Skull Base 2010; 20(3): 193-197
DOI: 10.1055/s-0029-1246219
CASE REPORT

© Thieme Medical Publishers

Large Cystic Hypoglossal Schwannoma with Fluid-Fluid Level: A Case Report

Wen-chen Li1 , Xin-yu Hong1 , Li-ping Wang2 , Peng-fei Ge1 , Shuang-lin Fu1 , Yi-nan Luo1
  • 1Department of Neurosurgery, First Hospital of Jilin University, Changchun, China
  • 2Department of Pathology, First Hospital of Jilin University, Changchun, China
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Publication History

Publication Date:
12 January 2010 (online)

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ABSTRACT

Hypoglossal schwannomas are rare skull base tumors. Furthermore, cystic hypoglossal schwannomas are extremely uncommon. We report the first case of a large cystic hypoglossal schwannoma with a fluid-fluid level. A 36-year-old woman presented with increased intracranial pressure and cerebellar signs without hypoglossal nerve palsy. Magnetic resonance imaging showed a predominantly cystic mass with a fluid-fluid level in the foramen magnum region extending into the hypoglossal canal. The intracranial tumor was largely removed via a midline suboccipital subtonsillar approach, leaving only a tiny residue in the hypoglossal canal. Histology confirmed a schwannoma with relative hypervascularity. Twenty months later, the tumor recurred and presented as a multicystic dumbbell-shaped lesion, extending intra- and extracranially through the enlarged hypoglossal canal. A complete resection of the intracranial and intracanalicular parts of the tumor was achieved with a small extracranial remnant treated by radiosurgery. Histology revealed a focal increased Ki67 proliferative index. In this report, we discuss the possible reasons for the absence of hypoglossal nerve palsy and the potential mechanism of the formation of the fluid-fluid level, and we consider the treatment of this lesion.

REFERENCES

Yi-nan LuoM.D. 

Professor, Department of Neurosurgery, First Hospital of Jilin University

71 Xinmin Street, Changchun 130021, China, 0431-88782466

Email: Luo.yinan@yahoo.com.cn