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- Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany,
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Neurosurgery, University Hospital Helsinki, Helsinki, Finland.
Correspondence Address:
Sajjad Muhammad, Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany.
DOI:10.25259/SNI_609_2023
Copyright: © 2024 Surgical Neurology International This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.How to cite this article: Sajjad Muhammad1, Atte Karppinen2, Leena Kivipelto2, Mika Niemela3. Endoscopic transsphenoidal resection of parasellar abducens nerve schwannoma: A video demonstration. 19-Apr-2024;15:136
How to cite this URL: Sajjad Muhammad1, Atte Karppinen2, Leena Kivipelto2, Mika Niemela3. Endoscopic transsphenoidal resection of parasellar abducens nerve schwannoma: A video demonstration. 19-Apr-2024;15:136. Available from: https://surgicalneurologyint.com/surgicalint-articles/12868/
Date of Submission
20-Jul-2023
Date of Acceptance
23-Mar-2024
Date of Web Publication
19-Apr-2024
Abstract
Background: The abducens nerve schwannoma (ANS) in the sellar and parasellar region are extremely rare. Only around two dozen of ANS have been described in the world literature. These cases were, however, operated through the transcranial approach. We demonstrate, with the help of an edited video, that ANS located in the sellar and parasellar region can be safely and effectively operated through a transsphenoidal approach under endoscopic visualization.
Case Description: Here, we present a case of a 30-year-old male who presented with a nine-month history of diplopia, weight gain, and loss of sexual functions. On neuro-opthalmological examination, a mild abducens palsy on the left side. Other cranial nerves were intact. On endocrinological testing, mild hypopituitarism on gonadal and thyroid axes. Magnetic resonance imaging (MRI) scan showed a contrast-enhanced cystic lesion in the sellar and parasellar region extending into the left temporal fossa. The patient underwent endonasal transsphenoidal endoscopic resection. A binostril standard approach was used, the left middle concha resected, and the nasoseptal flap was raised [Video 1]. The tumor was relatively soft and avascular yet invasive and could be removed with straight and curved suctions and gentle curettage. Subcapsular dissection was the key to saving the sixth nerve. Only minimal remnant posterior to the left internal carotid artery was assumed to be left behind. No cerebrospinal fluid (CSF) leakage was noted during the surgery. The skull base defect was reconstructed with the left-sided nasoseptal flap [Video 1]. Postoperatively, no new cranial nerve deficits. Diplopia is preoperative. Endocrine functions were unchanged. No CSF leak was observed. Postoperative MRI scan showed a near total resection. There was no operation-relevant complication. Diplopia resolved completely in a follow-up period of 6 months.
Conclusion: The endoscopic transsphenoidal route is safe and effective for the resection of parasellar ANS. Subcapsular dissection is key to keep the sixth nerve intact.
Keywords: Abducens nerve schwannoma, Endoscopic, Transsphenoidal surgery
Video 1
ANNOTATIONS
Case Presentation: 0-10 Seconds
Approach to Tumor: 11-60 Second
Tumor removal: 1:15-2:50
Closure: 3:00-3:39.
Ethical approval
The Institutional Review Board approval is not required.
Declaration of patient consent
Patient’s consent is not required as patients identity is not disclosed or compromised.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
Use of artificial intelligence (AI)-assisted technology for manuscript preparation
The authors confirm that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript and no images were manipulated using AI.
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Disclaimer
The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Journal or its management. The information contained in this article should not be considered to be medical advice; patients should consult their own physicians for advice as to their specific medical needs.
