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CC BY-NC-ND 4.0 · Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 2017; 36(03): 178-184
DOI: 10.1055/s-0037-1603919
Review Article | Artigo de Revisão
Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

Trochlear Nerve Schwannoma: Case Report and Literature Review

Schwannoma do nervo troclear: revisão da literatura e relato de caso
Marcelo Lemos Viera da Cunha
1   Neurosurgeon, Hospital Regional do Oeste, Chapecó, SC, Brasil
2   Sitting Member of the Brazilian Society of Neurosurgery – SBN, São Paulo, SP, Brasil
,
Mario Henrique Furlanetto Miranda
3   Medical Student, Universidade Comunitária da Região de Chapecó, Chapecó, SC, Brasil
,
Giulia Luiza Cecconello
3   Medical Student, Universidade Comunitária da Região de Chapecó, Chapecó, SC, Brasil
› Institutsangaben
Weitere Informationen

Publikationsverlauf

05. März 2017

02. Mai 2017

Publikationsdatum:
16. Juni 2017 (online)

   Lizenzen und Reprints

Abstract

Schwannomas arise from the Schwann cells of the peripheral and cranial nerves. They represent 8% of the primary cerebral neoplasms. Although schwannomas usually develop in sensory nerves, most often on the vestibular and trigeminal nerves, in very rare cases they can develop in motor nerves. We reported an unusual case of a 29-year-old woman with headache, nausea, vomiting, and blurred vision ongoing for 3 years. Magnetic resonance of the brain showed a solid-cystic expanded injury, heterogeneous, with limits partially defined and epicenter on the pineal gland. The lesion presented hyposignal in T1 and isosignal in T2. An intense enhancement of the solid part was observed after contrast injection. Foci of calcification and absence of diffusion restriction were also observed. The patient underwent microneurosurgery with supracerebellar infratentorial approach in a seated position. Subtotal resection was performed with maintenance of calcified tumor tissue adhered to the right Rosenthal basal vein. In the postoperative phase, the patient remained with diplopia when looking down; however, she reported improvement of headache and nausea.

Resumo

Os schwannomas surgem das células de Schwann, dos nervos periféricos e cranianos e representam 8% das neoplasias cerebrais primárias. Apesar de os schwannomas se desenvolverem comumente em nervos sensoriais, mais frequentemente no nervo vestibular e trigêmeo, em casos muito raros ele pode se desenvolver em nervos motores. Relatamos um caso raro, de uma paciente do sexo feminino, 29 anos, com quadro de cefaleia, náuseas, vômitos e turvação visual há três anos. Ressonância magnética de encéfalo demonstrou lesão expansiva sólido-cística, heterogênea, com limites parcialmente definidos e epicentro na glândula pineal. Apresentou hipossinal em T1 e isossinal em T2. Houve intenso realce da parte sólida após injeção de contraste. Foram observados focos de calcificação e ausência de restrição à difusão. A paciente foi submetida a tratamento microneurocirúrgico com acesso infratentorial supracerebelar em posição sentada. Houve ressecção subtotal com manutenção de tecido tumoral calcificado aderido a veia basal de Rosenthal direita. No pós-operatório, a paciente permaneceu com diplopia na mirada ocular para baixo, entretanto apresentou melhora de cefaleia e náuseas.

Keywords

neurilemmoma - trochlear nerve - diplopia

Palavras-chave

neurilemoma - nervo troclear - diplopia
 

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