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October 2008 Volume 2, Number 4
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Expanded endoscopic endonasal resection of an olfactory schwannoma
Case report Hilal A. Kanaan, M.D.1, Paul A. Gardner, M.D.1, Gabrielle Yeaney, M.D.2, Daniel M. Prevedello, M.D.1, Edward A. Monaco III, M.D., Ph.D.1, Geoffrey Murdoch, M.D.2, Ian F. Pollack, M.D.1, and Amin B. Kassam, M.D.1 1Departments of Neurological Surgery and 2Neuropathology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania Abbreviations used in this paper: EMA = epithelial membrane antigen; GTR = gross-total resection; OECT = olfactory ensheathing cell tumor. Address correspondence to: Amin B. Kassam, M.D., University of Pittsburgh Medical Center Presbyterian, 200 Lothrop Street, Suite B-400, Pittsburgh, Pennsylvania 15213. email: kassamab@upmc.edu. DOI: 10.3171/PED.2008.2.10.261 Olfactory schwannomas are rare tumors of the anterior skull base that are possibly derived from ectopic Schwann cells, perivascular neural tissue, or sensory nerves of the meninges. The authors report the case of a 14-year-old boy with an olfactory schwannoma that extended inferiorly through the cranial base and superiorly into the frontal lobe. Because of the growth characteristics of the tumor and the significant overlying frontal lobe edema, the lesion was approached via an endonasal endoscopic route, as a strategy to minimize brain retraction. This tumor was characterized radiographically as contrast-enhancing with cystic areas and erosion into bone. The tumor showed immunoreactivity for S100 protein and leukocyte antigen 7 (CD57) but not epithelial membrane antigen, supporting the diagnosis of olfactory schwannoma. A gross-total resection was achieved. This approach represents a novel application of endoscopic endonasal surgery to the pediatric neurosurgical context, as well as a favorable outcome in an extremely unusual tumor type, that should be applicable to other appropriately selected pediatric brain tumors. KEYWORDS:endonasal approach; endoscopic approach; olfactory schwannoma; pediatric brain tumor; skull base.
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