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Abducens nerve schwannoma mimicking intrinsic brainstem tumor

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Abstract

Schwannomas of the abducens nerve are extremely rare tumors affecting cavernous, cisternal or both segments of sixth cranial nerve. Clinical features and neuroradiological imagery are frequently insufficient to reach an accurate pre-operative diagnosis. We report a patient with a cystic tumor with ring-like contrast enhancement at the right anterior pontomesencephalic junction. Radical excision was performed via anterior transpetrosal approach and showed an extrinsic tumor originating from the sixth nerve. A postoperative sixth nerve palsy had disappeared completely 9 months after the surgery. The correct diagnosis of an abducens nerve schwannoma is established by the intraoperative finding of a tumor attachment to the sixth nerve and by histopathological analysis. The various differential diagnoses, the clinical and radiological features of this diagnosis and management are issues discussed in this illustrated review.

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Author information

Authors and Affiliations

  1. Department of Neurosurgery, Masaryk Hospital, J. E. Purkinje University, Usti nad Labem, Czech Republic

    Petr Vachata & Martin Sameš

  2. Department of Neurosurgery, UJEP, Masaryk Hospital, Socialni pece 12/A, Usti nad Labem, 40113, Czech Republic

    Petr Vachata

Authors
  1. Petr Vachata
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  2. Martin Sameš
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Corresponding author

Correspondence to Petr Vachata.

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Comment

This case report bears merit, since the pathology described herein is rare and worth being reminded of, for instance as a possible differential diagnosis of intrinsic brain stem tumors. Surgery was performed in a state of the art fashion, using multichannel neurophysiologic monitoring techniques, frameless navigation, lumbar drain and a tailored anterior petrosectomy, without significant morbidity. Initial postoperative abduces palsy recovered within months, indicating a certain resilience of the abducens nerve against surgical manipulation. The discussion is exhaustive and covers questions of approach, differential diagnosis, alternate treatments and outcome.

W. Stummer

Duesseldorf, Germany

Comment

Well written, clear and original case report followed by a good review

Pierre-Hughes Roche

Marseille, France

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Vachata, P., Sameš, M. Abducens nerve schwannoma mimicking intrinsic brainstem tumor. Acta Neurochir 151, 1281–1287 (2009). https://doi.org/10.1007/s00701-009-0302-9

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  • DOI: https://doi.org/10.1007/s00701-009-0302-9

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