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LETTER TO EDITOR
Year : 2013  |  Volume : 61  |  Issue : 3  |  Page : 330-332

Primary fourth ventricular solitary schwannoma: Case report and review of the literature


Department of Neuro-oncology, The Affiliated, Bayi Brain Hospital, The Military General Hospital of Beijing PLA, Beijing - 100700, China

Date of Submission03-May-2013
Date of Decision10-May-2013
Date of Acceptance30-May-2013
Date of Web Publication16-Jul-2013

Correspondence Address:
Ru-Xiang Xu
Department of Neuro-oncology, The Affiliated, Bayi Brain Hospital, The Military General Hospital of Beijing PLA, Beijing - 100700
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.115099

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How to cite this article:
Chen LH, Zhang HT, Xu RX, Wei Q, Li YJ, Li WD, Zhao H. Primary fourth ventricular solitary schwannoma: Case report and review of the literature. Neurol India 2013;61:330-2

How to cite this URL:
Chen LH, Zhang HT, Xu RX, Wei Q, Li YJ, Li WD, Zhao H. Primary fourth ventricular solitary schwannoma: Case report and review of the literature. Neurol India [serial online] 2013 [cited 2019 Oct 17];61:330-2. Available from: http://www.neurologyindia.com/text.asp?2013/61/3/330/115099

(#Hong-Tian Zhang contribute the same with the first author)


Sir,

Schwannomas have been reported in various unusual intracranial locations including the cerebellum, ventricle, sella and brain stem. [1],[2],[3],[4] We present an extremely rare case of schwannoma originating in the fourth ventricle where it did not have any attachment to the surrounding structures.

A 53-year-old woman was admitted for clinical signs of intracranial hypertension: Severe headache with intermittent episodic vomiting, visual obscuration, progressive hoarseness, diplopia, dysphagia requiring insertion of a gastric canal, progressively worsening generalized weakness, memory disturbances, gait instability and moderate facial paresis accompanied by low nasolabial groove on the left-side, which had developed in the last 5 months before presentation. A ventriculoperitoneal shunt was inserted in another hospital because of severe hydrocephalus. The patient became progressively more drowsy and experienced worsening vomiting 45 days prior to admission. Magnetic resonance imaging (MRI) [Figure 1]a-c, enhanced with intravenous administration of gadolinium [Figure 1]d-f, showed a large mass, mixed solid-cystic lesion, 5.1 cm × 5.3 cm in size, filling the fourth ventricle. Microsurgical excision was performed via a midline suboccipital approach. The tumor did not have any attachment to the cranial nerves nearby. Intraoperative MRI confirmed total resection of the tumor [Figure 2]a. Final pathology revealed this lesion to be an intraventricular schwannoma [Figure 2]b.
Figure 1: (a and b) T1‑and T2‑flair showing an iso‑to hypodense mass in the fourth ventricle; the shape of the brain stem is altered and shifted to the right because of tumor compression;
(c) DWI sequence showing mixed hyperdense tumor with isodense tumor periphery; (d) sagittal T1‑WI and enhanced T1‑WI in the sagittal; (e) and coronal; (f) plane revealing a well‑enhanced primary intraventricular schwannoma extending into the fourth ventricle


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Figure 2: (a) Intra‑operative magnetic resonance (T1‑BRAVO subsequence) images with gadolinium showing total tumor removal and edema in the middle cerebellar peduncle on the left side; (b) final pathology revealed this lesion to be an intraventricular schwannoma

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In 1957, Marchand et al. published the first case of an intraventricular schwannoma. [3] Only 18 further cases of intraventricular schwannomas have been reported in the literature, with the majority of cases reported located in the lateral ventricle with only eight cases (including the present) in the fourth ventricle. [1],[2],[3],[4],[5],[6] On review of the literature, the present case was the biggest fourth ventricular schwannoma.The clinical features of all reported fourth ventricular schwannomas are summarized in [Table 1]. The ages of patients ranged from 7 years to 78 years (average 49.8 years) and only one pediatric patient was reported. On the total, five patients were male and 3 were female. The tumor frequently present with short duration of signs and symptoms of increased intracranial pressure and focal neurological deficits. Their clinical presentation varies from incidental findings to symptoms of intracranial hypertension, resulting from mass effect or obstructive hydrocephalus, associated with headache, vomiting, papilledema and focal neurological deficits. Pre-operative diagnosis is difficult. The optimal treatment of a fourth ventricular schwannoma is microsurgical resection without having to resort to further adjuvant therapy.
Table 1: Summary of primary fourth ventricular schwannoma

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 » Acknowledgment Top


This work was supported by the Natural Scientific Research funds of China (No.81100916) for Dr. Hong-Tian Zhang and China Postdoctoral Science Foundation (201104901907) for Dr. Hong-Tian Zhang.

 
 » References Top

1.Hodges TR, Karikari IO, Nimjee SM, Tibaleka J, Cummings TJ, Radhakrishnan S, et al. Fourth ventricular schwannoma: Identical clinicopathologic features as schwann cell-derived schwannoma with unique etiopathologic origins. Case Rep Med 2011;2011:165954.  Back to cited text no. 1
[PUBMED]    
2.Kachhara R, Raje P, Pauranik A. Schwannoma originating in lateral recess of the fourth ventricle. Asian J Neurosurg 2012;7:151-3.  Back to cited text no. 2
  Medknow Journal  
3.Marchand L, Koechlin P, Racine Y. Malignant neurinoma of the fourth ventricle with intrabulbar propagation in a schizophrenic; death during electroshock. Ann Med Psychol (Paris) 1957;115:108-13.  Back to cited text no. 3
[PUBMED]    
4.Oertel MF, Nolte KW, Blaum M, Weis J, Gilsbach JM, Korinth MC. Primary intraventricular schwannomas. Clin Neurol Neurosurg 2009;111:768-73.  Back to cited text no. 4
[PUBMED]    
5.Redekop G, Elisevich K, Gilbert J. Fourth ventricular schwannoma. Case report. J Neurosurg 1990;73:777-81.  Back to cited text no. 5
[PUBMED]    
6.Weiner HL, Zagzag D, Babu R, Weinreb HJ, Ransohoff J. Schwannoma of the fourth ventricle presenting with hemifacial spasm. A report of two cases. J Neurooncol 1993;15:37-43.  Back to cited text no. 6
[PUBMED]    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1]

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