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Minim Invasive Neurosurg 2007; 50(6): 374-378
DOI: 10.1055/s-2007-993206
Case Report

© Georg Thieme Verlag KG Stuttgart · New York

Intradural Microsurgery and Extradural Gamma Knife Surgery for Hypoglossal Schwannoma: Case Report and Review of the Literature

A. Tucker 1 , H. Miyake 1 , M. Tsuji 1 , T. Ukita 1 , K. Nishihara 1 , T. Ohmura 1
  • 1Department of Neurological Surgery, Nishinomiya Kyoritsu Neurosurgical Hospital, Nishinomiya, Hyogo, Japan
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Publication History

Publication Date:
22 January 2008 (online)

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Abstract

There have been only 26 cases of hypoglossal schwannomas reported to originate intradurally and extend extradurally into the hypoglossal canal. This 31-year-old mother of two children presented with a 5-day history of progressive headache, nausea, vomiting and vertigo. Her neurological exam was significant for nystagmus and left tongue deviation with marked atrophy. An initial head CT revealed extensive left hypoglossal canal erosion with 4th ventricle compression. T1-weighted MR images with contrast revealed a 4×3 cm left cerebellopontine angle non-homogeneously enhancing mass with an intracranial cystic component and prominent extension into the eroded hypoglossal canal. A left lateral suboccipital craniotomy was performed for subtotal microsurgical resection of the intradural posterior fossa mass. A schwannoma was diagnosed after resection and gamma knife surgery (GKS) was performed three months later for the extradural residual tumor without further deficits. This is a rare report of a hypoglossal schwannoma in a young patient who was treated with a multimodality approach in order to minimize risks. A review of the literature and discussion of the respective benefits of microsurgery versus GKS and long-term follow-up issues are presented.

Key words

hypoglossal schwannoma - lateral suboccipital approach - gamma knife surgery - stereotactic radiosurgery

