NeoplasmOculomotor nerve schwannoma located in the oculomotor cistern
Introduction
Schwannomas constitute about 7% of all intracranial tumors and commonly arise from vestibulocochlear and trigeminal nerves [17], [22], [32], [33]. The sensory division of cranial nerves is most likely to be affected [32]. Motor nerve schwannomas arising from ocular nerves are very rare in the absence of neurofibromatosis type II [13]. Only 32 cases of isolated schwannomas arising from the oculomotor nerve have been reported in the literature [1], [2], [3], [4], [5], [8], [9], [10], [12], [13], [14], [15], [16], [17], [18], [19], [21], [22], [23], [24], [25], [26], [27], [28], [29], [30], [33], [34], [35], [37], [38], [39], [40]. The most common site of occurrence for these lesions is the neuronal segment within the interpeduncular cistern and the CS. We report the case of an OS located predominantly within the oculomotor cistern, the arachnoid sac that surrounds the nerve for a short distance in the roof of the CS and extends forward to where the nerve passes under the anterior clinoid process.
Section snippets
Case report
A 34-year-old woman presented to our clinic with intermittent headaches for the last 6 months. She had developed ptosis, an enlarged pupil on the right side, and experienced lateral deviation of her right eye 3 weeks before her admission. Examination of the extraocular muscles revealed right oculomotor nerve palsy. The right pupil was irregularly shaped and mydriatic. The right optic disc appeared pale upon ophthalmoscopic examination. Examination of her left eye was normal.
An MRI scan
Surgical anatomy—oculomotor cistern
The oculomotor nerve arises in the interpeduncular cistern from the midbrain on the medial side of the cerebral peduncle and courses between the posterior cerebral and superior cerebellar arteries [39]. The nerve courses medial to the uncus before piercing the dura at the roof of the CS. The oculomotor nerve enters the roof of the CS approximately 5 mm posterior to the initial supraclinoidal segment of the ICA and slightly lateral to the posterior clinoid process (Fig. 3) [7], [31]. A short
Conclusions
In conclusion, isolated OSs are very rare, and the oculomotor cistern creates a favorable site for these tumors to expand for those cases with CS involvement. The part of the OS within the cistern can be removed while preserving the anatomical continuity of the nerve. OSs should be considered in the differential diagnosis among lesions along the roof of the CS.
Acknowledgments
The anatomical dissections have been performed by one of the authors (NT) in the Microsurgical Anatomy Laboratory at the University of Florida, Department of Neurosurgery. The authors thank Özlem Tanriover, MD, for her assistance in preparation of the manuscript.
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