Skip to main content
Top
Published in: BMC Neurology 1/2022

Open Access 01-12-2022 | Xerophthalmia | Case report

Schwannomas of the greater superficial petrosal nerve – case series, discussion of surgical techniques, and review of literature

Authors: A. Kaywan Aftahy, Maximilian Groll, Arthur Wagner, Melanie Barz, Denise Bernhardt, Stephanie E. Combs, Bernhard Meyer, Jens Gempt, Chiara Negwer

Published in: BMC Neurology | Issue 1/2022

Login to get access

Abstract

Background

Facial nerve schwannomas account for about 0.8% of all petrous mass lesions. Schwannomas of the greater superficial petrosal nerve (GSPN) are a rare subtype with few case-reports up to date.

Case presentations

A retrospective analysis of clinical outcomes, radiographic findings and postoperative complication between June 2007 and December 2020 was performed. Four cases of GSPN schwannomas were reported. The presenting symptoms were facial nerve palsy and hearing loss. Imaging studies showed a subtemporal mass on the anterosuperior aspect of the petrous bone, in one case with extraordinary petrous bone and mastoid infiltration and destruction. Three cases were removed through a subtemporal extra- or intradural approach, one case via a combined pre- and retrosigmoid approach. Improvement of facial nerve palsy occurred in one case; new hearing loss was observed in another case. Xeropthalmia was a short-term temporary deficit in three cases. Short- to mid-term follow-up of the patients has not shown any tumor recurrence.

