Transoral or parapharyngeal approach to remove sporadic skull base schwannoma

Sporadic schwannomas of the skull base are rare. We present two cases with sporadic schwannoma of this region that pose diagnostic and therapeutic problems. The first patient (female, 40 years of age) developed an extensive vagal schwannoma with deviation of the internal carotid to the medial side. A transoral extirpation of the tumour was chosen to allow for surgery without visible scars. A second patient (female, 63 years of age) developed a skull base tumour some months after resection of oral squamous cell carcinoma from the floor of the mouth. This tumour was not visible on computed-tomographic scans taken prior to ablative surgery for oral cancer. A lateral pharyngotomy was chosen in order to allow for extension of the resection in case of carcinoma spread. Healing was uneventful in both patients. Both patients developed solitary schwannomas-only, without any hint of type 2 neurofibromatosis or schwannomatosis during a follow-up of several years. Exclusion of a tumour predisposition syndrome is recommended in patients with peripheral nerve sheath tumours.