Spinal Accessory Schwannoma Mimicking a Tumor of the Fourth Ventricle: Case Report

Kurokawa, Ryu; Tabuse, Masanao; Yoshida, Kazunari; Kawase, Takeshi

doi:10.1227/01.neu.0000103676.82231.91

Cited by 15 publications

(22 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Patients present with unspecific combinations of neck pain [10], cerebellar signs, myelopathy or foramen magnum syndrome mostly resulting from the mass effect of the tumor; SAN features may be present or absent altogether [7,9]. Some cases manifest their onset by intracranial hypertension [10], mimic normal pressure hydrocephalus or fourth ventricle tumor [5,6]. Our case is the only one described presenting as isolated SAN, as the tumor was small, not exerting mass effect.…”

Section: Contents Lists Available At Sciencedirectmentioning

confidence: 66%

Isolated spinal accessory neuropathy and intracisternal schwannomas of the spinal accessory nerve

Alajmi

Rousseff

Shamov³

et al. 2015

Interdisciplinary Neurosurgery

View full text Add to dashboard Cite

We report a 40-year-old female patient presenting with isolated left spinal accessory neuropathy that developed insidiously over 6 years. She complained of ill-defined deep neck and shoulder pain. On examination, prominent sternocleidomastoid and trapezoid muscle weakness and atrophy, shoulder instability, and lateral scapular winging were observed. MRI identified a small mass of the cisternal portion of the spinal accessory nerve. Its appearance was typical of schwannoma. Surgical treatment was not offered because of the small tumor size, lack of mass effect and the questionable functional recovery in the presence of muscular atrophy.Isolated spinal accessory neuropathy (SAN) is not uncommon after iatrogenic surgical injury of the accessory nerve (AN) during various procedures in the posterior triangle of the neck [1,2]. Less frequent aetiologies include traction injury, blunt or penetrating trauma, neuralgic amyotrophy, infection, or tumors involving the AN along its complicated course (intraaxially; intradurally in the high cervical segment of the spinal canal and at the foramen magnum; extradurally but intracranially, at the skull base/jugular foramen; extracranially, distal to the jugular foramen in the neck) [1,2]. Schwannomas of the AN are very rare and occur extracranially [3] or intracranially. The intracranial ones are further divided by location into intrajugular and intracisternal. Intrajugular masses result in jugular foramen syndrome and only occasionally present as isolated SAN [4].Intracisternal AN schwannomas are exceedingly rare and usually manifest by the mass effects they produce [3]. The patient we report is -to the best of our knowledge -the first with this type of neoplasm to present with isolated SAN.A 40-year-old female patient presented with poorly localized deep pain in the neck and left shoulder of 6 years duration. Her complaints were stationary over the last years, and she denied any other symptoms. There was no history of surgery or trauma to the neck. Examination showed prominent atrophy of the left trapezius and sternocleidomastoid (SCM) muscles (Fig. 1), drooping of the left shoulder and lateral scapular winging, accentuated by shoulder abduction.Muscle power testing (MRC scale) was 4/5 for the trapezius and 3/ 5 for the SCM. Abduction of the left arm was limited to 90 degrees. The rest of her neurological examination was normal. In particular, there was no evidence of tongue atrophy or asymmetry, the soft palate and uvula were symmetrical with preserved gag reflexes. Direct laryngoscopy was normal. Formal gustometry was not performed, but the patient denied any changes in taste sensation and testing for sour of the posterior third of the tongue (citric acid strip 16.5%) revealed no loss of taste. Clinical impression was of an isolated left spinal accessory neuropathy (SAN).Nerve conduction studies revealed normal latencies but markedly reduced compound muscle action potential amplitude of the left trapezius muscle (0.4 mV versus 6 mV on the right) (Fig. 2).Needle EMG examination...

show abstract

Section: Contents Lists Available At Sciencedirectmentioning

confidence: 66%

Isolated spinal accessory neuropathy and intracisternal schwannomas of the spinal accessory nerve

Alajmi

Rousseff

Shamov³

et al. 2015

Interdisciplinary Neurosurgery

View full text Add to dashboard Cite

show abstract

“…To our knowledge, this is the first documented case of an MPNST arising from an extracranial segment of the spinal accessory nerve and metastasizing to the brain 1-4…”

Section: Discussionmentioning

confidence: 85%

“…Kurokowa et al4 described the first case of a spinal accessory schwannoma arising in the fourth ventricle in a 50-year-old man presenting with neck pain after trauma. Physical examination findings from the patient described in their report were not consistent with cranial nerve involvement; and they did not report upper or lower extremity weakness or gait disturbance.…”

Section: Discussionmentioning

confidence: 99%

“…MPNSTs of the spinal accessory nerve may involve the nerve at various points along its course from the cervical segment of the spinal cord to the trapezius muscle 2-7. The various segments of the nerve are classified as cisternal, foraminal, and intrasternomastoid 4,6. The extracranial portion of the nerve, specifically its intrasternomastoid segment, is the least common location of the nerve to be involved by a peripheral nerve sheath tumor,4-6 and metastasis to the brain from this location has not been reported.…”

Section: Introductionmentioning

confidence: 99%

“…The various segments of the nerve are classified as cisternal, foraminal, and intrasternomastoid 4,6. The extracranial portion of the nerve, specifically its intrasternomastoid segment, is the least common location of the nerve to be involved by a peripheral nerve sheath tumor,4-6 and metastasis to the brain from this location has not been reported. We report here a patient with a well-circumscribed mass in the brain parenchyma, which was a metastatic lesion of an MPNST of the intrasternomastoid segment spinal accessory nerve - a unique presentation of an exceeding rare tumor.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Malignant Nerve Sheath Tumor of the Spinal Accessory Nerve: A Unique Presentation of a Rare Tumor

Sheikh¹,

Reaves

Kralick

et al. 2012

J Clin Neurol

View full text Add to dashboard Cite

BackgroundMalignant peripheral nerve sheath tumors (MPNSTs), sarcomas originating from tissues of mesenchymal origin, are rare in patients without a history of neurofibromatosis.Case ReportWe report a case of an MPNST of the spinal accessory nerve, unassociated with neurofibromatosis, which metastasized to the brain. The tumor, originating in the intrasternomastoid segment of the spinal accessory nerve, was removed. Two years later, the patient presented with focal neurological deficits. Radiographic findings revealed a well-defined 2.2×2.2×2.2 cm, homogeneously enhancing mass in the left parieto-occipital region of the brain surrounded by significant vasogenic edema and mass effect, culminating in a 1-cm midline shift to the right. The mass was surgically removed. The patient had nearly complete recovery of vision, speech, and memory.ConclusionsTo our knowledge, this is the first documented case of an MPNST arising from an extracranial segment of the spinal accessory nerve and metastasizing to the brain.

show abstract

Nonvestibular Schwannoma

2016

Diagnostic Imaging: Brain

View full text Add to dashboard Cite

Spinal Accessory Schwannoma Mimicking a Tumor of the Fourth Ventricle: Case Report

Abstract: Intracisternal-type spinal accessory schwannomas sometimes mimic a tumor of the fourth ventricle. Total surgical resection can be achieved with good outcome.

Cited by 15 publications

References 18 publications

Isolated spinal accessory neuropathy and intracisternal schwannomas of the spinal accessory nerve

Isolated spinal accessory neuropathy and intracisternal schwannomas of the spinal accessory nerve

Malignant Nerve Sheath Tumor of the Spinal Accessory Nerve: A Unique Presentation of a Rare Tumor

Nonvestibular Schwannoma

Contact Info

Product

Resources

About