Abstract
Intraventricular schwannomas are rarely encountered in neurosurgical practice. The development and progression of a schwannoma within the ventricular system is still a hypothesised theory. Here, we present a case of a 59-year-old female who presented with a three-week history of headaches. Her symptoms progressively worsened, with resultant altered mental status within the last week. Imaging scans of the brain demonstrated a well-defined mass within the right lateral ventricle with associated midline shift and obstructive hydrocephalus. A parietal craniotomy and resection of the intraventricular mass was performed. Her postoperative course was uneventful. Histopathological assessment depicted a biphasic pattern of Antoni A and B, with a strongly positive S100. This was in keeping with an intraventricular schwannoma. The diagnosis of an intraventricular schwannoma does not fit within the classical differential framework for ventricular masses. These tumours are extremely uncommon but fortunately, they are typically benign. Therefore, adequate surgical resection remains the gold standard of care for these unfamiliar masses.
Highlights
Schwannomas represent approximately 5%-8% of intracranial tumours [1]
No correlation with familial syndromes and reported intraventricular schwannomas has been shown in the literature [3]
Neoplasms within the lateral ventricle in the adult neurosurgical patient are typically diagnosed as meningiomas, gliomas, choroid plexus tumours or possible metastasis
Summary
Schwannomas represent approximately 5%-8% of intracranial tumours [1]. These benign lesions typically arise from the nerve sheaths of peripheral and cranial nerves. Computed tomography (CT) of the brain with contrast showed a 4.3cm x 4.6cm x 5.2cm well-defined mass arising from the posterior horn of the right lateral ventricle. This was associated with significant midline shift and effacement of the quadrigeminal cistern (Figure 1). Magnetic resonance imaging (MRI) with gadolinium revealed a heterogeneous mass within the posterior horn of the right lateral ventricle with accompanying perilesional oedema, and hydrocephalus This mass was isointense on both T1-weighted and T2-weighted images (Figure 2). A: T2- weighted imaging (axial view) showing heterogenous isointense mass within the right lateral ventricle B: T1- weighted imaging (coronal view) showing contrast enhancement of tumour, with associated midline shift and obstructive hydrocephalus.
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