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Naser PV, Haux-Nettesheim D, Rahmanzade R, Lenga P, Reuss D, Unterberg AW, Beynon C. Accessory nerve schwannoma extending into the fourth ventricle: case report and review of literature. Br J Neurosurg 2023:1-4. [PMID: 36799128 DOI: 10.1080/02688697.2023.2179598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 01/24/2023] [Accepted: 02/07/2023] [Indexed: 02/18/2023]
Abstract
Accessory nerve schwannoma is a rare entity in patients presenting with cranial nerve (CN) deficits. Most of these tumours arise from the cisternal segment of the eleventh CN and extend caudally. Herein, we report the third case of an accessory schwannoma extending cranially into the fourth ventricle. A 61-year-old female presented with a history of variable headaches. Cerebral magnetic resonance imaging (cMRI) revealed a large inhomogeneous contrast-enhancing lesion at the craniocervical junction extending through the foramen of Magendi and concomitant hydrocephalus due to obstruction of the foramina of Luschkae. Microsurgical tumour resection was performed in the half-sitting position. Intraoperatively, the tumour arose from a vestigial fascicle of the spinal accessory nerve. At three month follow-up, neither radiological tumour recurrence nor neurological deficits were observed.
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Affiliation(s)
| | | | - Ramin Rahmanzade
- Department of Neuropathology, Heidelberg University, Heidelberg, Germany
| | - Pavlina Lenga
- Department of Neurosurgery, Heidelberg University, Heidelberg, Germany
| | - David Reuss
- Department of Neuropathology, Heidelberg University, Heidelberg, Germany
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2
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Yan P, Wang P. Accessory nerve schwannoma: A new case report and systematic review. INTERDISCIPLINARY NEUROSURGERY 2020. [DOI: 10.1016/j.inat.2019.100571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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3
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Venous vascular malformations and compressive neuropathy. INTERDISCIPLINARY NEUROSURGERY 2019. [DOI: 10.1016/j.inat.2019.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Mohri M, Yamano J, Saito K, Nakada M. Spinal Accessory Nerve Meningioma at the Foramen Magnum with Medullar Compression: A Case Report and Literature Review. World Neurosurg 2019; 128:158-161. [PMID: 31082561 DOI: 10.1016/j.wneu.2019.05.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Revised: 04/30/2019] [Accepted: 05/02/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND Meningiomas that arise from the cranial nerve are rare. We present a case with an intradural extramedullary tumor at the foramen magnum originating from the spinal accessory nerve. CASE DESCRIPTION The patient was a 69-year-old woman with dizziness and pain in the bilateral shoulder for 2 years. Neurologic examination revealed spinal accessory nerve palsy (difficult in raising the shoulder, deficit of 3/5) on the left side without further deficits. Magnetic resonance imaging showed medullar compression because of a left intradural extramedullary foramen magnum lesion dorsolateral to the medulla. Surgical exposure via a midline suboccipital approach with C1 laminectomy revealed that the lesion arises from the left accessory nerve without dural attachment. The tumor was resected without injury to the spinal accessory nerve, and histologic examination revealed that it was a meningothelial meningioma. The spinal accessory nerve palsy improved to 4 of 5 after 3 months after surgery. CONCLUSIONS To our knowledge, this is the first report of an accessory nerve meningioma at the foramen magnum in which the spinal accessory nerve palsy appeared before operation and improved after tumor resection.
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Affiliation(s)
- Masanao Mohri
- Department of Neurosurgery, Toyama City Hospital, Toyama, Japan.
