Abstract
Extensive large dumbbell-shaped hypoglossal schwannoma is extremely rare, and total resection is nearly impossible. We present a case of a 61-year-old male with a giant-size hypoglossal schwannoma with moderate tongue atrophy. The tumor extended from the enlarged hypoglossal canal to the brainstem intradurally and the high cervical region extradurally. Through the extreme lateral infrajugular transcondylar (ELITE) skull base approach, the tumor was totally removed in a single-stage operation. Single-stage total resection is feasible by an experienced skull base team utilizing transcondylar skull base techniques and high cervical dissection.
Similar content being viewed by others
References
Aihara K, Morita A (2005) Dumbbell-shaped hypoglossal schwannoma in an elderly woman: a clinical dilemma. Surgical Neurol 63:526–528
Bertalanffy H, Seeger W (1991) The dorsolateral, suboccipital, transcondylar approach to the lower clivus and anterior portion of the craniocervical junction. Neurosurgery 29:815–821
Elsharkawy M, Xu Z, Schlesinger D, Sheehan JP (2012) Gamma Knife surgery for nonvestibular schwannomas: radiological and clinical outcomes. J Neurosurg 116:66–72
Hoshi M, Yoshida K, Ogawa K, Kawase T (2000) Hypoglossal neurinoma—two case reports. Neurol Med Chir (Tokyo) 40:489–493
Inoue H, Nakagawa Y, Ikemura M, Usugi E, Kiyofuji Y, Nata M (2013) Acute brainstem compression by intratumoral hemorrhages in an intracranial hypoglossal schwannoma. Leg Med (Tokyo) 15:249–252
Kabatas S, Cansever T, Yilmaz C, Demiralay E, Celebi S, Caner H (2010) Giant craniocervical junction schwannoma involving the hypoglossal nerve: case report. Turk Neurosurg 20:73–76
Kadri PA, Al-Mefty O (2004) Surgical treatment of dumbbell-shaped jugular foramen schwannomas. Neurosurg Focus 17:E9
Kuo LT, Huang AP, Kuo KT, Tseng HM (2008) Extradural dumbbell schwannoma of the hypoglossal nerve: a case report with review of the literature. Surg Neurol 70:34–39
Li WC, Hong XY, Wang LP, Ge PF, SL F, Luo YN (2010) Large cystic hypoglossal schwannoma with fluid-fluid level: a case report. Skull Base 20:193–197
Li Y, Lou J, Qiu S, Guo Y, Pan M (2016) Hypofractionated stereotactic radiotherapy for dumbbell-shaped hypoglossal schwannomas: two cases of long-term follow-up and a review of the literature. Mol Clin Oncol 5:371–374
Mathiesen T, Svensson M, Lundgren J, Kihlström L, Parisotto R, Bagger-Sjöbäck D (2009) Hypoglossal schwannoma-successful reinnervation and functional recovery of the tongue following tumour removal and nerve grafting. Acta Neurochir 151:837–841
Mariniello G, Horvat A, Popovic M, Dolenc VV (2000) Cellular dumbbell schwannoma of the hypoglossal nerve presenting without hypoglossal nerve palsy. Clin Neurol Neurosurg 102:40–43
Mazur MD, Couldwell WT, Cutler A et al (2017) Occipitocervical instability after far-lateral transcondylar surgery: a biomechanical analysis. Neurosurgery 80:140–145
Nonaka Y, Grossi PM, Bulsara KR, Taniguchi RM, Friedman AH, Fukushima T (2011) Microsurgical management of hypoglossal schwannomas over 3 decades: a modified grading scale to guide surgical approach. Neurosurgery 69:121–140
Oyama H, Kito A, Maki H, Hattori K, Noda T, Wada K (2012) Schwannoma originating from lower cranial nerves: report of 4 cases. Nagoya J Med Sci 74:199–206
Rachinger J, Fellner FA, Trenkler J (2003) Dumbbell-shaped hypoglossal schwannoma. A case report. Magn Reson Imaging 21:155–158
Santarius T, Dakoji S, Afshari FT et al (2012) Isolated hypoglossal schwannoma in a 9-year-old child. J Neurosurg Pediatr 10:130–133
Sato M, Kanai N, Fukushima Y et al (1996) Hypoglossal neurinoma extending intra- and extracranially: case report. Surg Neurol 45:172–175
Sen CN, Sekhar LN (1990) An extreme lateral approach to intradural lesions of the cervical spine and foramen magnum. Neurosurgery 27:197–204
Suri A, Bansal S, Sharma BS et al (2014) Management of hypoglossal schwannomas: single institutional experience of 14 cases. J Neurol Surg B Skull Base 75:159–164
Wanibuchi M, Fukushima T, Zenga F, Friedman AH (2009) Simple identification of the third segment of the extracranial vertebral artery by extreme lateral inferior transcondylar-transtubercular exposure (ELITE). Acta Neurochir 151:1499–1503
Yu Z, Zhao G, Zhao Z, Li Y, Xie G (2016) Giant recurrent dumbbell-shaped hypoglossal schwannoma in an elderly male: a case report. Oncol Lett 11:283–286
Zhang Q, Kong F, Guo H et al (2012) Surgical treatment of dumbbell-shaped hypoglossal schwannoma via a pure endoscopic transoral approach. Acta Neurochir 154:267–275
Acknowledgments
We thank Ms. Lori Radcliffe for assistance with English language editing.
Funding
No funding was received for this report.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest, or non-financial interest in the subject matter or materials discussed in this manuscript.
Ethical approval
All procedures performed in this report involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Informed consent
Informed consent was obtained from the patient in the report.
Rights and permissions
About this article
Cite this article
Inoue, T., Nonaka, Y., Hirai, H. et al. Single-stage total resection of giant dumbbell-shaped hypoglossal schwannoma: a case report. Acta Neurochir 160, 727–730 (2018). https://doi.org/10.1007/s00701-017-3431-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00701-017-3431-6