The Clinical Spectrum of Schwannomas Presenting With Visual Dysfunction: A Clinicopathologic Study of Three Cases

Cockerham, Kimberly Peele; Cockerham, Glenn C; Stutzman, Richard; Hidayat, Ahmed A; Depper, Mark H; Turbin, Roger E; Kennerdell, John S

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Volume 44, Issue 3 , Pages 226-234, November 1999

The Clinical Spectrum of Schwannomas Presenting With Visual Dysfunction:

A Clinicopathologic Study of Three Cases

Kimberly Peele Cockerham, MD
- Ophthalmology Department, Allegheny General Hospital, Pittsburgh, PA, USA
- Reprint address: Kimberly Peele Cockerham, MD, Allegheny Ophthalmic and Orbital Associates, 420 E. North Ave., Suite 116, Pittsburgh, PA 15212–9986
Glenn C Cockerham, MD
- Ophthalmology Service, Andrews Air Force Base, MD, USA
Richard Stutzman, MD
- Ophthalmology Service, Walter Reed Army Medical Center, Washington, DC, USA
Ahmed A Hidayat, MD
- Department of Ophthalmic Pathology, Armed Forces Institute of Pathology, Washington, DC, USA
Mark H Depper, MD
- Department of Radiology, Walter Reed Army Medical Center, Washington, DC, USA
Roger E Turbin, MD
- Ophthalmology Department, Allegheny General Hospital, Pittsburgh, PA, USA
John S Kennerdell, MD
- Ophthalmology Department, Allegheny General Hospital, Pittsburgh, PA, USA

JONATHAN WIRTSCHAFTER, EDITOR

Abstract

Schwannomas (neurilemomas) are benign tumors that arise from Schwann cells in the peripheral nervous system. The most commonly involved nerves that cause neuro-ophthalmic manifestations are cranial nerves V and VIII. In this series of three women, schwannomas presented as intraconal masses that mimicked a cavernous hemangioma, a superior orbital mass transgressing the superior orbital fissure, and an expansive frontal lobe mass with clinical symptoms and signs of increased intracranial pressure. Although all three complained of visual blurring, none of our patients presented with Vth or VIIIth cranial nerve dysfunction. Histopathologic studies demonstrated well-circumscribed, encapsulated spindle-cell lesions with classic Antoni A and B patterns. Histopathologic examination is essential to confirm the diagnosis of a schwannoma that may be otherwise clinically confusing. Direct optic nerve compression, globe indentation with induced hyperopia, or increased intracranial pressure with optic nerve compromise may be responsible for visual symptoms. A multidisciplinary approach is often required because of the size and location of schwannomas.

Keywords: neurilemoma, schwannoma, tumor