J Korean Neurosurg Soc.  2013 Oct;54(4):340-343. 10.3340/jkns.2013.54.4.340.

Supratentorial Intracerebral Schwannoma : Its Fate and Proper Management

• Lee S
• Park SH
• Chung CK

• KMID: 1499341
• DOI: http://doi.org/10.3340/jkns.2013.54.4.340

Abstract

Intracerebral schwannomas are rare and there have been none reported in Korea. We present the case of a 25-year-old man with newly developed right-side weakness and recent seizure aggravation. His seizures started approximately 9 years prior to admission. At that time, a 1 cm diameter intra-axial enhancing mass at the left precentral gyrus was found on magnetic resonance image (MRI). After 9 years of observation and treatment with antiepileptic medication, an MRI taken due to symptom aggravation revealed peri-tumoral cyst formation with tumor enlargement. The tumor was surgically removed. Subsequently, right-side weakness diminished and there was good seizure control. Pathologic diagnosis was schwannoma. Schwannoma is a very rare tumor and there are no pathognomonic findings on radiologic images; thus, it is challenging to make a correct diagnosis. However, considering the natural course and excellent prognosis after surgical treatment of this kind of intra-axial mass with benign features, early surgery for diagnosis and proper treatment is highly recommended.

Keyword

Intracerebral schwannoma; Supratentorial; Precentral gyrus; Treatment; Seizure

MeSH Terms

Adult
Diagnosis
General Surgery
Humans
Korea
Magnetics
Magnets
Neurilemmoma*
Prognosis
Seizures

Figure

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  Fig. 1 Brain MRI after the first seizure attack revealed a small mass lesion at the precentral gyrus with peritumoral edema. The mass is of heterogeneously high signal intensity on a T2-weighted axial image (A) and predominantly hypointense to gray matter on a T1-weighted sagittal image (B). It enhances homogeneously after gadolinium injection (C and D).

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  Fig. 2 9-year follow-up brain MRI revealed a slightly increased enhancing mass with a large, newly appeared peritumoral cyst. The cyst is hyperintense on a T2-weighted axial image (A), and hypointense on a T1-weighted axial and coronal images (B and C). Cystic fluid shows a similar signal as the cerebrospinal fiuid.

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  Fig. 3 After opening the dura, a bluish discoloration of the cerebral cortex is observed. Tumor location with the discoloration is marked as '*'. In addition, diffuse swollen brain is observed.

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  Fig. 4 One month after the operation, postoperative T1 enhance images shows no residual enhancing mass. The size of the peritumoral cyst is decreased, but remains after the operation.

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  Fig. 5 A : The tumor shows a fascicular arrangement of spindle neoplastic cells with perivascular hyalinization of the blood vessel wall (H&E, ×100). B : The tumor cell nuclei and cytoplasm are robustly positive for S100 protein (S100 protein immunostaining, ×100).

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