Direct Cranial Nerve Involvement by Gliomas: Case Series and Review of the Literature

Abstract

Malignant gliomas are characterized by infiltrative growth of tumor cells, including along white matter tracts. This may result in clinical cranial neuropathy due to direct involvement of a cranial nerve rather than by leptomeningeal spread along cranial nerves. Gliomas directly involving cranial nerves III-XII are rare with only eleven cases reported in the literature prior to 2014, including eight with imaging. We present eight additional cases demonstrating direct infiltration of a cranial nerve by glioma. Asymmetric cisternal nerve expansion as compared to the contralateral nerve was noted with a mean length of involvement of 9.4 mm. Based on our case series, the key imaging feature to recognize direct cranial nerve involvement by a glioma is the detection of an intra-axial mass in the pons or midbrain that is directly associated with expansion, signal abnormality, and/or enhancement of the adjacent cranial nerve(s).

Diffuse Midline Gliomas with Histone H3‐K27M Mutation: A Series of 47 Cases Assessing the Spectrum of Morphologic Variation and Associated Genetic Alterations

“…An autopsy was performed on this patient following palliative radiation and chemotherapy, and histone H3-K27M immunohistochemistry was helpful in assessing the widespread infiltration of the tumor cells throughout the brain and spinal cord. Tumor cells were seen infiltrating from the brainstem into multiple cranial nerves (Figures 3H and I), a finding that has only been rarely observed in malignant gliomas (22). …”

Progressive multifocal exophytic pontine glioblastoma: a case report with literature review

“…Cranial nerve glioblastomas are presumably originated from CNS tissue locating at the root entry zone of the cranial nerve or from heterotopic neuroglia cells in the leptomeninges. Similarly, Mabray et al [17] recently reported eight cases of glioblastoma originated from the cranial nerve. These glioblastomas were located at the CPA and involved the unilateral brainstem.…”

“…Matsuda et al [18] reported a case of glioblastoma originated from the cerebellum and reviewed another three similar cases. In the reports by both Mabray et al [17] and Matsuda et al [18], the relatively clear boundary between the brainstem and tumor were demonstrated during the operation. In our case, neither preoperative MRI nor surgery alone supported an origin at the cranial nerve cerebellum.…”

Neuroprotective effect of lurasidone via antagonist activities on histamine in a rat model of cranial nerve involvement

“…Currently, although several factors have been reported to exhibit correlation with the initiation and development of cranial nerve involvement, the mechanism of interactions between cranial nerve involvement and affecting factors remain to be fully elucidated (24). Several potentially neuroprotective agents function to upregulate gene transcription at the onset of brain ischemia, which may be an effective approach for limiting brain tissue damage (25). Studies on the mechanisms of cranial nerve involvement have shown that the serotonin systematic signaling pathway shows high correlation with the initiation, development, treatment and prognosis of cranial nerve involvement (26,27).…”