Kurokawa Ryu, Tabuse Masanao, Yoshida Kazunari, Kawase Takeshi
Department of Neurological Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan.
Neurosurgery. 2004 Feb;54(2):510-4; discussion 514. doi: 10.1227/01.neu.0000103676.82231.91.
Spinal accessory schwannomas unassociated with neurofibromatosis are very rare, and only 30 cases have been reported in the literature. To our knowledge, this is the first report of a spinal accessory schwannoma mimicking a tumor of the fourth ventricle.
A 50-year-old man presented with neck pain after being involved in a motor vehicle accident. There were no neurological deficits, but a computed tomographic scan revealed a large hypodense mass with punctuate calcifications in the fourth ventricle. The tumor exhibited low intensity on the T1-weighted magnetic resonance imaging scan and high intensity on the T2-weighted scan, and it showed inhomogeneous contrast enhancement.
The tumor was totally removed by a bilateral suboccipital craniectomy and C1 laminectomy. Dissection of the surgical specimen revealed that the tumor had originated from the left spinal accessory nerve. Histopathological examination confirmed the diagnosis of schwannoma. The patient experienced transient postoperative cerebellar ataxia but recovered completely.
Intracisternal-type spinal accessory schwannomas sometimes mimic a tumor of the fourth ventricle. Total surgical resection can be achieved with good outcome.
与神经纤维瘤病无关的副神经鞘瘤非常罕见，文献中仅报道过30例。据我们所知，这是首例类似第四脑室肿瘤的副神经鞘瘤报告。
一名50岁男性在机动车事故后出现颈部疼痛。无神经功能缺损，但计算机断层扫描显示第四脑室内有一个大的低密度肿块，伴有点状钙化。该肿瘤在T1加权磁共振成像扫描上呈低信号，在T2加权扫描上呈高信号，且表现为不均匀强化。
通过双侧枕下颅骨切除术和C1椎板切除术将肿瘤完全切除。手术标本解剖显示肿瘤起源于左侧副神经。组织病理学检查确诊为神经鞘瘤。患者术后出现短暂的小脑共济失调，但完全康复。
脑池内型副神经鞘瘤有时类似第四脑室肿瘤。手术全切可取得良好效果。
