Acute brainstem compression by intratumoral hemorrhages in an intracranial hypoglossal schwannoma

Inoue, Hiromasa; Nakagawa, Yasuhisa; Ikemura, Mayumi; Usugi, Eri; Kiyofuji, Yuma; Nata, Masayuki

doi:10.1016/j.legalmed.2013.02.001

Cited by 5 publications

(5 citation statements)

References 18 publications

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“…Independently from the nerve that is affected, surgical treatment consists of systematic exeresis of the lesions. This has been furthermore confirmed by the experience of the present authors and by case reports (2,(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)30,31). In fact, all except one of the cases were treated surgically.…”

Section: Imaging and Diagnosissupporting

confidence: 86%

“…In almost all cases, there are varying degrees of paresis of the HyN, which appear as ipsilateral deviation, hemiatrophy and fasciculations of the tongue. These symptoms may be accompanied by hoarseness, intermittent-to-persistent headaches, dysarthria, slurred speech, swallowing difficulties and throat cramps (2,4,(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28). Whereas the effects on the specific functions of the nerve may be attributable to the local damage of the tumour on the nerve, these types of lesions, particularly when they increase in volume, may determine mass effects on surrounding or adjacent structures; for example, Mariniello et al (19) reported on the case of a patient who exhibited signs of cerebellar ataxia, right-sided hypotonia and increased intracranial pressure.…”

Section: Discussionmentioning

confidence: 99%

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Schwannoma of the hypoglossal nerve: Review of the literature based on an illustrative case

et al. 2017

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Abstract. Schwannomas are benign tumours that originate from the myelin sheath of peripheral nerves. They are characterised by a slow growth tendency. Benign schwannomas represent 35% of the head and neck district tumours. Hypoglossal schwannomas account for 5% of non-vestibular schwannomas, and malignant schwannomas occur very rarely. In the present case report, the case of a 49-year-old man who presented with paraesthesias in the left parotid and submandibular region, associated with sensation of foreign bodies and dysphagia for solids, is described. A clinical examination revealed the presence of an ovoid palpable mass in the lateral-cervical region of the neck. The patient subsequently underwent excisional surgery, and neuropathological evaluation of the specimen confirmed the diagnosis of benign schwannoma with Antoni areas A and B. Despite the rarity of schwannomas, this condition should be considered in differential diagnoses for masses localised in the neck, as in cases where they reach considerable sizes (>3 cm in diameter). Surgery therefore represents the first-choice treatment.

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Section: Imaging and Diagnosissupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Schwannoma of the hypoglossal nerve: Review of the literature based on an illustrative case

et al. 2017

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“…Magnetic resonance imaging (MRI) is considered superior to computed tomography for the diagnosis of skull base tumors, as MRI accurately demonstrates the relationship between tumor location and the surrounding soft tissues (4). Although 39 cases of dumbbell-shaped, hypoglossal schwannoma have been described in the literature to date (3,(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15), only a small proportion of these cases (<30%) achieved a complete tumor resection (12), and no recurrent cases were reported. At present, the standard surgical technique used for the treatment of hypoglossal schwannomas is the far lateral approach with partial resection of the condyle, which exposes the hypoglossal canal (3,16).…”

Section: Introductionmentioning

confidence: 99%

Giant recurrent dumbbell-shaped hypoglossal schwannoma in an elderly male: A case report

