Recurrent Schowannoma With Extensive Xanthomatous Changes: A Case Report

Schwannoma is one of the most common benign intracranial tumors, which originates from the Schwann cells of neural structures in the upper part of the vestibular branch of the eighth cranial nerve. This report describes a 64-year-old woman with headache and vertigo who had a past surgical history of acoustic schwannoma about 10 years ago. The patient underwent excisional surgery. Histological examinations revealed schwannoma with extensive xanthomatous changes. Immunohistochemistry staining confirmed the diagnosis. Base on the diagnosis, the patient received no more treatment. After 6 months of close follow-up examinations, no recurrence and complication were observed. Schwannoma could be seen with a vast variety of histologic changes. Recurrence of Schownnoma is uncommon in patients without neurofibromatosis, but it should be considered in a proper clinical context.

ACOUSTIC SCHWANNOMA WITH INTRATUMORAL HEMORRHAGE –REPORT OF AN UNUSUAL COMPLICATION

Acoustic Schwannoma is a benign neoplasm of the 8th cranial nerve pair, and accounts for 8-10% of all intracranialtumors. Intratumoral haemorrhage is unusual in these tumors and can lead to hydrocephalus or aggravate a preexisting condition. This paper reports a case of acoustic Schwannoma in a child with complication with intratumoral hemorrhage that lead patient to death. Female patient, 9 years old, presented anacusis on the right, sudden, progressing with vomiting, intense headache and vertigo. Magnetic resonance imaging of the skull showed expansive lesion in the cistern of the right cerebellar angle, with content inside the internalauditory canal, with compression of the adjacent brain stem. The diagnostic hypothesis was acoustic Schwannoma. It progressed with worsening of headache, initially controlled with medication and later loss of consciousness. Computed tomography of the skull revealed an expansive lesion in the cistern of the right cerebellar angle with signs of bleeding with extension to the ventricular system. External ventricular shunt was performed, but the patient evolved with several complications, septic shock and death. Intratumoral hemorrhage in the acoustic Schwannoma is a rare event, but its occurrence worsens the clinical picture and may lead to death of the patients due to intracranial hypertension.

Surgical Outcomes of Cerebellopontine Angle Tumors in 48 Cases

Background: Share our experiences with a series of surgical removal of cerebellopontine angle with retrosigmoid suboccipital procedure. Materials and Methods: It was a retrospective study of 48 patients (mean age, 45 years) with Cerebellopontine Angle tumors (predominantly acoustic schwannoma) who underwent surgical removal and one year post-operative follow up. Results: Hearing improvement about 50% of patient. Facial nerve function as measured by the House Brackmann system was recorded in all patients 1 year following surgery: 35% had a score of 1 or 2; 25% had a score of 3 or 4; and 8% had a score of 5 or 6. Rest of the patient full recover Two death occurred during this study. There was one cerebrospinal fluid leak, and two patients were diagnosed as having bacterial meningitis. Complete gross tumor removal was not achieved in five patients (10%). Two cases had wound infections. Conclusion: The retrosigmoid suboccipital procedure was used in our series for removal CPA tumors, and outcome was good in this series. Bang. J Neurosurgery 2020; 9(2): 117-220

Persistent Enlarged Occipital Sinus with Absent Unilateral Transverse Sinus

The occipital sinus may occasionally remain patent, but the incidence is extremely low and observed in less than 10% of cases. A persistent patent occipital sinus (POS) may be associated with other venous sinus abnormality. The absence of transverse sinus in association with POS is an extremely rare condition and not reported yet. The neuroradiologist, neurosurgeons, otolaryngologist, and neurologist must be aware of the possible existence of POS and other associated venous sinus anomaly, as its warrants very crucial modification of surgical planning, selection of appropriate approaches, and, additionally, may also critically limit the extent of surgical exposure of target, and may hinder intended extent of surgical excision of tumor and associated possibility of injury to POS, which may produce catastrophic hemorrhage, brain swelling, and neurosurgical morbidity. The authors report a 35-year-old male who underwent suboccipital craniotomy for right-side giant acoustic schwannoma. Following the raising bone flap, a markedly prominent, turgid, occipital sinus was observed, not placed exactly in the midline but deviated to the right side, causing further restraining of dural opening. Surgical nuances and intraoperative difficulty encountered along with pertinent literature is reviewed briefly.

Central nervous system tumours

Chapter 17 discusses central nervous system tumours, including principles, planning volumes, dose distribution, high- and low-grade glioma, ependymoma, medulloblastoma, germ cell tumours , vestibular (acoustic) schwannoma, pituitary tumours (including craniopharyngioma), meningioma, and primary spinal cord tumours.