Intraventricular Schwannoma Research Articles

CT and MRI findings of intra-parenchymal and intra-ventricular schwannoma: a series of seven cases

ObjectiveTo analyze the computed tomography (CT) and magnetic resonance imaging (MRI) features of patients with intra-parenchymal and intra-ventricular schwannoma.MethodsThe CT and MRI features of seven cases with intra-parenchymal and intra-ventricular schwannoma were analyzed retrospectively.ResultsThere were four men and three women (median age, 25 years; range, 12–42 years) in this study. The median tumor size was 4.4 cm (range, 3.1–6.5 cm). The mass was, respectively, round in four cases (57.1%), lobulated in two cases (28.6%) and oval in one case (14.3%). All tumors were well-circumscribed. Septa in the mass could be observed in three cases (42.9%), and nodular calcification was observed in two cases (28.6%), which peritumoral edema (n = 3, 42.9%) and hydrocephalus (n = 3, 42.9%) could be observed. Most of these lesions (n = 6) presented iso-hypointensity on T1-weighted images and iso-hyperintensity on T2-weighted images, except one lesion showing low intensity on T2WI. In addition, a fluid–fluid level was observed in one case. After contrast agents’ injection, all masses illustrated heterogeneously moderate to marked enhancement.ConclusionsA well-defined solid and cystic mass with calcification and moderate to marked delayed enhancement may be an objective account of intra-parenchymal or intra-ventricular schwannoma.

Intraventricular schwannoma: Case report and review of literature

We report here a case of intraventricular schwannoma. This location is rare. Our patient was a 68-year-old female with a large intraventricular lesion of the body of the lateral ventricle on the right side. Brain magnetic resonance imaging (MRI) revealed this lesion. After a right parietotemporal craniotomy, microsurgical excision using neuronavigation was performed to completely remove the tumor. Histological and immunohistochemical examination confirmed the diagnosis of intraventricular schwannoma devoid of atypical features. Postoperative MRI showed macroscopically complete tumor removal with no recurrence after 12 months of follow-up. A review of the literature identified 32 such cases published to date.

Third ventricular schwannoma with hydrocephalus

Intraventricular schwannomas are rare, with only 20 cases reported in the literature to our knowledge, including two cases of schwannomas in the third ventricle. We report a 23-year-old man with a mass in the posterior portion of the third ventricle and obstructive hydrocephalus. The intraventricular mass was clearly visualized and removed by neuroendoscopic surgery, and endoscopic third ventriculostomy was simultaneously performed for the hydrocephalus. Histological and immunohistochemical assays of the surgical sample established a diagnosis of intraventricular schwannoma. The patient had a favourable outcome and no neurological deficits 1year later. The schwannoma was distant from the choroid plexus, which supports the hypothesis that the schwannoma originated from ectopic neural crest cells that were displaced during embryogenesis.

The Primary Large Fourth Ventricular Schwannoma Removed by the Cerebellomedullary Fissure Approach. Case Report and Review of the Literature

The objective of this study was to present a case of a solitary fourth intraventricular schwannoma with a review of the literature, and to analyzing the current theories of its origin and application of trancerebellomedullary fissure approach. The authors presented a primary intraventricle schwannoma occurring in the lateral recess of the fourth ventricle in a 53-year-old female. She presented with severe headache, dysphagia, horizontal nystagmus, ataxia and quadriparesis were detected on initial examination. Imaging studies showed a large mass in the fourth ventricle and a marked hydrocephalus. The tumor was removed by microsurgical dissection using the cerebellomedullary fissure approach at our Institution. Complete removal was achieved and no reccurrence was noted follow-up period of 8 months after surgery. To our knowledge, this is the ninth reported case schwannoma of fourth intraventricule in the literature, which is unrelated to the cranial nerves and cerebellar hemisphere parenchyma, blood vessel or to the dura, is extremely rare. The etiology and natural history of intraventricular schwannomas is not well understood. The presenting clinical, radiological and pathological features of this tumor are summarized. We have discussed the effectiveness of this approach for removal of bulky tumors of the fourth ventricle, the other cases reported in the literature are reviewed and the benefits and potential hazards of trancerebellomedullary fissure (T-CMF) approach. Intraventricular schwannomas are benign tumours that are amenable to complete surgical removal, having a good prognosis without the need of adjuvant therapy.