| | - Jun Yamano
- Department of Neurosurgery, Toyama City Hospital, Toyama, Japan
| | - Katsuhiko Saito
- Department of Pathology, Toyama City Hospital, Toyama, Japan
| | - Mitsutoshi Nakada
- Department of Neurosurgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa, Japan
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Zhu T, Chen M, Xu M, Chen D, Xu J, Yang L, Zhong P. Schwannoma of the Fourth Ventricle: Report of Two Cases and Review of Literature. World Neurosurg 2018; 117:357-362. [DOI: 10.1016/j.wneu.2018.06.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 06/03/2018] [Accepted: 06/04/2018] [Indexed: 01/28/2023]
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Al-Ajmi AM, Rousseff RT, Shamov T, Ismail MJ, Sayer FT. Isolated spinal accessory neuropathy and intracisternal schwannomas of the spinal accessory nerve. INTERDISCIPLINARY NEUROSURGERY 2015. [DOI: 10.1016/j.inat.2015.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Krishnan SS, Bojja S, Vasudevan MC. Spinal accessory nerve schwannomas masquerading as a fourth ventricular lesion. J Neurosci Rural Pract 2015; 6:112-5. [PMID: 25552867 PMCID: PMC4244770 DOI: 10.4103/0976-3147.143217] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Schwannomas are benign lesions that arise from the nerve sheath of cranial nerves. The most common schwannomas arise from the 8th cranial nerve (the vestibulo-cochlear nerve) followed by trigeminal and facial nerves and then from glossopharyngeal, vagus, and spinal accessory nerves. Schwannomas involving the oculomotor, trochlear, abducens and hypoglossal nerves are very rare. We report a very unusual spinal accessory nerve schwannoma which occupied the fourth ventricle and extended inferiorly to the upper cervical canal. The radiological features have been detailed. The diagnostic dilemma was due to its midline posterior location mimicking a fourth ventricular lesion like medulloblastoma and ependymoma. Total excision is the ideal treatment for these tumors. A brief review of literature with tabulations of the variants has been listed.
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Affiliation(s)
- Shyam Sundar Krishnan
- Department of Neurosurgery, Achantha Lakshmipathy Neurosurgical Centre, Voluntary Health Services, Chennai, Tamil Nadu, India
| | - Sivaram Bojja
- Department of Neurosurgery, Achantha Lakshmipathy Neurosurgical Centre, Voluntary Health Services, Chennai, Tamil Nadu, India
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Jin SW, Park KJ, Park DH, Kang SH. Intracisternal cranial root accessory nerve schwannoma associated with recurrent laryngeal neuropathy. J Korean Neurosurg Soc 2014; 56:152-6. [PMID: 25328655 PMCID: PMC4200365 DOI: 10.3340/jkns.2014.56.2.152] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2014] [Revised: 07/07/2014] [Accepted: 08/16/2014] [Indexed: 11/27/2022] Open
Abstract
Intracisternal accessory nerve schwannomas are very rare; only 18 cases have been reported in the literature. In the majority of cases, the tumor origin was the spinal root of the accessory nerve and the tumors usually presented with symptoms and signs of intracranial hypertension, cerebellar ataxia, and myelopathy. Here, we report a unique case of an intracisternal schwannoma arising from the cranial root of the accessory nerve in a 58-year-old woman. The patient presented with the atypical symptom of hoarseness associated with recurrent laryngeal neuropathy which is noted by needle electromyography, and mild hypesthesia on the left side of her body. The tumor was completely removed with sacrifice of the originating nerve rootlet, but no additional neurological deficits. In this report, we describe the anatomical basis for the patient's unusual clinical symptoms and discuss the feasibility and safety of sacrificing the cranial rootlet of the accessory nerve in an effort to achieve total tumor resection. To our knowledge, this is the first case of schwannoma originating from the cranial root of the accessory nerve that has been associated with the symptoms of recurrent laryngeal neuropathy.
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Affiliation(s)
- Sung-Won Jin
- Department of Neurosurgery, Korea University Medical Center, College of Medicine, Korea University, Seoul, Korea
| | - Kyung-Jae Park
- Department of Neurosurgery, Korea University Medical Center, College of Medicine, Korea University, Seoul, Korea
| | - Dong-Hyuk Park
- Department of Neurosurgery, Korea University Medical Center, College of Medicine, Korea University, Seoul, Korea
| | - Shin-Hyuk Kang
- Department of Neurosurgery, Korea University Medical Center, College of Medicine, Korea University, Seoul, Korea
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Bouaziz M, Derdour S, Laouar O, Lankar A. [Spinal root of accessory nerve shwannoma: about a new case]. Neurochirurgie 2012; 58:258-62. [PMID: 22622236 DOI: 10.1016/j.neuchi.2012.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2011] [Revised: 03/31/2012] [Accepted: 04/10/2012] [Indexed: 11/25/2022]
Abstract
BACKGROUND The accessory nerve schwannoma localized in spinal canal is extremely rare; only nine cases have been reported in the literature until now. We report a new case of schwannoma at the spinal root of accessory nerve. OBSERVATION A young woman aged 30 had a high cervical spinal cord compression with respiratory problems. At admission, magnetic resonance imaging (MRI) showed a tumor compressing the spinal cord at C2 to the foramen magnum. The tumor was removed successfully and its origin from the left accessory nerve was confirmed peroperatively. CONCLUSION Although schwannoma of the accessory nerve is exceptional, this entity should be considered as a differential diagnosis with the other tumors of the foramen magnum.