Conclusions

GSPN schwannomas are rare entities presenting with heterogenous symptoms. Our surgical findings emphasize safe resection. Complete remission is possible by GTR. Since the small data set limits the expressiveness of statements regarding standard of care and alternative therapy options, additional data is needed.
Literature
1.
go back to reference Uppar AM, Rao S, Prasad C, Arimappamagan A, Santosh V. Schwannoma of the greater superficial petrosal nerve: an unusual site for a common tumor. J Neurol Surg A Cent Eur Neurosurg. 2020;81(6):565–70.CrossRef Uppar AM, Rao S, Prasad C, Arimappamagan A, Santosh V. Schwannoma of the greater superficial petrosal nerve: an unusual site for a common tumor. J Neurol Surg A Cent Eur Neurosurg. 2020;81(6):565–70.CrossRef
2.
go back to reference Amirjamshidi A, Hashemi SM, Abbassioun K. Schwannoma of the greater superficial petrosal nerve. J Neurosurg. 2010;113(5):1093–8.CrossRef Amirjamshidi A, Hashemi SM, Abbassioun K. Schwannoma of the greater superficial petrosal nerve. J Neurosurg. 2010;113(5):1093–8.CrossRef
3.
go back to reference Ginsberg LE, De Monte F, Gillenwater AM. Greater superficial petrosal nerve: anatomy and MR findings in perineural tumor spread. AJNR Am J Neuroradiol. 1996;17(2):389–93. Ginsberg LE, De Monte F, Gillenwater AM. Greater superficial petrosal nerve: anatomy and MR findings in perineural tumor spread. AJNR Am J Neuroradiol. 1996;17(2):389–93.
4.
go back to reference Schmidinger A, Deinsberger W. Greater superficial petrosal nerve schwannoma. Acta Neurochir. 2005;147(6):659–63.CrossRef Schmidinger A, Deinsberger W. Greater superficial petrosal nerve schwannoma. Acta Neurochir. 2005;147(6):659–63.CrossRef
5.
go back to reference Wiggins RH 3rd, Harnsberger HR, Salzman KL, Shelton C, Kertesz TR, Glastonbury CM. The many faces of facial nerve schwannoma. AJNR Am J Neuroradiol. 2006;27(3):694–9. Wiggins RH 3rd, Harnsberger HR, Salzman KL, Shelton C, Kertesz TR, Glastonbury CM. The many faces of facial nerve schwannoma. AJNR Am J Neuroradiol. 2006;27(3):694–9.
6.
go back to reference Tremble GE, Penfield W. Operative exposure of the facial canal: with removal of a tumor of the greater superficial petrosal nerve. Arch Otolaryngol. 1936;23(5):573–9.CrossRef Tremble GE, Penfield W. Operative exposure of the facial canal: with removal of a tumor of the greater superficial petrosal nerve. Arch Otolaryngol. 1936;23(5):573–9.CrossRef
7.
go back to reference Kleinsasser O, Friedmann G. [On neurinoma of the nervus facialis]. Zentralbl Neurochir. 1959;19:49–59. Kleinsasser O, Friedmann G. [On neurinoma of the nervus facialis]. Zentralbl Neurochir. 1959;19:49–59.
8.
go back to reference Furlow LT. The neurosurgical aspects of seventh nerve neurilemmoma. J Neurosurg. 1960;17(4):721–35.CrossRef Furlow LT. The neurosurgical aspects of seventh nerve neurilemmoma. J Neurosurg. 1960;17(4):721–35.CrossRef
9.
go back to reference Dolenc VV, Koršič M. Middle cranial fossa schwannoma of the facial nerve. Br J Neurosurg. 1996;10(5):519–24.CrossRef Dolenc VV, Koršič M. Middle cranial fossa schwannoma of the facial nerve. Br J Neurosurg. 1996;10(5):519–24.CrossRef
10.
go back to reference Kumon Y, Sakaki S, Ohta S, Ohue S, Nakagawa K, Tanaka K. Greater superficial petrosal nerve neurinoma. Case report J Neurosurg. 1999;91(4):691–6. Kumon Y, Sakaki S, Ohta S, Ohue S, Nakagawa K, Tanaka K. Greater superficial petrosal nerve neurinoma. Case report J Neurosurg. 1999;91(4):691–6.
11.
go back to reference Michel O, Wagner M, Guntinas-Lichius O. Schwannoma of the greater superficial petrosal nerve. Otolaryngol Head Neck Surg. 2000;122(2):302–3.CrossRef Michel O, Wagner M, Guntinas-Lichius O. Schwannoma of the greater superficial petrosal nerve. Otolaryngol Head Neck Surg. 2000;122(2):302–3.CrossRef
12.
