Ancient Schwannoma affecting the intracranial portion of the trigeminal nerve: A case report

BACKGROUND: Ancient trigeminal schwannomas are extremely uncommon benign tumors. Such tumors are longstanding, slow growing and may demonstrate seemingly malignant features irrespective of its benign nature. The tumor may involve the trigeminal nerve root, the trigeminal ganglion, or any of its peripheral branches. Its clinical presentation may include trigeminal neuralgia, blurry vision, diplopia, or even seizures. Surgical excision is the mainstay of treatment with definite diagnosis only by histopathology. CASE DESCRIPTION: We described a case of a 35-year-old female presenting with recurrent episodes of generalized seizure and left-sided weakness. Brain imaging showed a right temporal space occupying lesion. Results of histopathology were consistent with trigeminal schwannoma associated with ancient histopathological changes. Complete tumor excision was achieved by a two-stage craniotomy, which led to the patient’s condition to dramatically improve. CONCLUSION: Ancient trigeminal schwannomas are easily diagnosed through histopathology and result in favorable clinical outcomes after total microscopic surgical excision. A high suspicion index of ancient schwannoma diagnosis should be derived from the patient’s presenting clinical picture and the classical findings derived from neuroimaging.