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Case Reports
. 2022 May-Aug;13(2):302-306.
doi: 10.4103/njms.njms_360_21. Epub 2022 Jun 15.

Orbital intraconal abducens nerve schwannoma: An interdisciplinary approach for management

Kumar Nilesh  1 , Vinayak Raje  2 , Vijay Hari Karambelkar  3
Affiliations
Case Reports

Orbital intraconal abducens nerve schwannoma: An interdisciplinary approach for management

Kumar Nilesh et al. Natl J Maxillofac Surg. 2022 May-Aug.

Abstract

Schwannomas are rare benign tumors arising from Schwann cells of the nerve sheath. Although the head-and-neck region accounts for a large percentage of extracranial schwannomas, those located within the orbit are infrequent. This paper presents an extremely rare case of orbital schwannoma arising from the terminal branch of abducens nerve in a 37-year-old female. The lesion presented as a large intraconal mass causing proptosis and weakness to abduct the left eye. Imaging showed a well-defined, solid-cystic lesion, measuring 2.7 cm and displacing the lateral rectus muscle laterally and the optic nerve medially. A multidisciplinary approach was used for the surgical management of the tumor. Access was attained through lateral rim osteotomy. Histopathological evaluation was diagnostic for schwannoma. A search of English literature revealed only five previously published cases of abducens nerve schwannomas. A review of these cases has also been discussed along with the present report.

Keywords: Access osteotomy; neurogenic; orbit; tumor.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Preoperative photographs showing proptosis (a) and limitation of lateral movement of left eye (b)
Figure 2
Figure 2
Magnetic resonance imaging of the lesion presenting as oval-to-round solid-cystic mass measuring 2.27 cm × 2.07 cm × 2.69 cm, located between optic nerve and lateral rectus muscle, causing stretching of the muscle and medial deviation of optic nerve; axial (a), coronal (b) and sagittal (c) views
Figure 3
Figure 3
Intraoperative images showing; incision (a), access lateral orbital rim osteotomy cuts marked (b) and completed (c), exposure of the orbital content (d), excised lesion (e), and fixation of lateral orbital rim (f)
Figure 4
Figure 4
Photomicrograph of excised specimen showing spindle-shaped cells predominantly arranged in Antoni A pattern around verocay bodies along with less organized Antoni B tissue (H and E stained section, ×10 magnification)
Figure 5
Figure 5
Postoperative clinical photographs showing resolution of proptosis (a) and surgical scar (b)
See this image and copyright information in PMC

References

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