go back to reference Kinouchi H, Mikawa S, Suzuki A, Sasajima T, Tomura N, Mizoi K. Extradural neuromas at the petrous apex: report of two cases. Neurosurg. 2001;49(4):999–1003 (discussion -4). Kinouchi H, Mikawa S, Suzuki A, Sasajima T, Tomura N, Mizoi K. Extradural neuromas at the petrous apex: report of two cases. Neurosurg. 2001;49(4):999–1003 (discussion -4).
13.
go back to reference Aihara N, Yamada K, Matsuda F, Murakami S. Neurinoma of the greater superficial petrosal nerve developed acute facial palsy: case report and review of the literature. Skull Base. 2001;11(1):77–80.CrossRef Aihara N, Yamada K, Matsuda F, Murakami S. Neurinoma of the greater superficial petrosal nerve developed acute facial palsy: case report and review of the literature. Skull Base. 2001;11(1):77–80.CrossRef
14.
go back to reference Mori R, Sakai H, Kato M, Hida T, Nakajima M, Fukunaga M, et al. Huge facial nerve schwannoma extending into the middle cranial fossa without facial palsy: case report. No Shinkei Geka. 2007;35(6):591–8. Mori R, Sakai H, Kato M, Hida T, Nakajima M, Fukunaga M, et al. Huge facial nerve schwannoma extending into the middle cranial fossa without facial palsy: case report. No Shinkei Geka. 2007;35(6):591–8.
15.
go back to reference Sade B, Lee JH. Recovery of low-frequency sensorineural hearing loss following resection of a greater superficial petrosal nerve schwannoma. J Neurosurg JNS. 2007;107(1):181.CrossRef Sade B, Lee JH. Recovery of low-frequency sensorineural hearing loss following resection of a greater superficial petrosal nerve schwannoma. J Neurosurg JNS. 2007;107(1):181.CrossRef
16.
go back to reference Ayberk G, Ozveren MF, Uzum N, Tosun O, Akcay EK. cellular schwannoma of the greater superficial petrosal nerve presenting with abducens nerve palsy and xerophthalmia: case repORT. Neurosurg. 2008;63(4):E813–4.CrossRef Ayberk G, Ozveren MF, Uzum N, Tosun O, Akcay EK. cellular schwannoma of the greater superficial petrosal nerve presenting with abducens nerve palsy and xerophthalmia: case repORT. Neurosurg. 2008;63(4):E813–4.CrossRef
17.
go back to reference Ichimura S, Yoshida K, Sutiono AB, Horiguchi T, Sasaki H, Kawase T. Greater petrosal nerve schwannomas—analysis of four cases and review of the literature. Neurosurg Rev. 2010;33(4):477–82.CrossRef Ichimura S, Yoshida K, Sutiono AB, Horiguchi T, Sasaki H, Kawase T. Greater petrosal nerve schwannomas—analysis of four cases and review of the literature. Neurosurg Rev. 2010;33(4):477–82.CrossRef
18.
go back to reference De Paulis D, Di Cola F, Marzi S, Ricci A, Coletti G, Galzio RJ. A rare case of greater petrosal nerve schwannoma. Surg Neurol Int. 2011;2:60.CrossRef De Paulis D, Di Cola F, Marzi S, Ricci A, Coletti G, Galzio RJ. A rare case of greater petrosal nerve schwannoma. Surg Neurol Int. 2011;2:60.CrossRef
19.
go back to reference Umredkar A, Singla N, Gupta S, Radotra B. Greater superficial petrosal nerve schwannoma: report of two cases and literature review. Neurol India. 2011;59(5):786–8.CrossRef Umredkar A, Singla N, Gupta S, Radotra B. Greater superficial petrosal nerve schwannoma: report of two cases and literature review. Neurol India. 2011;59(5):786–8.CrossRef
20.
go back to reference Kusumi M, Oka H, Aliabadi H, Sato S, Kumabe T. The appropriate surgical approach to a greater petrosal nerve Schwannoma in the setting of temporal lobe edema. World Neurosurg. 2016;85(364):e5-10. Kusumi M, Oka H, Aliabadi H, Sato S, Kumabe T. The appropriate surgical approach to a greater petrosal nerve Schwannoma in the setting of temporal lobe edema. World Neurosurg. 2016;85(364):e5-10.
21.
go back to reference Ishikawa T, Matsuda M, Sakakura K, Ishikawa E, Akutsu H, Matsumura A. Huge greater superficial petrosal nerve Schwannoma with intradural peritumoral cyst. World Neurosurg. 2019;122:85–9.CrossRef Ishikawa T, Matsuda M, Sakakura K, Ishikawa E, Akutsu H, Matsumura A. Huge greater superficial petrosal nerve Schwannoma with intradural peritumoral cyst. World Neurosurg. 2019;122:85–9.CrossRef