References

  • 1 Berger MS, Edwards MSB, Bingham WG. Hypoglossal neurilemoma: case report and review of the literature.  Neurosurgery. 1982;  10 617-620
    CrossrefPubMedGoogle Scholar
  • 2 Kadri PAS, Al-Mefty O. Surgical treatment of dumbbell-shaped jugular foramen schwannomas.  Neurosurg Focus. 2004;  17 56-62
    CrossrefPubMedGoogle Scholar
  • 3 Samii M, Babu RP, Tatagiba M, Sepehrnia A. Surgical treatment of jugular foramen schwannomas.  J Neurosurg. 1995;  82 924-932
    CrossrefPubMedGoogle Scholar
  • 4 Liu D, Xu D, Zhang Z, Zhang Y, Zheng L. Long-term outcomes after gamma knife surgery for vestibular schwannomas: a 10-year experience.  J Neurosurg. 2006;  105 ((Suppl)) 149-153
    PubMedGoogle Scholar
  • 5 Aihara K, Morita A. Dumbell-shaped hypoglossal schwannoma in an elderly woman: a clinical dilemma.  Surg Neurol. 2005;  63 526-528
    CrossrefPubMedGoogle Scholar
  • 6 Bartal AD, Djaldetti MM, Mandel EM, Lerner MA. Dumb-bell neurinoma of the hypoglossal nerve.  J Neurol Neurosurg Psychiatry. 1973;  36 592-595
    CrossrefPubMedGoogle Scholar
  • 7 Beldarrain MG, Canton GF, Garcia-Monco JC. Hypoglossal schwannoma: an uncommon cause of twelfth-nerve pasly.  Neurologia. 2000;  15 182-183
    PubMedGoogle Scholar
  • 8 Bunc G, Milojkovic V, Kosir G, Kovacic S, Rebol J. Dumb-bell hypoglossal neurinoma with intra- and extracranial paravertebral expansion.  Acta Neurochir (Wien). 1998;  140 1209-1210
    CrossrefPubMedGoogle Scholar
  • 9 Dolan EJ, Tucker WS, Rotenberg D, Chui M. Intracranial hypoglossal schwannoma as an unusual cause of facial nerve pasly.  J Neurosurg. 1982;  56 420-423
    PubMedGoogle Scholar
  • 10 Fujita K, Nozaki K, Nagata I, Kikuchi H. A case of dumbell-shaped hypoglossal neurinoma.  No Shinkei Geka. 1994;  22 775-779 , (in Japanese)
    PubMedGoogle Scholar
  • 11 Fujiwara M, Bitoh S, Hasegawa H, Nakata M. A case of intracranial hypoglossal neurinoma.  No Shinkei Geka. 1981;  9 953-958 , (in Japanese)
    PubMedGoogle Scholar
  • 12 Ho CH, Deruytter MJ. Navigated dorsolateral suboccipital transcondylar (NADOSTA) approach for treatment of hypoglossal schwannoma. Case report and review of the literature.  Clin Neurol Neurosurg. 2005;  107 236-242
    CrossrefPubMedGoogle Scholar
  • 13 Hoshi M, Yoshida K, Ogawa K, Kawase T. Hypoglossal neurinoma - two case reports.  Neuro Med Chir (Tokyo). 2000;  40 489-493
    CrossrefPubMedGoogle Scholar
  • 14 Kachhara R, Nair S, Radhakrishnan VV. Large dumbbell neurinoma of hypoglossal nerve: case report.  Br J Neurosurg. 1999;  13 338-340
    CrossrefPubMedGoogle Scholar
  • 15 Kuramitsu T, Seiki Y, Shibata I, Terao H. A case of intracranial hypoglossal neurinoma.  No Shinkei Geka. 1986;  14 953-958 , (in Japanese)
    PubMedGoogle Scholar
  • 16 Mariniello G, Horvat A, Popovic M, Dolenc VV. Cellular dumbbell schwannoma of the hypoglossal nerve presenting without hypoglossal palsy.  Clin Neurol Neurosurg. 2000;  102 40-43
    CrossrefPubMedGoogle Scholar
  • 17 Miyamori T, Yamano K, Hasegawa T, Minamide H, Kurosaki M, Takayanagi N. A dumbbell-shaped neurinoma of the hypoglossal nerve: a case report.  No Shinkei Geka. 1992;  1 265-269 , (in Japanese)
    PubMedGoogle Scholar
  • 18 Ohara K, Kaneko T, Konno A, Naito J, Suzuki H, Numata T, Ishige T. A case of intra- and extra- cranial hypoglossal neurinoma.  Jibi Rinsho. 1992;  85 1885-1892 , (in Japanese)
    PubMedGoogle Scholar
  • 19 Rachinger J, Fellner FA, Trenkler J. Dumbbell-shaped hypoglossal schwannoma. A case report.  Magn Res Imag. 2003;  21 155-158
    CrossrefPubMedGoogle Scholar
  • 20 Sato M, Kanai N, Fukushima Y, Matsumoto S, Tatsumi C, Kitamura K, Ozaki M, Hayakawa T. Hypoglossal neurinoma extending intra- and extracranially: case report.  Surg Neurol. 1996;  45 172-175
    CrossrefPubMedGoogle Scholar
  • 21 Serizawa T, Yamaura A, Osato K, Nakamura T, Mine S. A case of intracranial hypoglossal neurinoma.  No Shinkei Geka. 1989;  17 279-283 , (in Japanese)
    PubMedGoogle Scholar
  • 22 Takahashi A, Shiozawa Z, Satoh D, Noda T, Hibi G. A case of operated hypoglossal neurinoma.  Rinsho Shinkeigaku. 1976;  16 98-99 , (in Japanese)
    PubMedGoogle Scholar
  • 23 De Martel T, Subirana A, Guillaume J. Los tumors de la fosa cerebral posterior: voluminoso neurinoma del hipogloso con desarollo juxta-bulbo-protuberancial.  Poeracioncuracion Ars Med. 1933;  9 416-419
    PubMedGoogle Scholar
  • 24 Tuck RR, Mokri B, Cilloffo JM. Intracranial schwannoma of the hypoglossal nerve.  Arch Neurol. 1984;  41 502-505
    PubMedGoogle Scholar
  • 25 Kline DG, Hudson AR, Tiel R, Guha AB. Management of peripheral nerve tumors. In: Winn RH (ed). Youmans Neurological Surgery. 5th edn., Philadelphia: WB Saunders 2004 Vol. 4 pp 3941-3947
    Google Scholar