Zhao

Zhao³

et al. 2015

Oncology Letters

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Abstract. Dumbbell-shaped hypoglossal Schwannomas of the 12th cranial nerve are extremely rare, and complete removal of these tumors is difficult, particularly in elderly patients with recurrent tumors. The present study reports the case of a 61-year-old male with a giant recurrent dumbbell-shaped hypoglossal schwannoma that arose extracranially. The recurrent tumor was completely removed in a one-stage surgical procedure via the far lateral suboccipital approach in combination with the transcervical approach. To the best of our knowledge, such a lesion has not been reported previously. The life expectancy and natural course of the disease are important factors to take into account when considering the individual end-point of surgery in patients. More studies on hypoglossal schwannomas are required, particularly cases in which the hypoglossal schwannoma was not totally resected, not only in order to develop more definitive and secure surgical treatments, but also to reduce the resultant unnecessary suffering of patients. IntroductionHypoglossal schwannomas are rare, and were reported for the first time by De Martel et al (1) in 1933. The most common symptoms are unilateral tongue atrophy and fasciculation (2) and the disease has been found to exhibit a female predominance (3). Magnetic resonance imaging (MRI) is considered superior to computed tomography for the diagnosis of skull base tumors, as MRI accurately demonstrates the relationship between tumor location and the surrounding soft tissues (4). Although 39 cases of dumbbell-shaped, hypoglossal schwannoma have been described in the literature to date (3,(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15), only a small proportion of these cases (<30%) achieved a complete tumor resection (12), and no recurrent cases were reported. At present, the standard surgical technique used for the treatment of hypoglossal schwannomas is the far lateral approach with partial resection of the condyle, which exposes the hypoglossal canal (3,16). Complete tumor resection is difficult due to intradural and extradural growth through the enlarged hypoglossal canal. A further challenge for surgical treatment is being able to achieve a radical resection and decrease the risk of recurrence at the same time as preserving lower cranial nerve function (9). It is occasionally difficult to decide which management strategies should be used for benign cranial base tumors in patients (10), particularly in elderly patients with recurrent dumbbell-shaped hypoglossal schwannoma. The present study reports the case of an elderly patient with a giant recurrent dumbbell-shaped hypoglossal schwannoma that arose extracranially, to the best of our knowledge, this is the largest case of hypoglossal schwannoma that has been completely removed in a one-stage surgical procedure. Case reportA 61-year-old male presented with a cough after drinking water, which had persisted for 8 months, accompanied by hoarseness for the last 4 months. The patient first visited the local Ear, Nose and Throat Department in January 2...

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“…Another report in 2013 described a patient who died of brain stem compression induced by intratumoural haemorrhaging within an intracranial schwannoma, showing that brain stem compression can result in respiratory disturbances [ 22 ]. The definite diagnosis and location make it goal-directed to find the cause, while the herein-reported cases, for which this information was unavailable, prove the importance of spinal cord examination in forensic practice.…”

Section: Discussionmentioning

confidence: 99%

Intramedullary schwannoma of the upper cervical spinal cord: a case study of identification in pathologic autopsy

et al. 2017

Forensic Sciences Research

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Intramedullary schwannoma of the upper cervical spinal cord is rarely reported in forensic medicine. We herein report a case involving a patient who died of compression from an intramedullary schwannoma in the upper cervical spinal cord. A 30-year-old man initially presented with a five-day history of pain in the left chest that progressed to weakening in the left arm. Although the patient was treated with analgesic poultices, he developed inspiratory dyspnoea and died while working the next day without having undergone any medical imaging examination or surgical treatment. Anatomical and histopathological examinations revealed an intramedullary schwannoma in the left cervical spinal cord (C3–C5) underneath the spinal nerve root. The cause of death might have been asphyxia secondary to the tumour, which interfered with the nerve function in the respiratory muscles. This finding suggests that an autopsy is essential for pathologists and medicolegists to comprehensively undertake their due obligation to obtain “the first evidence”, especially when there is a lack of directly related evidence. As part of the central nervous system, the spinal cord could be systematically included in a routine pathological autopsy in some cases.

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Acute brainstem compression by intratumoral hemorrhages in an intracranial hypoglossal schwannoma

Cited by 5 publications

References 18 publications

Schwannoma of the hypoglossal nerve: Review of the literature based on an illustrative case

Schwannoma of the hypoglossal nerve: Review of the literature based on an illustrative case

Giant recurrent dumbbell-shaped hypoglossal schwannoma in an elderly male: A case report

Intramedullary schwannoma of the upper cervical spinal cord: a case study of identification in pathologic autopsy

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