Giant nasal schwannoma with intracranial extension Case illustration

We present an additional case of an intranasal schwannoma with extension into the anterior cranial fossa and describe its successful removal by a less invasive approach than those previously reported. This 50-year-old woman presented with a 3-year history of frontal headaches, anosmia, and gradual bilateral visual deterioration. Six months prior to admission, she also developed swelling of the bridge of her nose and intermittent clear nasal discharge. Clinical findings included bilateral anosmia, a visual acuity of 3/60 unaided in the right eye and 2/60 unaided in the left eye, as well as bilateral optic nerve atrophy. Magnetic resonance (MR) imaging revealed an anterior fossa lesion filling the entire nasal complex and extending inferiorly to the hard palate. The tumor was successfully excised via a standard bifrontal craniotomy without the need for a transfacial approach. The histological diagnosis of the lesion was a benign nasal schwannoma. Nasal and paranasal schwannomas present with nasal obstruction, nasal swelling, anosmia, and proptosis; a computerized tomography (CT) or MR image may show no further specificity with regard to the diagnosis other than features of a benign, slowly growing tumor of greater signal intensity than polyps or mucoceles. The differential diagnosis includes papilloma, sarcoma, carcinoma, and lymphoma. 3