A locally destructive, completely asymptomatic, C1-root schwannoma with base of skull invasion: a case report

Abstract

Patients with C1 nerve root schwannomas usually present with signs relating to nerve root compression. However, asymptomatic presentations have never been reported. A healthy, 37-year-old female was referred in view of a slow-growing lump in the left posterosuperior aspect of the neck. The lump was asymptomatic and neurological examination was normal. Magnetic resonance imaging revealed a left C1 nerve root tumour, extending around the C1 vertebra and compressing the thecal sac. The tumour had invaded the basiocciput and was impinging on the left cerebellar hemispheric dura. Stereotactic biopsies of the lesion showed a spindle-cell tumour exhibiting an immunoprofile consistent with a schwannoma. The lesion was surgically excised by blunt dissection using a posterior midline approach. The case report adds to the diverse modes of presentation of C1 nerve root schwannomas, in that such lesions must be included in the differential diagnosis of asymptomatic posterior neck lumps.

Surgical Management of Craniovertebral Junction Schwannomas: A Systematic Review

“…The high frequency of sensory disturbances likely stems from the sensory nerve roots’ tumor origin, while other impairments are caused by tumors compressing contiguous structures, such as lower cranial nerves (hoarseness, speech disorders, hearing disturbance), cerebellum (ataxia), and brainstem/cervical spinal cord (motor disorders) [ 31 , 36 , 54 ]. Tongue atrophy is typical in hypoglossal schwannomas [ 40 ], while evident neck masses may be found in otherwise asymptomatic slow-growing C1–C2 tumors [ 55 ]. Owing to the frequent multiple cranial neuropathies (27.1%) in our pooled cohort, we suggest performing comprehensive pre-operative neurological and radiological evaluations in patients with suspected CVJ masses to optimize the surgical planning and restore cranial nerves’ functions.…”