Brainstem Schwannoma —Case Report—

Tanabe, Michiharu; Miyata, Hajime; Okamoto, Hisayo; Watanabe, Takashi; Hori, Tomokatsu; Masakawa, Akiko; Horie, Yasushi

doi:10.2176/nmc.36.880

Cited by 12 publications

(15 citation statements)

References 23 publications

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Section: Discussionmentioning

confidence: 68%

“…4 Our review of literature revealed only 6 cases of intraparenchymal schwannomas located in the brain stem. 1,[5][6][7][8][9] Our case has unique and interesting features compared with other cases in the literature: 1) Our patient, at 68 years of age, tied with 1 other patient as the oldest on record (and this other elderly patient had an incidentally discovered lesion in the setting of ischemia 9 ).2) The high level of symptoms in our patient developed during 2 weeks; in the other 6 cases, symptoms developed from 6 weeks to 3 years. 3) Perhaps related to this acute presentation, our case is the second one 10 with recorded T2 signal-intensity abnormality surrounding the lesion (of 3 cases with MR imaging available 1,6,9 ).…”

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confidence: 54%

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Imaging and Clinical Features of an Intra-Axial Brain Stem Schwannoma

Muzzafar¹,

Ketonen²,

Weinberg³

et al. 2009

AJNR Am J Neuroradiol

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SUMMARY:A 68-year-old man presented with a highly symptomatic brain stem tumor originally thought to be a brain stem glioma. Intraoperative MR imaging guidance was used to resect the tumor, and real-time evoked potentials improved during surgery. Pathology findings unexpectedly indicated that the tumor was an intra-axial brain stem schwannoma, a condition reported, to our knowledge, only 6 times previously in the literature. The patient made an excellent recovery with reversal of his symptoms. We report an unusual case of a highly symptomatic intra-axial schwannoma that was successfully treated surgically. Case ReportA 68-year-old man developed gait imbalance, coughing, and hiccups during a 2-month period. The symptoms progressed, and he developed nausea, vomiting, intermittent diplopia, and weakness in his right arm.Physical examination revealed an alert well-oriented patient, with normally reacting pupils and intact extraocular movements. Positive findings included bilateral nystagmus on lateral gaze, right facial weakness, hoarse voice, and weakness in the right upper and lower extremity (4 of 5 weaknesses on the 5-point strength scale). Swallowing and motor speech assessment showed severe pharyngeal phase dysphagia with noneffective and unsafe swallowing.MR imaging showed a cystic septate lesion involving the midbrain, pons, and medulla (Fig 1). The upper extent was in the left midbrain in the anterior pretectal region. The inferior extent was from the left medulla up to the anterior pyramids. The lesion was hypointense on T1 (not shown), hyperintense on T2 (Fig 2), and had enhancing septa on gadolinium-enhanced images (Fig 1). The cerebellar peduncles and anterior cerebellum on the left were also involved, showing fluid-attenuated inversion recovery signal-intensity abnormality (not shown).The patient underwent a craniotomy with intraoperative MR imaging and sonography, with microscopic dissection guided by motorevoked potentials. The surface of the brain stem where the tumor came to the surface was abnormal, but there was no extension along any cranial nerve. A biopsy showed a pure spindle cell tumor. Pathologic considerations at the time were either meningioma, schwannoma, or tanycytic ependymoma. There were no mitotic figures. Xanthochromic intratumoral cyst fluid was found to be under moderate pressure. The tumor was resected but had to be coagulated medially and inferiorly at the brain stem attachment where dissection was difficult. Multiple septa were fenestrated and resected. Right-sided evoked potentials returned immediately once the cyst was decompressed. A gross total resection was achieved.Pathologic results after the surgery showed a spindle cell neoplasm. Additional special studies were performed on permanent tissue. A positive tumor reactivity was seen in tumor cells with S-100, but they were negative for glial fibrillary acidic protein and epithelial membrane antigen. Studies for MIB-1 showed rare labeled tumor nuclei. A diagnosis of schwannoma was made. The patient's neurologic status improv...

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Section: Discussionmentioning

confidence: 68%

mentioning

confidence: 54%

Imaging and Clinical Features of an Intra-Axial Brain Stem Schwannoma

Muzzafar¹,

Ketonen²,

Weinberg³

et al. 2009

AJNR Am J Neuroradiol

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“…However, these findings were not specific to intraparenchymal schwannoma and always resulted in tentative preoperative diagnoses of low grade glioma. 3,4,12,18,19,23,25,28,31) Although the tumor in our case fulfilled two of the characteristic features, the possibility of an intraparenchymal schwannoma was not considered because we were not aware of this rare entity preoperatively.…”

Section: Discussionmentioning

confidence: 81%

“…11) However, thorough immunohistochemical investigations were performed in only 41 cases, based on our literature review. 1,[3][4][5][6][7][8][9]12,13,[16][17][18][19][20][21][22][23][24][25][26][28][29][30][31] Only these cases were considered in the following discussion. Unlike vestibular schwannomas, intraparenchymal schwannomas tend to occur in young patients, with slight male predominance ( Table 1).…”

Section: Discussionmentioning

confidence: 99%

“…Since there are no specific radiological and pathological findings characteristic of intraparenchymal schwannomas, their rarity always resulted in a tentative diagnosis of gliomas preoperatively and even intraoperatively. 3,4,12,18,19,23,25,28,31) However, the treatment, including the surgical management, would be totally different, so it is important to distinguish this uncommon neoplasm from its radiological and pathological mimics, especially low grade gliomas.…”

Section: Introductionmentioning

confidence: 99%

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Periventricular Intraparenchymal Schwannoma

Khoo

Taki

2012

Neurol. Med. Chir.(Tokyo)

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A 60-year-old male presented with a rare case of periventricular schwannoma. Imaging studies revealed a partially calcified, well-enhanced tumor in the periventricular area of the left frontal horn. The preoperative diagnosis was low grade glioma, but postoperative pathological findings revealed that the tumor was schwannoma. Most intraparenchymal schwannomas are benign, so total extirpation is usually curative. However, this uncommon neoplasm is difficult to distinguish from mimics, especially low grade gliomas, with only preoperative radiological findings or intraoperative pathological findings. Based on our experience and analysis of the characteristic radiological and pathological features in previous cases, we suggest that an accurate intraoperative diagnosis is possible. The key element is the combination of correct interpretation of the intraoperative pathology analysis and careful evaluation of the preoperative radiological studies. An appropriate intraoperative judgment is important, because the treatment, including the surgical management, would be totally different for schwannoma and glioma.

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Tumours of the Neuroendocrine System and the Peripheral Nervous System

Eyden

Banerjee

2013

The Ultrastructure of Human Tumours

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Brainstem Schwannoma —Case Report—

Cited by 12 publications

References 23 publications

Imaging and Clinical Features of an Intra-Axial Brain Stem Schwannoma

Imaging and Clinical Features of an Intra-Axial Brain Stem Schwannoma

Periventricular Intraparenchymal Schwannoma

Tumours of the Neuroendocrine System and the Peripheral Nervous System

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