22.
go back to reference Woodruff JM, Godwin TA, Erlandson RA, Susin M, Martini N. Cellular schwannoma: a variety of schwannoma sometimes mistaken for a malignant tumor. Am J Surg Pathol. 1981;5(8):733–44.CrossRef Woodruff JM, Godwin TA, Erlandson RA, Susin M, Martini N. Cellular schwannoma: a variety of schwannoma sometimes mistaken for a malignant tumor. Am J Surg Pathol. 1981;5(8):733–44.CrossRef
23.
go back to reference Ansari K, Menon G, Abraham M, Nair S. Greater superficial petrosal nerve Schwannoma: 3 case reports and review of literature. Open Neurosurg J. 2015;7:1–5.CrossRef Ansari K, Menon G, Abraham M, Nair S. Greater superficial petrosal nerve Schwannoma: 3 case reports and review of literature. Open Neurosurg J. 2015;7:1–5.CrossRef
24.
go back to reference Tanriover N, Sanus GZ, Ulu MO, Tanriverdi T, Akar Z, Rubino PA, et al. Middle fossa approach: microsurgical anatomy and surgical technique from the neurosurgical perspective. Surg Neurol. 2009;71(5):586–96 (discussion 96).CrossRef Tanriover N, Sanus GZ, Ulu MO, Tanriverdi T, Akar Z, Rubino PA, et al. Middle fossa approach: microsurgical anatomy and surgical technique from the neurosurgical perspective. Surg Neurol. 2009;71(5):586–96 (discussion 96).CrossRef
25.
go back to reference Ramina R, Mattei TA, Sória MG, da Silva EB, Jr., Leal AG, Neto MC, et al. Surgical management of trigeminal schwannomas. Neurosurg Focus. 2008;25(6):E6 (discussion E).CrossRef Ramina R, Mattei TA, Sória MG, da Silva EB, Jr., Leal AG, Neto MC, et al. Surgical management of trigeminal schwannomas. Neurosurg Focus. 2008;25(6):E6 (discussion E).CrossRef
26.
go back to reference Niranjan A, Barnett S, Anand V, Agazzi S. Multimodality management of Trigeminal Schwannomas. J Neurological Surg Part B, Skull base. 2016;77(4):371–8.CrossRef Niranjan A, Barnett S, Anand V, Agazzi S. Multimodality management of Trigeminal Schwannomas. J Neurological Surg Part B, Skull base. 2016;77(4):371–8.CrossRef
27.
go back to reference Fukaya R, Yoshida K, Ohira T, Kawase T. Trigeminal schwannomas: experience with 57 cases and a review of the literature. Neurosurg Rev. 2010;34(2):159–71.CrossRef Fukaya R, Yoshida K, Ohira T, Kawase T. Trigeminal schwannomas: experience with 57 cases and a review of the literature. Neurosurg Rev. 2010;34(2):159–71.CrossRef
28.
go back to reference Yoshida K, Kawase T. Trigeminal neurinomas extending into multiple fossae: surgical methods and review of the literature. J Neurosurg. 1999;91(2):202–11.CrossRef Yoshida K, Kawase T. Trigeminal neurinomas extending into multiple fossae: surgical methods and review of the literature. J Neurosurg. 1999;91(2):202–11.CrossRef
29.
go back to reference Al-Mefty O, Ayoubi S, Gaber E. Trigeminal schwannomas: removal of dumbbell-shaped tumors through the expanded Meckel cave and outcomes of cranial nerve function. J Neurosurg. 2002;96(3):453–63.CrossRef Al-Mefty O, Ayoubi S, Gaber E. Trigeminal schwannomas: removal of dumbbell-shaped tumors through the expanded Meckel cave and outcomes of cranial nerve function. J Neurosurg. 2002;96(3):453–63.CrossRef
30.
go back to reference Kouyialis AT, Stranjalis G, Papadogiorgakis N, Papavlassopoulos F, Ziaka DS, Petsinis V, et al. Giant dumbbell-shaped middle cranial fossa trigeminal schwannoma with extension to the infratemporal and posterior fossae. Acta Neurochir (Wien). 2007;149(9):959–63 (discussion 64).CrossRef Kouyialis AT, Stranjalis G, Papadogiorgakis N, Papavlassopoulos F, Ziaka DS, Petsinis V, et al. Giant dumbbell-shaped middle cranial fossa trigeminal schwannoma with extension to the infratemporal and posterior fossae. Acta Neurochir (Wien). 2007;149(9):959–63 (discussion 64).CrossRef
