Maria M Santos1, Ângela Timóteo2, Domingos Coiteiro3, José Pimentel4. 1. Department of Neurological Surgery, Centro Hospitalar Lisboa Norte, Entidade Pública Empresarial, Lisbon, Portugal. Electronic address: mariamanesantos@gmail.com. 2. Department of Neurology, Hospital Fernando Fonseca, Amadora, Portugal. 3. Department of Neurological Surgery, Centro Hospitalar Lisboa Norte, Entidade Pública Empresarial, Lisbon, Portugal. 4. Department of Neuropathology, Centro Hospitalar Lisboa Norte, Entidade Pública Empresarial, Lisbon, Portugal.
Abstract
OBJECTIVE: We report an uncommon case of a surgical resection of a fourth ventricle tumor in an adult that proved to be a schwannoma. METHODS: A 53-year-old man presented with a 1.5-year history of gait unsteadiness and vertigo and a few-week history of headache, emesis, and neurogenic dysphagia. A brain magnetic resonance imaging revealed a large, heterogeneously contrast enhancing mass located within the fourth ventricle, compressing the brainstem and causing supratentorial ventricle enlargement. A suboccipital craniotomy and a telovelar approach were performed to resect the tumor. The ventricular system was repermeabilized at the end of the operation. RESULTS: A postoperative magnetic resonance imaging confirmed complete tumor removal. There was an initial worsening of the preoperative deficits, which progressively improved. The tumor was classified as a fourth ventricle schwannoma. There has been no evidence of tumor recurrence during the 6 years of follow-up. At present, the patient is ambulatory and reports an intermittent diplopia on conjugated gaze. CONCLUSION: This case report intends to reveal the eighth case of a fourth ventricle schwannoma since 1957. Schwannomas of the fourth ventricle are infrequent but should be accounted in the differential diagnosis of space-occupying lesions in this location. Gross total resection might be the definite treatment of these tumors if deemed possible.
OBJECTIVE: We report an uncommon case of a surgical resection of a fourth ventricle tumor in an adult that proved to be a schwannoma. METHODS: A 53-year-old man presented with a 1.5-year history of gait unsteadiness and vertigo and a few-week history of headache, emesis, and neurogenic dysphagia. A brain magnetic resonance imaging revealed a large, heterogeneously contrast enhancing mass located within the fourth ventricle, compressing the brainstem and causing supratentorial ventricle enlargement. A suboccipital craniotomy and a telovelar approach were performed to resect the tumor. The ventricular system was repermeabilized at the end of the operation. RESULTS: A postoperative magnetic resonance imaging confirmed complete tumor removal. There was an initial worsening of the preoperative deficits, which progressively improved. The tumor was classified as a fourth ventricle schwannoma. There has been no evidence of tumor recurrence during the 6 years of follow-up. At present, the patient is ambulatory and reports an intermittent diplopia on conjugated gaze. CONCLUSION: This case report intends to reveal the eighth case of a fourth ventricle schwannoma since 1957. Schwannomas of the fourth ventricle are infrequent but should be accounted in the differential diagnosis of space-occupying lesions in this location. Gross total resection might be the definite treatment of these tumors if deemed possible.
Authors: Luis Rafael Moscote-Salazar; Guru Dutta Satyarthee; Hector Farid-Escorcia; Willem Guillermo Calderon-Miranda; Huber Said Padilla-Zambrano; Angel Lee; Alfonso Pacheco-Hernandez; Amit Agrawal Journal: J Pediatr Neurosci Date: 2017 Oct-Dec