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Affiliation(s)
- M Bouaziz
- Service de neurochirurgie, hôpital Ibn Rochd, CHU d'Annaba, 2, rue de Strasbourg, 23000 Annaba, Algérie.
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Sheikh OA, Reaves A, Kralick FA, Brooks A, Musial RE, Gasperino J. Malignant nerve sheath tumor of the spinal accessory nerve: a unique presentation of a rare tumor. J Clin Neurol 2012; 8:75-8. [PMID: 22523517 PMCID: PMC3325436 DOI: 10.3988/jcn.2012.8.1.75] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2011] [Revised: 05/03/2011] [Accepted: 05/03/2011] [Indexed: 01/05/2023] Open
Abstract
Background Malignant peripheral nerve sheath tumors (MPNSTs), sarcomas originating from tissues of mesenchymal origin, are rare in patients without a history of neurofibromatosis. Case Report We report a case of an MPNST of the spinal accessory nerve, unassociated with neurofibromatosis, which metastasized to the brain. The tumor, originating in the intrasternomastoid segment of the spinal accessory nerve, was removed. Two years later, the patient presented with focal neurological deficits. Radiographic findings revealed a well-defined 2.2×2.2×2.2 cm, homogeneously enhancing mass in the left parieto-occipital region of the brain surrounded by significant vasogenic edema and mass effect, culminating in a 1-cm midline shift to the right. The mass was surgically removed. The patient had nearly complete recovery of vision, speech, and memory. Conclusions To our knowledge, this is the first documented case of an MPNST arising from an extracranial segment of the spinal accessory nerve and metastasizing to the brain.
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Affiliation(s)
- Omair A Sheikh
- Department of Neurology, Section, Critical Care Medicine, Philadelphia, PA, USA
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Cavalcanti DD, Martirosyan NL, Verma K, Safavi-Abbasi S, Porter RW, Theodore N, Sonntag VKH, Dickman CA, Spetzler RF. Surgical management and outcome of schwannomas in the craniocervical region. J Neurosurg 2011; 114:1257-67. [DOI: 10.3171/2010.5.jns0966] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Schwannomas occupying the craniocervical junction (CCJ) are rare and usually originate from the jugular foramen, hypoglossal nerves, and C-1 and C-2 nerves. Although they may have different origins, they may share the same symptoms, surgical approaches, and complications. An extension of these lesions along the posterior fossa cisterns, foramina, and spinal canal—usually involving various cranial nerves (CNs) and the vertebral and cerebellar arteries—poses a surgical challenge. The primary goals of both surgical and radiosurgical management of schwannomas in the CCJ are the preservation and restoration of function of the lower CNs, and of hearing and facial nerve function. The origins of schwannomas in the CCJ and their clinical presentation, surgical management, adjuvant stereotactic radiosurgery, and outcomes in 36 patients treated at Barrow Neurological Institute (BNI) are presented.
Methods
Between 1989 and 2009, 36 patients (mean age 43.6 years, range 17–68 years) with craniocervical schwannomas underwent surgical resection at BNI. The records were reviewed retrospectively regarding clinical presentation, radiographic assessment, surgical approaches, adjuvant therapies, and follow-up outcomes.
Results
Headache or neck pain was present in 72.2% of patients. Cranial nerve impairments, mainly involving the vagus nerve, were present in 14 patients (38.9%). Motor deficits were found in 27.8% of the patients. Sixteen tumors were intra- and extradural, 15 were intradural, and 5 were extradural. Gross-total resection was achieved in 25 patients (69.4%). Adjunctive radiosurgery was used in the management of residual tumor in 8 patients; tumor control was ultimately obtained in all cases.
Conclusions
Surgical removal, which is the treatment of choice, is curative when schwannomas in the CCJ are excised completely. The far-lateral approach and its variations are our preferred approaches for managing these lesions. Most common complications involve deficits of the lower CNs, and their early recognition and rehabilitation are needed. Stereotactic radiosurgery, an important tool for the management of these tumors as adjuvant therapy, can help decrease morbidity rates.
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Affiliation(s)
| | | | - Ketan Verma
- 2Neuroscience Research Center, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
| | - Sam Safavi-Abbasi
- 3Department of Neurosurgery, University of Oklahoma, Oklahoma City, Oklahoma
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