31.
go back to reference Sekhar LN, Schramm VL, Jones NF. Subtemporal-preauricular infratemporal fossa approach to large lateral and posterior cranial base neoplasms. J Neurosurg. 1987;67(4):488.CrossRef Sekhar LN, Schramm VL, Jones NF. Subtemporal-preauricular infratemporal fossa approach to large lateral and posterior cranial base neoplasms. J Neurosurg. 1987;67(4):488.CrossRef
33.
go back to reference Hsu FPK, Anderson GJ, Dogan A, Finizio J, Noguchi A, Liu KC, et al. Extended middle fossa approach: quantitative analysis of petroclival exposure and surgical freedom as a function of successive temporal bone removal by using frameless stereotaxy. J Neurosurg. 2004;100(4):695.CrossRef Hsu FPK, Anderson GJ, Dogan A, Finizio J, Noguchi A, Liu KC, et al. Extended middle fossa approach: quantitative analysis of petroclival exposure and surgical freedom as a function of successive temporal bone removal by using frameless stereotaxy. J Neurosurg. 2004;100(4):695.CrossRef
35.
go back to reference Samii M, Migliori MM, Tatagiba M, Babu R. Surgical treatment of trigeminal schwannomas. J Neurosurg. 1995;82(5):711–8.CrossRef Samii M, Migliori MM, Tatagiba M, Babu R. Surgical treatment of trigeminal schwannomas. J Neurosurg. 1995;82(5):711–8.CrossRef
36.
go back to reference Elsmore A, Mendoza N. The operative learning curve for vestibular schwannoma excision via the retrosigmoid approach. Br J Neurosurg. 2002;16(5):448–55.CrossRef Elsmore A, Mendoza N. The operative learning curve for vestibular schwannoma excision via the retrosigmoid approach. Br J Neurosurg. 2002;16(5):448–55.CrossRef
37.
go back to reference Fezeu F, Lee CC, Dodson BK, Mukherjee S, Przybylowski CJ, Awad AJ, et al. Stereotactic radiosurgery for facial nerve schwannomas: a preliminary assessment and review of the literature. Br J Neurosurg. 2015;29(2):213–8.CrossRef Fezeu F, Lee CC, Dodson BK, Mukherjee S, Przybylowski CJ, Awad AJ, et al. Stereotactic radiosurgery for facial nerve schwannomas: a preliminary assessment and review of the literature. Br J Neurosurg. 2015;29(2):213–8.CrossRef
38.
go back to reference Sheehan JP, Kano H, Xu Z, Chiang V, Mathieu D, Chao S, et al. Gamma Knife radiosurgery for facial nerve schwannomas: a multicenter study. J Neurosurg. 2015;123(2):387–94.CrossRef Sheehan JP, Kano H, Xu Z, Chiang V, Mathieu D, Chao S, et al. Gamma Knife radiosurgery for facial nerve schwannomas: a multicenter study. J Neurosurg. 2015;123(2):387–94.CrossRef
39.
go back to reference Hasegawa T, Kato T, Kida Y, Hayashi M, Tsugawa T, Iwai Y, et al. Gamma Knife surgery for patients with facial nerve schwannomas: a multiinstitutional retrospective study in Japan. J Neurosurg. 2016;124(2):403–10.CrossRef Hasegawa T, Kato T, Kida Y, Hayashi M, Tsugawa T, Iwai Y, et al. Gamma Knife surgery for patients with facial nerve schwannomas: a multiinstitutional retrospective study in Japan. J Neurosurg. 2016;124(2):403–10.CrossRef
40.
go back to reference World Medical Association Declaration of Helsinki. ethical principles for medical research involving human subjects. JAMA. 2013;310(20):2191–4.CrossRef World Medical Association Declaration of Helsinki. ethical principles for medical research involving human subjects. JAMA. 2013;310(20):2191–4.CrossRef
Metadata
Title
Schwannomas of the greater superficial petrosal nerve – case series, discussion of surgical techniques, and review of literature
Authors
A. Kaywan Aftahy
Maximilian Groll
Arthur Wagner
Melanie Barz
Denise Bernhardt
Stephanie E. Combs
Bernhard Meyer
Jens Gempt
Chiara Negwer
Publication date
01-12-2022
Publisher
BioMed Central
Published in
BMC Neurology / Issue 1/2022
Electronic ISSN: 1471-2377
DOI
https://doi.org/10.1186/s12883-022-02960-3

Other articles of this Issue 1/2022

BMC Neurology 1/2022 Go to the issue