Farrokhi Majid Reza, Ghaffarpasand Fariborz, Taghipour Mousa, Derakhshan Nima
Shiraz Neuroscience Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran.
Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran.
World Neurosurg. 2018 Jun;114:274-280. doi: 10.1016/j.wneu.2018.03.132. Epub 2018 Mar 27.
The schwannoma of the trochlear nerve is rare and originates mostly from the distal parts in the interpeduncular cistern. A lesion on the proximal segment in the inferior pineal region is extremely rare. Because of the rarity of the disease, the surgical approach to this region for the resection of trochlear nerve schwannoma has not been well documented in the literature. We herein describe a novel approach to successfully resect the trochlear nerve schwannoma.
A 12-year-old boy presented with occipital headache, abnormal gait, and disturbed conjoined eye movement. He was diagnosed with a lesion in the inferior pineal region compressing the superior medullary velum into the roof of the fourth ventricle. A bilateral midline suboccipital craniotomy was performed, and the fourth ventricle was exposed. The lesion was approached through the fourth ventricle superior medullary velum (transventricular transvelar approach). The lesion was totally resected, and his histopathology examination revealed trochlear schwannoma.
The patient's symptoms resolved, and he had no recurrence at 12-year follow-up with normal eye movement and vision.
The transventricular transvelar approach is feasible and safe to treat a lesion of the lower part of the pineal region being pushed through the superior medullary velum.
滑车神经鞘瘤罕见，大多起源于脚间池的远端部分。松果体区下方近端节段的病变极为罕见。由于该疾病罕见，文献中对于该区域滑车神经鞘瘤切除术的手术入路尚未有充分记载。我们在此描述一种成功切除滑车神经鞘瘤的新方法。
一名12岁男孩出现枕部头痛、异常步态及双眼联合运动障碍。他被诊断为松果体区下方的病变将上髓帆压迫至第四脑室顶部。实施双侧枕下中线开颅术，暴露第四脑室。通过第四脑室上髓帆（经脑室经帆入路）接近病变。病变被完全切除，其组织病理学检查显示为滑车神经鞘瘤。
患者症状消失，在12年的随访中无复发，眼球运动和视力正常。
经脑室经帆入路治疗经上髓帆推挤至松果体区下部的病变是可行且安全的。
