J Korean Neurosurg Soc.  2014 Aug;56(2):152-156. 10.3340/jkns.2014.56.2.152.

Intracisternal Cranial Root Accessory Nerve Schwannoma Associated with Recurrent Laryngeal Neuropathy

• Jin SW
• Park KJ
• Park DH
• Kang SH

• KMID: 1956520
• DOI: http://doi.org/10.3340/jkns.2014.56.2.152

Abstract

Intracisternal accessory nerve schwannomas are very rare; only 18 cases have been reported in the literature. In the majority of cases, the tumor origin was the spinal root of the accessory nerve and the tumors usually presented with symptoms and signs of intracranial hypertension, cerebellar ataxia, and myelopathy. Here, we report a unique case of an intracisternal schwannoma arising from the cranial root of the accessory nerve in a 58-year-old woman. The patient presented with the atypical symptom of hoarseness associated with recurrent laryngeal neuropathy which is noted by needle electromyography, and mild hypesthesia on the left side of her body. The tumor was completely removed with sacrifice of the originating nerve rootlet, but no additional neurological deficits. In this report, we describe the anatomical basis for the patient's unusual clinical symptoms and discuss the feasibility and safety of sacrificing the cranial rootlet of the accessory nerve in an effort to achieve total tumor resection. To our knowledge, this is the first case of schwannoma originating from the cranial root of the accessory nerve that has been associated with the symptoms of recurrent laryngeal neuropathy.

Keyword

Schwannoma; Accessory nerve; Intracisternal; Recurrent laryngeal neuropathy

MeSH Terms

Accessory Nerve*
Cerebellar Ataxia
Electromyography
Female
Hoarseness
Humans
Hypesthesia
Intracranial Hypertension
Middle Aged
Needles
Neurilemmoma*
Spinal Cord Diseases
Spinal Nerve Roots

Figure

• 

  Fig. 1 A : Axial T2-weighted magnetic resonance (MR) image showing a well-defined cystic lesion in the left cerebellomedullary cistern. B : Axial gadolinium-enhanced T1-weighted MR image showing enhancement in the cyst wall and inner solid components of the mass. The tumor compressed the medulla and high cervical spinal cord. C : Sagittal gadolinium-enhanced T1-weighted MR image showing severe impingement of the craniocervical brainstem. D : MR angiogram illustrating superiomedial displacement of the lateral medullary and tonsillomedullary segments of the left posteroinferior cerebellar artery (arrow).

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  Fig. 2 Intraoperative photograph showing the spinal accessory nerve (arrow) was easily dissected away from the tumor (*) (A). Multiple rootlets of IX, X, and XI (arrowhead) run to the jugular foramen. The cranial root of the accessory nerve (arrow) near the brain stem incorporated into the tumor (*) (B). Intracisternal segments of the IX and X nerves are seen in the cranial side (arrowhead).

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  Fig. 3 Photomicrograph showing palisading and whorling spindle cells with compact and loose areas (Antoni A and B arrangement), consistent with a diagnosis of schwannoma (H&E; original magnification ×100) (A). Most neoplastic cells are strongly positive for S-100 on immunohistochemical staining (original magnification ×400) (B).

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