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Abducens nerve schwannoma: case report and review of the literature

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Abstract

Schwannomas of the abducens nerve are extremely rare. The authors report a case with this tumor and discuss its clinical and radiographic characteristics. A 36-year-old man presented with 6-month history of diplopia. Right abducens nerve paresis was noted on neurologic examination. Magnetic resonance imaging revealed a 4-cm sized heterogeneously enhancing mass in the right cerebellopontine angle. Although schwannoma was suggested, no direct radiographic evidences regarding its origin were identified. Instead, the facial and vestibulocochlear nerve complex was found to be displaced posteriorly by the tumor on MR three-dimensional T2-weighted driven equilibrium sequence. Resection of the tumor was carried out via retrosigmoid approach. As the encapsulated partially suckable yellowish tumor was debulked and dissected, the abducens nerve was found to fan along and be attached to the medial surface of the tumor, which was cut at this point. Complete excision of the tumor was accomplished, and reanimation of the nerve was done by end-to-end anastomosis. Histologic feature was typical of schwannoma. Abducens schwannoma, although rare, should be taken into account for differential diagnosis of the cerebellopontine angle tumors. Appreciation of the characteristic clinical and radiographic features may provide an accurate preoperative diagnosis.

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Authors and Affiliations

  1. Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap-2dong, Songpa-gu, Seoul, 138-736, South Korea

    Jin Hoon Park, Young Hyun Cho, Jeong Hoon Kim, Jung-Kyo Lee & Chang Jin Kim

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  1. Jin Hoon Park
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  2. Young Hyun Cho
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  3. Jeong Hoon Kim
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  4. Jung-Kyo Lee
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  5. Chang Jin Kim
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Correspondence to Chang Jin Kim.

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Comments

Nobutaka Kawahara, Yokohama, Japan

Park et al. reported a rare case harboring the sixth nerve schwannoma, which was located in the cerebellopontine angle. Since vestibular schwannoma can also be located in the cistern without extension into the meatus, accurate preoperative diagnosis of the sixth nerve schwannoma by imaging study would be difficult. In such situation, sixth nerve palsy may help.

This article teaches us the importance of clinical signs in differential diagnosis of CPA schwannoma.

I experienced a similar case of abducens nerve schwannoma, which was diagnosed during the operation. In my case, I rather left a small piece of tumor along the flattened sixth nerve. Postoperatively, mild diplopia improved markedly. Such surgical strategy may be sometimes beneficial for the patient.

Comments

Kiyoshi Saito, Fukushima, Japan

This is a rare case report of schwannoma originating from the cisternal portion of the abducens nerve. Although end-to-end anastomosis of the abducens nerve is usually difficult, the authors successfully performed the anastomosis after total removal of the tumor. As mentioned in the discussion, abducens nerve palsy and radiological characteristics such as normal size of the internal acoustic meatus and posterior displacement of the facial and acoustic nerves may suggest the possibility of abducens nerve origin of the cerebellopontine angle tumor.

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Park, J.H., Cho, Y.H., Kim, J.H. et al. Abducens nerve schwannoma: case report and review of the literature. Neurosurg Rev 32, 375–378 (2009). https://doi.org/10.1007/s10143-009-0203-7

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  • DOI: https://doi.org/10.1007/s10143-009-0203-7

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