Sawada K, Nakagaki H, Kitamura K, Kishikawa T, Numaguchi Y
No Shinkei Geka. 1981 Nov;9(12):1425-30.
Three cases of cystic neurinoma arising from the upper cervical spinal nerve roots and extending to the posterior cranial fossa through the foramen magnum were reported. Case 1 was a 52-year-old female presenting marked bilateral papilledema, hyperactive right knee jerk, left positive Gordon reflex and trunkal ataxia. The mass was mostly cystic and arose from the left 1st cervical nerve root. It extended to the posterior fossa, occupied the cerebello-medullary cistern and displaced the left cerebellar hemisphere posteriorly and superiorly. Case 2 was a 39-year-old male presenting marked bilateral papilledema, neck stiffness, dysfunction of the right 7, 9, 10 and 11th cranial nerves, gaze nystagmus, Horner's syndrome, right limb ataxia, and ataxic gait. The mass was totally cystic containing yellowish fluid and was growing from the right 2nd cervical spinal nerve root. The mass extended to the posterior cranial fossa up to the right cerebello-pontine angle and compressed the medulla oblongata, upper cervical cord and 7th through 11th cranial nerves on the right side. Case 3 was a 66-year-old male presenting marked bilateral papilledema, gaze nystagmus, left hemiparesis, bilateral hyperactive deep tendon reflexes, numbness of the left fingers and ataxic gait. CT scanning revealed in the midline of the posterior cranial fossa a low density mass which was enhanced in a ring-like fashion. Vertebral angiograms showed an avascular mass displacing the PICAs upwards and elongating its cranial loops antero-posteriorly. The mass was totally cystic, arose from the left 2nd cervical spinal nerve root, extended to the posterior cranial fossa and occupied the cisterna magna and vallecula. Foramen magnum syndrome was discussed and the symptoms and signs presented in these three cases were compared with those presented by foramen magnum meningioma in other reports.
报告了3例起源于颈上段脊神经根并经枕骨大孔延伸至后颅窝的囊性神经鞘瘤。病例1为一名52岁女性,表现为明显的双侧视乳头水肿、右膝反射亢进、左侧戈登征阳性及躯干共济失调。肿块大部分为囊性,起源于左侧第1颈神经根。它延伸至后颅窝,占据小脑延髓池,并将左侧小脑半球向后上方推移。病例2为一名39岁男性,表现为明显的双侧视乳头水肿、颈部僵硬、右侧第7、9、10和11对脑神经功能障碍、凝视性眼球震颤、霍纳综合征、右下肢共济失调及共济失调步态。肿块完全为囊性,内含淡黄色液体,起源于右侧第2颈神经根。肿块延伸至后颅窝直至右侧小脑脑桥角,压迫延髓、颈上段脊髓及右侧第7至11对脑神经。病例3为一名66岁男性,表现为明显的双侧视乳头水肿、凝视性眼球震颤、左侧偏瘫、双侧深腱反射亢进、左手手指麻木及共济失调步态。CT扫描显示后颅窝中线有一低密度肿块,呈环形强化。椎动脉造影显示一无血管肿块,将小脑后下动脉向上推移,并使其颅环前后拉长。肿块完全为囊性,起源于左侧第2颈神经根,延伸至后颅窝,占据枕大池和小脑溪。讨论了枕骨大孔综合征,并将这3例患者的症状和体征与其他报告中枕骨大孔脑膜瘤的症状和体征进行了比较。