2025 Poster Presentations
P009: EXPLORING VIDIAN NERVE SCHWANNOMAS, A CASE REPORT AND LITERATURE REVIEW.
Maryam Aljneibi; Maryam Aljawi; Mahdi Shkoukani; Mohamed Elhammady; Florian Roser; Cleveland Clinic Abu Dhabi
Objective: To present a case of a Vidian nerve schwannoma resected through endoscopic endonasal surgery through a trans-pterygoid approach.
Case: A 45-year-old woman who presented with vision changes and dryness of the eye. MRI showed a large homogenous contrast enhancing mass in the sphenoid sinus with bone remodeling of the skull base.
Procedure: She underwent transsphenoidal endonasal excision of the mass by the otolaryngology and neurosurgery team. Intraoperatively, the mass in the lateral recess of the sphenoid was difficult to access and a trans-ptyregoid approach was used for better exposure. Complete resection of the tumor was achieved.
Follow up: Final surgical pathology came back as schwannoma. Further review of the preoperative MRI concluded the mass to be of a Vidian nerve origin. She was evaluated by ophthalmology at 1 month and 6 months postoperatively and had stable optic neuropathy with no progression in symptoms.
Discussion: Vidian nerve schwannomas are extremely rare entities with a handful of cases reported in the literature. Diagnosis can be challenging due to the paucity of cases and the wide differential diagnosis of anterior skull base lesions. Vidian nerve schwannomas can present with symptoms such as headaches, decreased sensation over V2 distribution, decreased lacrimation, or nasal dryness. These symptoms are not specific since any sphenoid or skull base lesion can cause a mass effect on the Vidian or Trigeminal nerve.
Surgical approaches to Vidian schwannomas are particularly challenging due to the difficult access to the lateral recess of the sphenoid sinus. Extended endoscopic skull base approaches have largely replaced the open approaches through the pterygopalatine fossa and have become the gold standard with good exposure and lower morbidity and complications. Although these tumors are benign, they can cause significant morbidity due to mass effect on the surrounding structures such as the optic nerve.
