomedial displacement of the optic nerve and axial proptosis. The patient was scheduled for surgery, and gross total excision was done. Postoperatively, the patient developed total third nerve palsy. Pre and postoperative third nerve deficit confirmed the origin of the tumor from the oculomotor nerve. Histopathological examination revealed schwannoma.

Conclusion: Orbital oculomotor nerve schwannoma, although rare, can be the cause of proptosis. Diagnosis can be confirmed histopathologically. It is a benign tumor; however, it can extend intracranially without any neurological symptoms. Therefore, neuroimaging is essential to rule out intracranial extension. Early surgical removal is mandatory.

Keywords: Cavernous Sinus; Oculomotor Nerve; Proptosis; Schwannoma.

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Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
Preoperative axial proptosis of the left eye.
Figure 2
Figure 2
MRI showing an antero-posteriorly oblong fusiform lesion measuring 4.3×2.1×1.9 cms in size in the retro bulbar region of left orbit extending into superior orbital fissure and the left cavernous sinus causing superomedial displacement of optic nerve and proptosis.
Figure 3
Figure 3
Tumor cells arranged in fascicles with elongated nuclei showing palisading (H and E stain 400X) (a) Tumor cells with S-100 positivity (b) Tumor cells showing EMA negativity (c).
Figure 4
Figure 4
Complete third nerve palsy four months after operation.
See this image and copyright information in PMC

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