Khoo Hui Ming, Taki Takuyu
Department of Neurosurgery, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan.
Neurol Med Chir (Tokyo). 2012;52(8):603-7. doi: 10.2176/nmc.52.603.
A 60-year-old male presented with a rare case of periventricular schwannoma. Imaging studies revealed a partially calcified, well-enhanced tumor in the periventricular area of the left frontal horn. The preoperative diagnosis was low grade glioma, but postoperative pathological findings revealed that the tumor was schwannoma. Most intraparenchymal schwannomas are benign, so total extirpation is usually curative. However, this uncommon neoplasm is difficult to distinguish from mimics, especially low grade gliomas, with only preoperative radiological findings or intraoperative pathological findings. Based on our experience and analysis of the characteristic radiological and pathological features in previous cases, we suggest that an accurate intraoperative diagnosis is possible. The key element is the combination of correct interpretation of the intraoperative pathology analysis and careful evaluation of the preoperative radiological studies. An appropriate intraoperative judgment is important, because the treatment, including the surgical management, would be totally different for schwannoma and glioma.
一名60岁男性患者，出现了一例罕见的脑室周围神经鞘瘤。影像学检查显示，在左侧额叶角脑室周围区域有一个部分钙化、强化良好的肿瘤。术前诊断为低级别胶质瘤，但术后病理结果显示该肿瘤为神经鞘瘤。大多数脑实质内神经鞘瘤是良性的，因此完整切除通常可治愈。然而，仅凭术前影像学检查结果或术中病理结果，这种不常见的肿瘤很难与其他类似疾病区分开来，尤其是低级别胶质瘤。基于我们的经验以及对既往病例特征性影像学和病理特征的分析，我们认为术中进行准确诊断是可行的。关键要素是正确解读术中病理分析并仔细评估术前影像学检查结果。进行恰当的术中判断很重要，因为神经鞘瘤和胶质瘤的治疗，包括手术处理，会完全不同。
