Santarius Thomas, Dakoji Srikanth, Afshari Fardad T, Raymond Frances L, Firth Helen V, Fernandes Helen M, Garnett Matthew R
Department of Neurosurgery, Addenbrooke's Hospital, University of Cambridge, United Kingdom.
J Neurosurg Pediatr. 2012 Aug;10(2):130-3. doi: 10.3171/2012.3.PEDS11555. Epub 2012 Jun 22.
The authors report a case of an isolated schwannoma of left hypoglossal nerve in a 9-year-old girl. To the authors' knowledge, this is the first case report of hypoglossal nerve schwannoma in the pediatric population in the absence of neurofibromatosis Type 2. The patient presented with a 2-month history of morning nausea and vomiting with occasional daytime headaches. Magnetic resonance imaging and subsequent CT scanning revealed a dumbbell tumor with a belly in the lower third of the posterior fossa and head underneath the left jugular foramen. Its neck protruded through an expanded hypoglossal canal. Although the lesion bore radiological characteristics of a hypoglossal schwannoma, the absence of hypoglossal palsy and the apparent lack of such tumors in the pediatric population the preoperative diagnosis was not certain. The tumor was approached via a midline suboccipital craniotomy, and gross-total resection was achieved. Pathological examination confirmed the diagnosis of schwannoma. Blood and tumor tests for mutations in the NF2 gene were negative. Postoperative mild hypoglossal palsy recovered by the 3-month follow-up, and an MRI study obtained at 1 year did not show recurrence.
作者报告了一例9岁女孩左侧舌下神经孤立性神经鞘瘤的病例。据作者所知，这是首例在无2型神经纤维瘤病的儿科人群中发生的舌下神经神经鞘瘤病例报告。该患者有2个月的晨起恶心呕吐病史，偶尔伴有日间头痛。磁共振成像及随后的CT扫描显示为哑铃形肿瘤，瘤体位于后颅窝下三分之一处，瘤头位于左侧颈静脉孔下方。其瘤颈穿过扩大的舌下神经管。尽管该病变具有舌下神经鞘瘤的放射学特征，但由于无舌下神经麻痹且儿科人群中明显缺乏此类肿瘤，术前诊断并不确定。通过枕下中线开颅术处理该肿瘤，实现了肿瘤全切。病理检查确诊为神经鞘瘤。血液及肿瘤组织的NF2基因突变检测均为阴性。术后轻度舌下神经麻痹在3个月随访时恢复，1年时的MRI检查未显示复发。
