Single-stage total resection of giant dumbbell-shaped hypoglossal schwannoma: a case report

Inoue, Tan; Nonaka, Yoichi; Hirai, Hisao; Shima, Ayako; Suzuki, Fumio; Matsuda, Masayuki; Fukushima, Takanori

doi:10.1007/s00701-017-3431-6

Cited by 5 publications

(4 citation statements)

References 20 publications

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“…Jiang et al [ 11 ] also reported the use of occipitocervical fusion in 6 patients (1.7%) after cervical laminectomy and facetectomy. As regards intraoperative neuromonitoring adjuncts, monitoring on the lower cranial nerves (IX-XII) was used in 22 patients (6.2%) [ 35 , 36 , 37 , 38 , 39 , 40 , 41 ], monitoring of the somatosensory evoked potentials in 17 patients (4.8%) [ 11 , 21 , 42 , 43 , 44 ], monitoring of the motor evoked potential in 16 patients (4.5%) [ 11 , 21 , 42 , 45 , 46 ], and monitoring the brainstem evoked potential in 1 patient (0.3%) [ 38 ]. Similarly, microdoppler assistance was used only by Oichi et al [ 26 ] to detect the relationship of the tumor and the surgical resection to the proximal arterial and venous structures in 1 patient (0.3%).…”

Section: Resultsmentioning

confidence: 99%

“…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.…”

Section: Discussionmentioning

confidence: 99%

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Surgical Management of Craniovertebral Junction Schwannomas: A Systematic Review

Palmisciano

Ferini²,

Watanabe

et al. 2022

Current Oncology

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Background: Craniovertebral junction (CVJ) schwannomas are rare, with surgery and stereotactic radiosurgery (SRS) being effective yet challenging options. We systematically reviewed the literature on CVJ schwannomas. Methods: PubMed, Scopus, Web-of-Science, and Cochrane were searched following the PRISMA statement to include studies reporting CVJ schwannomas. Clinical features, management, and outcomes were analyzed. Results: We collected 353 patients from 101 included articles. Presenting symptoms were mostly neck pain (30.3%) and headache (26.3%), with most cranial neuropathies involving the XII (31.2%) and X (24.4%) nerves. Most tumors originated from C2 (30.9%) and XII (29.4%) nerves, being extracranial (45.1%) and intradural-extradural (44.2%). Erosion of C1–C2 vertebrae (37.1%), the hypoglossal canal (28.3%), and/or jugular foramen (20.1%) were noted. All tumors were operated, preferably with the retrosigmoid approach (36.5%), with the far-lateral approach (29.7%) or with the posterior approach and cervical laminectomy (26.9%), far-lateral approaches (14.2%), or suboccipital craniotomy with concurrent cervical laminectomy (14.2%). Complete tumor resection was obtained most frequently (61.5%). Adjuvant post-surgery stereotactic radiosurgery was delivered in 5.9% patients. Median follow-up was 27 months (range, 12–252). Symptom improvement was noted in 88.1% of cases, and cranial neuropathies showed improvement in 10.2%. Post-surgical complications occurred in 83 patients (23.5%), mostly dysphagia (7.4%), new cranial neuropathies (6.2%), and cerebrospinal fluid leak (5.9%). A total of 16 patients (4.5%) had tumor recurrence and 7 died (2%), with median overall survival of 2.7 months (range, 0.1–252). Conclusions: Microsurgical resection is safe and effective for CVJ schwannomas. Data on SRS efficacy and indications are still lacking, and its role deserves further evaluation.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Surgical Management of Craniovertebral Junction Schwannomas: A Systematic Review

Palmisciano

Ferini²,

Watanabe

et al. 2022

Current Oncology

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“…Inoue et al reported a case of 61-year-old male presenting with a one year history of tongue atrophy and dysarthria. 22 Imaging revealed a dumb-bell shaped giant mass in the right extradural hypoglossal canal invading intradurally with a large extension to the high cervical region. The authors used a single-stage radical surgical procedure using the anterolateral extreme lateral infrajugular transcondylar exposure approach.…”

Section: Discussionmentioning

confidence: 99%

A rare clinical case: schwannoma of tongue

Singh

Radia

Sheikh

et al. 2019

Int J Otorhinolaryngol Head Neck Surg

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Schwannoma are slow growing tumours, which can arise from any peripheral nerve. 10% of schwannomas that occur in the head and neck region mostly originate from the vagus or sympathetic nervous system. Extracranial schwannomas in the head and neck region are rare neoplasm. Intraoral schwannoma are only 1% of the all head and neck tumours. Diagnosis is established by imaging studies such as magnetic resonance imaging or computed tomography, while FNAC is used to rule out other conditions. We report a rare case of lingual schwannomas generally present as a painless lump schwannoma of the tongue in a 27-year-old male complaining of asymptomatic swelling over a posterolateral surface of the tongue, treated by complete surgical excision. The diagnosis was established on the basis of clinical, histopathological, and immunohistochemical examination. We report a rare case of schwannoma over the posterolateral surface of tongue. Prognosis is good for the patient when this condition is correctly diagnosed as the condition rarely recurs after complete resection.

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“…Moreover, this typology of dissection reproduces with great reliability the "in vivo" surgical scenario, giving a more detailed idea of the feasibility of a specific surgical approach and making the neurosurgeon more familiar with the "real life" surgical anatomy. [29][30][31][32] Since the HN is commonly compressed or dislocated by CVJ lesions, 16,25 we decided to describe its anatomy by simulating a lateral approach to the CVJ.…”

Section: Discussionmentioning

confidence: 99%

Microsurgical Anatomy of the Hypoglossal Nerve in the Lateral Approaches to the Craniovertebral Junction: A Study on Fresh Non-Formalin-Fixed Human Specimens

Pescatori

Tropeano

Piccirilli

et al. 2022

J Neurol Surg A Cent Eur Neurosurg

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The aim of this anatomical study is to describe the anatomy of the hypoglossal nerve (HN) from its origin to the extracranial portion as it appears by performing a combined posterolateral and anterolateral approach to the craniovertebral junction (CVJ). Twelve fresh, non-formalin-fixed adult cadaveric heads (24 sides) were analyzed for the simulation of the combined lateral approach to the CVJ. The HN is divided into three main parts: cisternal, intracanalicular, and extracranial The anatomical relationships between the HN and other nerves, muscles, arteries and veins were carefully recorded, and some measurements were made between the HN and related structures. Thus, various landmarks were determined for the easy identification of the HN. Understanding the detailed anatomy of the HN and its relationships with the surrounding structures is crucial to prevent some complications during CVJ surgery.

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Single-stage total resection of giant dumbbell-shaped hypoglossal schwannoma: a case report

Cited by 5 publications

References 20 publications

Surgical Management of Craniovertebral Junction Schwannomas: A Systematic Review

Surgical Management of Craniovertebral Junction Schwannomas: A Systematic Review

A rare clinical case: schwannoma of tongue

Microsurgical Anatomy of the Hypoglossal Nerve in the Lateral Approaches to the Craniovertebral Junction: A Study on Fresh Non-Formalin-Fixed Human Specimens

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