Intracranial intraparenchymal schwannoma: Report of three cases

Tsuiki, Hiromasa; Kuratsu, Jun Ichi; Ishimaru, Yasuji; Nakahara, Tadashi; Kishida, Katsuaki; Takamura, M.; Marubayashi, Toru; Ushio, Yukitaka

doi:10.1007/bf01420049

Cited by 30 publications

(28 citation statements)

References 31 publications

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“…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 ). 4) Our patient had a multiloculated cystic lesion; all 3 other lesions 1,6,9 with MR imaging data available had unilocular cystic masses.…”

Section: Discussionmentioning

confidence: 77%

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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: 77%

“…Diffuse peritumoral edema has been described as another characterstic feature of intraparenchymal schwannomas, especially in the supratentorial compartment (35.7%). 2,10,12 The cause of edema around this benign neoplasm is uncertain.…”

Section: Discussionmentioning

confidence: 99%

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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“…19,30,31,50,57 Noncystic tumors have also been reported, most commonly in the frontal lobes. 3,14,49,50 Evidence of hypervascularity on angiography has been reported. 29 On MRI studies, intracerebral schwannomas appear relatively isointense to gray matter on T2-weighted images.…”

Section: Discussionmentioning

confidence: 99%

Intracerebral schwannomas: a rare disease with varying natural history

Scott

Koral²,

Margraf

et al. 2013

PED

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Although intracerebral schwannomas are typically regarded as benign intracranial tumors, malignancy and recurrence have been reported among patients harboring such neoplasms. The available literature consists of case reports and small series that present variable characteristics distinguishing these unusual lesions. Little advancement has been made to further the understanding and management of these tumors. The authors present 3 cases from their institution that highlight the difference between typical benign intracerebral schwannomas and histopathological variants that may portend more aggressive behavior. Also provided is a review of the literature in the hope of gaining a better understanding of these rare tumors.

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“…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%

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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Intracranial intraparenchymal schwannoma: Report of three cases

Cited by 30 publications

References 31 publications

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

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

Intracerebral schwannomas: a rare disease with varying natural history

Periventricular Intraparenchymal Schwannoma

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