Supratentorial intraventricular solitary schwannoma. Case report and literature review

The objectives of this study were to present a case of a solitary intraventricular schwannoma with a review of the literature and to analyse the current theories of its origin. A 16-year-old male patient, without any pathological, genetic or familial history of significance, presented with symptoms of intracranial hypertension and progressive left brachiocrural paresis. The magnetic resonance image showed a bulky intraventricular space-occupying lesion emerging from the posterior horn of the right lateral ventricle, with an irregular nodular component intimately connected to the choroid plexus, and a multiloculated cystic component extending beyond the ventricle. A right parietal craniotomy was performed, revealing a multiloculated cyst with xantochromic fluid and a soft brownish red nodule. The lesion was dissected surrounding the periphery and coagulating a vascular pedicle related to the wall of the right lateral ventricle and its choroid plexus. Total excision was achieved. The pathological exam reported an intraventricular schwannoma (WHO grade 1). The patient evolved favourably, with no recurrence at 36-month follow-up. The literature describes less than 45 cases of schwannomas not associated to cranial nerves of the following locations: intramedullary, leptomeningeal and only 12 intraventricular cases. The three theories explaining the origin of this last group describe: (1) a neoplastic transformation of peripheral nerve fibres, (2) a neoplastic transformation of autonomic neural tissue located within the intraventricular choroid plexus and (3) an abnormal embryogenesis leading to a failed migration of the neural crest cells. Complete resection is the therapeutic goal for this benign pathology to avoid recurrence.

Intra-Fourth Ventricular Schwannoma With Obstructive Hydrocephalus – A Rare Case Report

A rare case of intra-fourth-ventricular schwannoma with obstructive hydrocephalus in a 20-year-old male is described. CT and MRI showed schwannoma having cystic and solid components inside the fourth ventricle causing supra-tentorial obstructive hydrocephalus. Emergency right ventriculo-peritoneal shunt followed later by successful surgical resection of the tumor was done. Histo-pathological examination revealed a benign schwannoma. The clinical, radiographic, surgical, histopathological features and the aetiology of this tumor are elaborated. This rare intra-fourth-ventricular schwannoma is the first case reported in Hospital Pulau Pinang, Malaysia and also would be one of the very few cases reported in the literature. CASE SUMMARY A 20-year-old gentleman presented in a drowsy state (one week) with features of increased intra-cranial tension, ophthalmoperesis, brainstem & cerebellar compressions. There were no neuro-cutaneous markers and no family history of neurofibromatosis. CT-Brain & MRI-Brain showed a huge intensely contrast enhancing intra-fourth ventricular tumor compressing the brainstem and cerebellum causing obstructive hydrocephalus. Figure 1 Fig. 1 CT-Brain (Plain & Contrast) Figure 2 Fig. 2 MRI – Brain T1W & T2W Intra-Fourth Ventricular Schwannoma With Obstructive Hydrocephalus – A Rare Case Report 2 of 5 Figure 3 Fig. 3 MRI–Brain Post Gad A pre-operative diagnosis of Choroid Plexus Papilloma / Ependymoma was made and an emergency right ventriculoperitoneal shunt done . Shunt tube is found to be in-situ Figure 4 Fig. 4 Post Shunt MRI Brain This was followed by posterior fossa craniotomy for surgical resection of the tumor. The gross appearance of the tumor was greyish, fleshy, firm and vascular with cystic components Vermian split done to facilitate the excision of the whole tumor. Upon complete excision of the tumor CSF was flowing within the fourth ventricle. Figure 5 Fig. 5 Day 1 Post-Op CT-Brain Plain Postoperatively there was an improvement in the conscious level and swallowing of the patient as well his headache symptom. There was no improvement in cerebellar signs. Patient could walk with support. Figure 6 Fig. 6 Post Op Picture Histo-pathology of the tumor specimen under microscopy Intra-Fourth Ventricular Schwannoma With Obstructive Hydrocephalus – A Rare Case Report 3 of 5 showed areas of Antoni A (hypercellularity), Antoni B (hypocellularity). Focal areas of cystic changes seen. No necrosis and rare mitosis seen .In immuno-histochemistry, the lesional cells expressed S-100 protein (neural marker).The final impression was benign schwannoma. Figure 7 Fig. 7 Histopathological slide – under low power Figure 8 Fig. 8 Histopathological slide – under high power Figure 9 Fig. 9 Follow-up MRI at 6 months – shows no residual or recurrent tumor DISCUSSION Intracranial schwannomas comprise approximately 8% of all intracranial tumours .The incidence of intraventricular schwannoma is very rare. There are few case reports in the literature: (1) spinal accessory schwannoma mimicking a tumor of the fourth ventricle,(2) midline cerebellar cystic schwannoma, (3) a schwannoma arising from the dorsum of the pontomedullary junction and presenting as an exophytic mass in the fourth ventricle, (4) two cases of cystic schwannoma of the fourth ventricle presenting with hemifacial spasm.A variety of hypotheses have been proposed regarding the possible mode of origin of schwannoma unrelated to cranial nerves. In our case we propose the probable origin could be from the schwann cells in perivascular plexus. Intra-ventricular schwannomas are rare tumors that are amenable to complete surgical removal having a good prognosis without the need of adjuvant therapy.In our case we could completely excise the tumor and he has not been on any adjuvant therapy.His follow-up scans showed no residual or recurrent tumor.We would be from Hospital Pulau Pinang, one of the few, to add to this rare intra-fourth ventricular schwannoma to the literature. ACKNOWLEDGEMENT 1. Dr.Lee Suk Kam Specialist Pathologist, Department of Pathology, Hospital Pulau Pinang

