Oishi Tomoya, Takehara Seiya, Yamamura Yasuhiro, Tomida Mamoru, Ito Shinji, Kuriki Ken, Namba Hiroki
Department of Neurosurgery, Yaizu City Hospital, Yaizu, Shizuoka, Japan.
Department of Pathology, Yaizu City Hospital, Yaizu, Shizuoka, Japan.
NMC Case Rep J. 2017 Jun 12;4(3):83-87. doi: 10.2176/nmccrj.cr.2016-0267. eCollection 2017 Jul.
Schwannoma is a benign peripheral nerve sheath tumor originating from Schwann cells. Most intracranial schwannomas arise from vestibular nerve and schwannoma in the suprasellar region is extremely rare. A 64-year-old man presented with walking disturbance and blurred vision for three months. Lateral hemianopsia in the left eye and brachybasia were observed. Magnetic resonance imaging revealed a suprasellar tumor with strong contrast enhancement associated with communicating hydrocephalus. The cerebrospinal fluid tap test improved gait disturbance. Hypothalamic stimulation test revealed hypo-reaction of GH, FSH and LH. After ventriculo-peritoneal shunting, the tumor was totally removed via a bilateral front-basal approach with a clinical diagnosis of craniopharyngioma. No adhesion was observed between the tumor and surrounding structures such as meninges and brain. The histopathological diagnosis was schwannoma. Here we report a case of suprasellar schwannoma associated with communicating hydrocephalus that has not ever been previously reported, with special reference to its pathogenesis.
施万细胞瘤是一种起源于施万细胞的良性周围神经鞘瘤。大多数颅内施万细胞瘤起源于前庭神经,而鞍上区的施万细胞瘤极为罕见。一名64岁男性出现行走障碍和视力模糊3个月。观察到左眼外侧偏盲和短基底。磁共振成像显示鞍上区肿瘤伴有明显的对比增强,并伴有交通性脑积水。脑脊液穿刺试验改善了步态障碍。下丘脑刺激试验显示生长激素、促卵泡生成素和促黄体生成素反应低下。在进行脑室-腹腔分流术后,通过双侧额底部入路将肿瘤完全切除,临床诊断为颅咽管瘤。未观察到肿瘤与脑膜和脑等周围结构之间有粘连。组织病理学诊断为施万细胞瘤。在此,我们报告一例伴有交通性脑积水的鞍上施万细胞瘤病例,此前从未有过报道,并特别提及了其发病机制。