Intracranial hypoglossal neurinoma without preoperative hypoglossal nerve paresis--case report.

A 46-year-old female presented with an intracranial hypoglossal neurinoma manifesting only as spasticity in the lower extremities without hypoglossal nerve paresis. Magnetic resonance imaging greatly aided in the early detection of the tumor with this atypical presentation. Unilateral suboccipital craniotomy with resection of the occipital condyle allowed us to approach the tumor in front of the medulla from an inferolateral direction and to remove it successfully. We emphasize the need to pack dead space with fatty tissue to prevent cerebrospinal fluid leakage.