Hypoglossal schwannoma presenting as hemi-atrophy of the tongue

Baghel, Pushpraj Singh; Gupta, Avinash; Tripathi, Vishwa Deepak; Reddy, Donapati Sunil

doi:10.4103/0028-3886.115092

Cited by 11 publications

(6 citation statements)

References 4 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: 77%

“…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: 77%

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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“…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).…”

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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“…We know isolated hypoglossal nerve palsy is rare and most commonly associated with other cranial nerve involvement. 5 6 7 8 Isolated nerve palsy is reported to be caused by hypoglossal nerve schwannomas, 6 7 9 10 11 dural arteriovenous fistulas, enlarged emissary veins of the hypoglossal canal, aneurysms of the stump of a persistent hypoglossal artery, internal carotid and vertebral artery dissections, metastatic lesions to the skull base, arachnoid cysts, occipital condyle fractures, after a neck surgery, or with no apparent cause. 6 7 …”

Section: Discussionmentioning

confidence: 99%

Case Report: Intraneural Intracanalicular Ganglion Cyst of the Hypoglossal Nerve Treated by Extradural Transcondylar Approach

2015

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We report a case of an intraneural ganglion cyst of the hypoglossal canal. The patient presented with unilateral hypoglossal nerve palsy, and magnetic resonance imaging showed a small lesion in the hypoglossal canal with no contrast enhancement and high signal on T2-weighted imaging. The lesion was assumed to be a cystic schwannoma of the hypoglossal nerve. Stereotactic irradiation was considered, but in accordance with the patient's wishes, surgical exploration was performed. This revealed that, rather than a schwannoma, the patient had an intraneural ganglion cyst, retrospectively contraindicating irradiation as an option. This case illustrates a very rare location of an intraneural ganglion cyst in the hypoglossal nerve. To our knowledge there are no previous reports of an intraneural ganglion cyst confined to the hypoglossal canal.

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Hypoglossal schwannoma presenting as hemi-atrophy of the tongue

Cited by 11 publications

References 4 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

Case Report: Intraneural Intracanalicular Ganglion Cyst of the Hypoglossal Nerve Treated by Extradural Transcondylar Approach

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