Schwannomas of the Third Cranial Nerve: An Overview and Case Report

Background: Schwannomas of the third cranial nerve are exceedingly rare benign tumors, and standardized management guidelines are lacking. Their close relationship with critical neurovascular structures makes diagnosis and treatment challenging, with a significant risk of postoperative neurological deficits. Methods: A systematic review of the literature was conducted according to the PRISMA guidelines, including case reports and clinical studies on oculomotor nerve schwannomas (ONSs). Demographic data, clinical presentation, tumor location, diagnostic methods, treatment strategies, and functional outcomes were analyzed. In addition, an illustrative case treated with a multimodal approach is presented. Results: Ninety-six cases met the inclusion criteria. The mean age at diagnosis was 34 years, with a slight female predominance. The most common presenting symptoms were diplopia and ptosis. Contrast-enhanced magnetic resonance imaging was the diagnostic modality of choice. Surgical resection was the primary treatment in most cases but was associated with worsening oculomotor nerve function in 43.1% of surgically treated patients. Stereotactic radiotherapy demonstrated favorable tumor control with lower neurological morbidity. In the presented case, subtotal resection followed by stereotactic radiotherapy resulted in sustained tumor stability at the one-year follow-up. Conclusions: Management of oculomotor nerve schwannomas should be individualized. For small or mildly symptomatic lesions, stereotactic radiotherapy appears to be an effective and less invasive option, while surgery should be reserved for large tumors causing a mass effect or progressive neurological deterioration.