Stark Andreas M, Buhl Ralf, Hugo Heinz-Herrmann, Straube Thorsten, Mehdorn H Maximilian
Department of Neurosurgery, Schleswig-Holstein University Medical Center, Kiel Campus, Kiel, Germany.
Neurosurgery. 2006 Aug;59(2):E425; discussion E425. doi: 10.1227/01.NEU.0000223498.83238.B2.
Clinically significant intratumoral or peritumoral bleeding from trigeminal nerve tumors is very rare.
We report the case of a 59-year-old man who presented with recurrent subarachnoid hemorrhage from a left trigeminal nerve malignant peripheral nerve sheath tumor. He presented with decreased consciousness, left facial hypesthesia, and left facial weakness. Trigeminal neuralgia was present for 18 months. Cranial computed tomographic and magnetic resonance imaging scans revealed a left parapontine mass with cystic changes and intratumoral bleeding. Furthermore, signs of hemosiderosis of the subarachnoid space were noted. Lumbar puncture revealed fresh bleeding. Angiography detected no aneurysm or other causes of bleeding. The patient became fully alert within hours, the facial weakness improved within a few days. There was no evidence of vasospasm or persisting hydrocephalus. He underwent left-sided suboccipital craniotomy for macroscopically total tumor removal.
The patient underwent total tumor removal via a left suboccipital approach. Intraoperatively, evidence of recurrent intratumoral bleeding was noted. Histological examination revealed a malignant peripheral nerve sheath tumor (World Health Organization Grade III). Postoperatively, the hypesthesia improved significantly. The patient was transferred to radiotherapy for external beam radiation.
This is the first report regarding a malignant peripheral nerve sheath tumor of the trigeminal nerve that caused clinically significant subarachnoid hemorrhage caused by intratumoral bleeding.
三叉神经肿瘤出现具有临床意义的瘤内或瘤周出血极为罕见。
我们报告一例59岁男性患者，其因左侧三叉神经恶性外周神经鞘瘤反复发生蛛网膜下腔出血。他表现为意识减退、左侧面部感觉减退和左侧面部无力。三叉神经痛已持续18个月。头颅计算机断层扫描和磁共振成像扫描显示左侧桥脑旁有一伴有囊性改变和瘤内出血的肿块。此外，还发现了蛛网膜下腔含铁血黄素沉着的迹象。腰椎穿刺显示有新鲜出血。血管造影未发现动脉瘤或其他出血原因。患者在数小时内完全清醒，面部无力在数天内有所改善。没有血管痉挛或持续性脑积水的证据。他接受了左侧枕下开颅手术以大体上完整切除肿瘤。
患者通过左侧枕下入路接受了肿瘤全切手术。术中，发现有反复瘤内出血的迹象。组织学检查显示为恶性外周神经鞘瘤（世界卫生组织III级）。术后，感觉减退明显改善。患者被转至放疗科接受外照射放疗。
这是关于一例三叉神经恶性外周神经鞘瘤因瘤内出血导致具有临床意义的蛛网膜下腔出血的首例报告。
