Cervical Schwannoma Presenting with Acute Intracranial Subarachnoid Hemorrhage

Ji, Cheol; Ahn, Jae-Geun; Huh, Han-Yong; Park, Chun-Kun

doi:10.3340/jkns.2010.47.2.137

Cited by 11 publications

(6 citation statements)

References 9 publications

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“…Some masses caused occipital condyles erosion (18.7%), VA displacement (8.8%), brainstem compression (6.5%), 4th ventricle blockage (2.5%), and sigmoid sinus occlusion (1.1%). A total of 5 patients (1.4%) had concurrent CVJ intradural meningiomas separated from the extradural schwannomas [ 23 , 25 , 26 , 27 ], and 2 (0.6%) had acute subarachnoid hemorrhage (SAH) [ 28 , 29 ].…”

Section: Resultsmentioning

confidence: 99%

Surgical Management of Craniovertebral Junction Schwannomas: A Systematic Review

Palmisciano

Ferini²,

Watanabe

et al. 2022

Current Oncology

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Background: Craniovertebral junction (CVJ) schwannomas are rare, with surgery and stereotactic radiosurgery (SRS) being effective yet challenging options. We systematically reviewed the literature on CVJ schwannomas. Methods: PubMed, Scopus, Web-of-Science, and Cochrane were searched following the PRISMA statement to include studies reporting CVJ schwannomas. Clinical features, management, and outcomes were analyzed. Results: We collected 353 patients from 101 included articles. Presenting symptoms were mostly neck pain (30.3%) and headache (26.3%), with most cranial neuropathies involving the XII (31.2%) and X (24.4%) nerves. Most tumors originated from C2 (30.9%) and XII (29.4%) nerves, being extracranial (45.1%) and intradural-extradural (44.2%). Erosion of C1–C2 vertebrae (37.1%), the hypoglossal canal (28.3%), and/or jugular foramen (20.1%) were noted. All tumors were operated, preferably with the retrosigmoid approach (36.5%), with the far-lateral approach (29.7%) or with the posterior approach and cervical laminectomy (26.9%), far-lateral approaches (14.2%), or suboccipital craniotomy with concurrent cervical laminectomy (14.2%). Complete tumor resection was obtained most frequently (61.5%). Adjuvant post-surgery stereotactic radiosurgery was delivered in 5.9% patients. Median follow-up was 27 months (range, 12–252). Symptom improvement was noted in 88.1% of cases, and cranial neuropathies showed improvement in 10.2%. Post-surgical complications occurred in 83 patients (23.5%), mostly dysphagia (7.4%), new cranial neuropathies (6.2%), and cerebrospinal fluid leak (5.9%). A total of 16 patients (4.5%) had tumor recurrence and 7 died (2%), with median overall survival of 2.7 months (range, 0.1–252). Conclusions: Microsurgical resection is safe and effective for CVJ schwannomas. Data on SRS efficacy and indications are still lacking, and its role deserves further evaluation.

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Section: Resultsmentioning

confidence: 99%

Surgical Management of Craniovertebral Junction Schwannomas: A Systematic Review

Palmisciano

Ferini²,

Watanabe

et al. 2022

Current Oncology

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“…9 However, our literature review revealed that seven patients (77%) exhibited intracranial clinical symptoms. 8 – 14 As arterial aneurysm and vascular malformation are the more common causes of SAH, an angiographic study may be the preferential examination to confirm the diagnosis. In our patient, spinal infection or SAH from vascular malformation was considered first.…”

Section: Discussionmentioning

confidence: 99%

“…6 Spinal intradural schwannomas may also result in SAH; however, these are a very rare cause, especially without spinal compression symptoms. In this summary, we identified 8 cases of SAH from a spinal schwannoma reported in the last 20 years [7][8][9][10][11][12][13][14] (Table 1).…”

Section: Discussionmentioning

confidence: 99%

Spinal intradural schwannoma presenting with acute subarachnoid hemorrhage: a case report and review of published reports

Zhang

Fan

et al. 2022

J Int Med Res

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Acute subarachnoid hemorrhage (SAH) presentation is a very rare occurrence in spinal schwannomas. We report a case of lumbar schwannoma in a patient presenting first with acute SAH. A 40-year-old man was referred to our department 7 days after the sudden onset of headache, neck pain, and fever. SAH was suspected; however, head computed tomography (CT) findings were normal. A lumbar puncture indicated blood-stained cerebrospinal fluid (CSF). Moreover, the CSF pressure changed from 200 mmH2O to 90 mmH2O after drainage of 10 mL of CSF indicating a blockage of CSF. Subsequent magnetic resonance imaging (MRI) confirmed an intradural tumor with SAH, which also caused blockage of the CSF circulation. The patient underwent immediate surgery and fully recovered. In conclusion, the early diagnosis and total removal of the tumor and blood clot significantly improved the patient’s outcome. There is a high index of suspicion for spinal tumors resulting in SAH when there is a CSF pressure change after lumbar puncture in an SAH patient.

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“…A thorough search of literature led us to only 22 cases of spinal schwannomas with SAH till now. [ 6 29 30 ] In literature review that has the largest series on spinal schwannomas with SAH, Parmar et al . [ 6 ] identified 20 reports of spinal nerve sheath tumors that caused SAH, of which only 8 cases (28%) presented exclusively with intracranial symptoms as in our patient.…”

Section: Discussionmentioning

confidence: 99%

A rare case of spinal schwannoma in a child presenting with subarachnoid hemorrhage: A case report with review of literature

Tanki

Singh²,

Raswan

et al. 2018

J Pediatr Neurosci

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Pediatric spinal schwannomas/neurofibromas constitute only 2.5%–4% of all pediatric spinal tumors. However, subarachnoid hemorrhage (SAH) because of spinal pathologies is very rare, representing 1.5% of all cases of SAH. Spinal nerve sheath tumors such as schwannomas rarely present with SAH, especially before the appearance of overt signs of spinal cord or root compression. We report a case of dorsolumbar schwannoma in an 11-year-old girl presenting clinically with signs and symptoms mimicking meningitis, but meningeal signs later proved to be due to SAH associated with spinal (D12-L1) schwannoma and hydrocephalus. Mass was excised and ventriculoperitoneal shunt was inserted. In our clinical practice, we may sometimes come across some uncommon diseases with even more uncommon presentations as happened with us at our institute. We must always consider that there is a possibility of SAH owing to silent spinal lesion in patients with angiographic negative intracranial SAH as in this case.

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Cervical Schwannoma Presenting with Acute Intracranial Subarachnoid Hemorrhage

Cited by 11 publications

References 9 publications

Surgical Management of Craniovertebral Junction Schwannomas: A Systematic Review

Surgical Management of Craniovertebral Junction Schwannomas: A Systematic Review

Spinal intradural schwannoma presenting with acute subarachnoid hemorrhage: a case report and review of published reports

A rare case of spinal schwannoma in a child presenting with subarachnoid hemorrhage: A case report with review of literature

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