  • 26 Muthukumar N, Kondziolka D, Lundsford LD, Fleckinger JC. Stereotactic radiosurgery for jugular foramen schwannomas.  Surg Neurol. 1999;  52 172-179
    CrossrefPubMedGoogle Scholar
  • 27 Samii M, Gerganov V, Samii A. Improved preservation of hearing and facial nerve function in vestibular schwannoma surgery via the retrosigmoid approach in series of 200 patients.  J Neurosurg. 2006;  105 527-535
    CrossrefPubMedGoogle Scholar
  • 28 Ho KL. Schwannoma of the trochlear nerve: case report.  J Neurosurg. 1981;  55 132-135
    CrossrefPubMedGoogle Scholar
  • 29 Samii M, Migliori MM, Tagagiba M, Babu R. Surgical treatment of trigeminal neuromas.  J Neurosurg. 1995;  82 711-718
    CrossrefPubMedGoogle Scholar
  • 30 Odake G. Intracranial hypoglossal neurinoma with extracranial extension: Review and case report.  Neurosurgery. 1989;  24 583-587
    CrossrefPubMedGoogle Scholar
  • 31 Eldevik OP, Gabrielsen TO, Jacobsen EA. Imaging findings in schwannomas of the jugular foramen.  AJNR. 2000;  21 1139-1144
    PubMedGoogle Scholar
  • 32 Matsushima T, Hasuo K, Yasumori Yoshida K, Hirakata R, Fukui M, Masuda K. Magnetic resonance imaging of the jugular foramen neurinomas.  Acta Neurochiru. 1989;  96 83-87
    CrossrefPubMedGoogle Scholar
  • 33 Suzuki F, Handa J, Todo G. Intracranial glossopharyngeal neurinomas. Report of two cases with special emphasis on computed tomography and magnetic resonance imaging findings.  Surg Neurol. 1989;  31 390-394
    CrossrefPubMedGoogle Scholar
  • 34 Strang RR. Intracranial neurinoma of the hypoglossal nerve.  Aust N Z J Surg. 1967;  37 187-189
    PubMedGoogle Scholar
  • 35 Raney RB, Raney AA, Bayless AE. Tumors of the hypoglossal nerve: Report of a case.  Bull Los Angeles Neurol Soc. 1954;  19 160-165
    PubMedGoogle Scholar
  • 36 Martuza RL. Vestibular schwannoma.  J Neurosurg. 2006;  105 526 , (Editorial)
    PubMedGoogle Scholar
  • 37 Hasewgawa T, Kida Y, Yoshimoto M, Koike J. Trigeminal schwannomas: results of gamma knife surgery in 37 cases.  J Neurosurg. 2007;  106 18-23
    PubMedGoogle Scholar
  • 38 Malis L. Gamma surgery for vestibular schwannoma.  J Neurosurg. 2000;  92 894-895
    PubMedGoogle Scholar
  • 39 Sekhar LN, Estonillo R. Transtemporal approach to the skull base: an anatomical study.  Neurosurgery. 1986;  19 799-808
    CrossrefPubMedGoogle Scholar
  • 40 Ho CH, Deruytter MJ. Navigated dorsolateral suboccipital transcondylar (NADOSTA) approach for treatment of hypoglossal schwannoma. Case report and review of the literature.  Clin Neurol Neurosurg. 2005;  107 236-242
    CrossrefPubMedGoogle Scholar
  • 41 Smith PG, Backer RJ, Kletzker GR, Mishler ET, Loosmore JL, Leonetti JP, Biglow DC. Surgical management of transcranial hypoglossal schwannomas.  Amer J Otol. 1995;  16 451-456
    PubMedGoogle Scholar
  • 42 Spinnato S, Talacchi A, Musumeci A, Turazzi S, Bricolo A. Dumbell-shaped hypoglossal neurinoma: surgical removal via a dorsolateral transcondylar approach. A case report and review of the literature.  Acta Neurochir (Wein). 1998;  140 827-832
    CrossrefPubMedGoogle Scholar
  • 43 George B, Dematons C, Cophignon J. Lateral approach to the anterior portion of the foramen magnum. Application to the surgical removal of 14 benign tumors.  Surg Neurol. 1988;  29 484-490
    CrossrefPubMedGoogle Scholar
  • 44 Fisch M, Fagan P, Valavanis A. The infratemporal fossa approach for the lateral skull base.  Otolaryngol Clin North Am. 1984;  17 513-552
    Google Scholar
  • 45 Pollock BE, Foote RL, Stafford SL. Stereotactic radiosurgery: the preferred management for patients with nonvestibular schwannomas?.  Int J Radiation Oncology Biol Phys. 2002;  4 1002-1007
    PubMedGoogle Scholar
  • 46 Flickinger JC, Kondziolka D, Pollack BE, Lunsford LD. Evolution in technique for vestibular schwannoma radiosurgery and effect on outcome.  Int J Radiat Oncol Biol Phys. 1996;  36 275-280
    PubMedGoogle Scholar
  • 47 Kondziolka D, Lundsford LD, McLaughlin MR, Fleckinger JC. Long-term outcomes after radiosurgery for acoustic neuromas.  N Engl J Med. 1998;  339 1426-1433
    CrossrefPubMedGoogle Scholar
  • 48 Prasad D, Steiner M, Steiner L. Gamma surgery for vestibular schwannomas.  J Neurosurg. 2000;  92 745-759
    CrossrefPubMedGoogle Scholar
  • 49 Sheehan JP. Linear accelerator radiosurgery for vestibular schwannomas.  J Neurosurg. 2006;  105 655-656 , (Editorial)
    PubMedGoogle Scholar
  • 50 Pendl G, Ganz JC, Kitz K, Eustacchio S. Acoustic neurinomas with macrocysts treated with gamma knife radiosurgery.  Stereotact Funct Neurosurg. 1996;  66 ((suppl 1)) 103-111
    CrossrefPubMedGoogle Scholar

Correspondence

A. TuckerMD 

Department of Neurological Surgery

Nishinomiya Kyoritsu Neurosurgical Hospital

12-1 Imazu Yamanaka-cho

Nishinomiya

Hyogo 663-8211

Japan

Phone: +81/798/33 22 11

Fax: +81/798/33 24 38

Email: tucker@nk-hospital.or.jp