Neurological Disorders

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

Abstract

Chen Li-Hua, Ru-Xiang Xu, Wei Qun, Li Yun-Jun, Li Wen-De, Zhao Hao, Gao Jin-Bao and Yu Bin

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.