Supratentorial intraventricular schwannoma of the choroid plexus

Intraventricular tumours represent around 10% of central nervous system tumours1. A variety of intraventricular tumours can be found, with the differential diagnosis depending upon the location in the ventricular system2-4. In the lateral ventricles, the more common intraventricular tumours are meningiomas, astrocytomas and ependymomas, whereas choroid plexus papillomas and carcinomas, subependymomas and dermoid cysts are rare3,5 […] Supratentorial intraventricular schwannoma of the choroid plexus

Primary intraventricular schwannomas

Schwann cell tumors arising within the neuraxis and in an intraventricular location are an exceedingly rare tumor entity of the brain. The authors present the first case of a cellular intraventricular schwannoma occurring in the fourth ventricle. The pertinent literature is reviewed. A 71-year-old female was admitted to the hospital with an incidental finding of a ventricular tumor. Computed tomography scanning and magnetic resonance imaging revealed a solitary contrast enhancing exophytic mass lesion within the fourth ventricle. Microsurgical excision via a midline suboccipital craniotomy and tonsillo-nodular approach led to complete tumor removal. Subsequent histopathological examination confirmed the diagnosis of an unsuspected primary intraventricular cellular schwannoma. A unique case of an initially unexpected benign schwannoma arising from the fourth ventricle that could be successfully treated by microsurgery and finally confirmed by histopathological analysis with excellent patient outcome is presented. Although highly uncommon, Schwann cell tumors of both benign and malignant nature may present as ventricular lesions and should be included as a differential diagnosis in patients with either solely intraventricular masses or intra- and extraaxial tumors with extension to the ventricles.

Intraventricular schwannoma in a 15-year-old adolescent: a case report

Schwannomas are benign tumors that originate from the myelin-forming Schwann cells of peripheral nerves or at the Obersteiner-Redlich zone of the vestibular division of the eighth cranial nerve. Intraventricular schwannomas are rare, particularly among children. This case report illustrates a right occipital horn schwannoma in a 15-year-old adolescent boy who was successfully treated with surgical resection and discusses the possible origins of the tumor in this unique location.

A 21-YEAR-OLD FEMALE WITH ATHIRD VENTRICULAR TUMOR

A 21-year-old female presented with a 2-months history of tinnitus, vertigo and nausea. On magnetic resonance imaging of the brain, she demonstrated a small contrast-enhancing mass in the posterior part of the third ventricle. Intraoperatively, the tumor showed a close relationship to the choroid plexus of the third ventricle. Histopathology revealed a benign schwannoma of World Health Organization grade I. To our knowledge, only 9 cases of intraventricular Schwann cell tumors have been published so far. Most of these tumors were benign schwannomas, except for 2 cases of malignant peripheral nerve sheath tumors. The tumor of our patient is the first reported schwannoma of the third ventricle. The origin of intraventricular Schwann cell tumors is unknown. They may arise from autonomic perivascular nerves in the choroid plexus or from ectopic neural crest-derived cells. Histologically, intraventricular schwannoma needs to be distinguished from other spindle cell tumors, in particular pilocytic astrocytoma and fibroblastic meningioma.

Supratentorial intraventricular schwannoma

A rare case of supratentorial intraventricular schwannoma is described. A 16-year-old male with asymptomatic papilloedema was found to have a 5-cm intraventricular tumour arising from the trigone of the right lateral ventricle. A craniotomy and total macroscopic excision was performed.

Cystic intraventricular schwannoma: case report and review of the literature

Intraventricular schwannoma is an exceedingly rare tumour with only 6 cases described in the literature. One case of a cystic intraventricular schwannoma operated on at our Institution is analyzed and the other cases reported in the literature are reviewed. Complete removal was achieved and no recurrence was noted after a follow-up period of 10 years. Intraventricular schwannomas are rare tumours that are amenable to complete surgical removal, having a good prognosis without the need of adjuvant therapy.