A Babbu, R Katheerayson
aimst university, associate professor of neurosurgery, department of neurosurgery, dr.mr.a.daniel rajesh babbu, email: firstname.lastname@example.org, hospital pulau pinang, jalan residensi, malaysia, pulau pinang, specialist neurosurgeon attached
A Babbu, R Katheerayson. Intra-Fourth Ventricular Schwannoma With Obstructive Hydrocephalus – A Rare Case Report. The Internet Journal of Neurosurgery. 2009 Volume 7 Number 1.
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.
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.
A pre-operative diagnosis of
This was followed by
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.
Histo-pathology of the tumor specimen
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.
Specialist Pathologist, Department of Pathology,
Hospital Pulau Pinang