Jin Sung-Won, Park Kyung-Jae, Park Dong-Hyuk, Kang Shin-Hyuk
Department of Neurosurgery, Korea University Medical Center, College of Medicine, Korea University, Seoul, Korea.
J Korean Neurosurg Soc. 2014 Aug;56(2):152-6. doi: 10.3340/jkns.2014.56.2.152. Epub 2014 Aug 31.
Intracisternal accessory nerve schwannomas are very rare; only 18 cases have been reported in the literature. In the majority of cases, the tumor origin was the spinal root of the accessory nerve and the tumors usually presented with symptoms and signs of intracranial hypertension, cerebellar ataxia, and myelopathy. Here, we report a unique case of an intracisternal schwannoma arising from the cranial root of the accessory nerve in a 58-year-old woman. The patient presented with the atypical symptom of hoarseness associated with recurrent laryngeal neuropathy which is noted by needle electromyography, and mild hypesthesia on the left side of her body. The tumor was completely removed with sacrifice of the originating nerve rootlet, but no additional neurological deficits. In this report, we describe the anatomical basis for the patient's unusual clinical symptoms and discuss the feasibility and safety of sacrificing the cranial rootlet of the accessory nerve in an effort to achieve total tumor resection. To our knowledge, this is the first case of schwannoma originating from the cranial root of the accessory nerve that has been associated with the symptoms of recurrent laryngeal neuropathy.
枕骨大池内副神经鞘瘤非常罕见；文献中仅报道过18例。在大多数病例中，肿瘤起源于副神经的脊髓根，肿瘤通常表现为颅内高压、小脑共济失调和脊髓病的症状和体征。在此，我们报告一例58岁女性患者，其枕骨大池内副神经鞘瘤起源于副神经的颅根。患者表现出与喉返神经病变相关的非典型症状——声音嘶哑（针极肌电图证实），以及身体左侧轻度感觉减退。肿瘤在牺牲起源神经根丝的情况下被完全切除，但未出现额外的神经功能缺损。在本报告中，我们描述了患者异常临床症状的解剖学基础，并讨论了牺牲副神经颅根丝以实现肿瘤全切的可行性和安全性。据我们所知，这是首例起源于副神经颅根且与喉返神经病变症状相关的神经鞘瘤病例。
