Kumar Amandeep, Singh Manmohan, Sharma Mehar C, Chandra Poodipedi S, Sharma Bhawani S, Mahapatra Ashok K
Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India.
Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India.
World Neurosurg. 2017 Sep;105:1038.e17-1038.e22. doi: 10.1016/j.wneu.2017.06.077. Epub 2017 Jun 20.
Intracranial schwannomas most commonly arise from the vestibulocochlear nerve and less frequently from trigeminal, facial, and hypoglossal nerves. Intracranial schwannomas unrelated to cranial nerves are very rare; only approximately 50 cases have been reported in the literature. Tentorial schwannoma (TS) is even rarer, with only 13 cases reported to date. We present a rare case of giant TS.
A 21-year-old man presented with generalized headache and dizziness for the past 6 months and worsening of symptoms for the past 2 months. On evaluation, he was found to have a cystic lesion arising from the right tentorium with multiple internal septa and fluid levels, with both supratentorial and infratentorial extension. The presence of a dural tail sign and tentorial origin led us to make a preoperative diagnosis of tentorial meningioma. The patient underwent complete excision, and a diagnosis of TS was made based on histopathologic analysis.
TSs are extremely rare. Knowledge of radiologic and morphologic features can be helpful in making a preoperative diagnosis. The dural tail sign, which is considered a characteristic feature of meningioma, is commonly seen in TS as well, and thus TS should always be considered in the differential diagnosis of lesions arising from the tentorium.
颅内神经鞘瘤最常起源于前庭蜗神经，较少起源于三叉神经、面神经和舌下神经。与颅神经无关的颅内神经鞘瘤非常罕见；文献中仅报道了约50例。小脑幕神经鞘瘤（TS）更为罕见，迄今为止仅报道了13例。我们报告1例罕见的巨大TS病例。
一名21岁男性在过去6个月出现全身性头痛和头晕，近2个月症状加重。经评估，发现其右侧小脑幕有一个囊性病变，有多个内部间隔和液平，幕上和幕下均有延伸。硬脑膜尾征的存在及小脑幕起源使我们术前诊断为小脑幕脑膜瘤。患者接受了完整切除，术后根据组织病理学分析诊断为TS。
TS极其罕见。了解其影像学和形态学特征有助于术前诊断。硬脑膜尾征虽被认为是脑膜瘤的特征性表现，但在TS中也常见，因此在鉴别诊断起源于小脑幕的病变时应始终考虑TS。
