Download PDF
J Neurol Surg Rep 2014; 75(01): e183-e188
DOI: 10.1055/s-0034-1378156
Case Report
Georg Thieme Verlag KG Stuttgart · New York

Trochlear Nerve Schwannoma with Intratumoral Hemorrhage Presenting with Persistent Hiccups: A Case Report

Ryusuke Hatae
1   Department of Neurosurgery, National Hospital Organization Ureshino Medical Center, Ureshino, Saga, Japan
3   Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
,
Masayuki Miyazono
1   Department of Neurosurgery, National Hospital Organization Ureshino Medical Center, Ureshino, Saga, Japan
,
Ryusuke Kohri
1   Department of Neurosurgery, National Hospital Organization Ureshino Medical Center, Ureshino, Saga, Japan
,
Kazushi Maeda
1   Department of Neurosurgery, National Hospital Organization Ureshino Medical Center, Ureshino, Saga, Japan
,
Shinji Naito
2   Department of Pathology, National Hospital Organization Ureshino Medical Center, Ureshino, Saga, Japan
› Author Affiliations
Further Information

Publication History

08 February 2014

22 April 2014

Publication Date:
04 June 2014 (online)

   Permissions and Reprints

Abstract

Trochlear nerve schwannoma without neurofibromatosis is extremely rare. To our knowledge, only 31 surgical cases have been reported to date, and only 2 cases of trochlear nerve schwannoma with intratumoral hemorrhage have been reported. None of those cases presented with persistent hiccups. We report the case of a 44-year-old man with trochlear nerve schwannoma associated with intratumoral hemorrhage who presented with a 10-day history of persistent hiccups. Computed tomography and magnetic resonance imaging revealed a solid tumor with a 3-cm diameter and intratumoral hemorrhage in the left petroclival region that compressed the midbrain and pons. Subtotal removal of the tumor was performed via the zygomatic transpetrosal approach. Intraoperative findings revealed a tumor arising from the trochlear nerve. The histologic diagnosis was schwannoma of Antoni type A cells with intratumoral hemorrhage. Although the patient's left trochlear nerve palsy worsened temporarily, his postoperative course was uneventful. We present this rare case and discuss the mechanism underlying the patient's persistent hiccups.

Keywords

persistent hiccup - trochlear nerve schwannoma - intratumoral hemorrhage
 

  • References

  • 1 Russell DS, Rubinstein LJ. Pathology of Tumors of the Nervous System. 5th ed. Baltimore, MD: Williams and Wilkins; 1989: 537-560
    Google Scholar
  • 2 Ho KL. Schwannoma of the trochlear nerve. Case report. J Neurosurg 1981; 55 (1) 132-135
    CrossrefPubMedGoogle Scholar
  • 3 Abe T, Iwata T, Shimazu M , et al. Two cases of trochlear nerve neurinoma. [in Japanese]. No Shinkei Geka 1994; 22 (4) 371-375
    PubMedGoogle Scholar
  • 4 Abe T, Iwata T, Shimazu M, Matsumoto K. Trochlear nerve neurinoma associated with a giant thrombosed dissecting aneurysm of the contralateral vertebral artery. Surg Neurol 1994; 42 (5) 438-441
    CrossrefPubMedGoogle Scholar
  • 5 Bartalena T, Leoni C, Trossello MP , et al. Hourglass cystic schwannoma of the trochlear nerve. Acta Biomed 2010; 81 (2) 147-150
    PubMedGoogle Scholar
  • 6 Beppu T, Yoshida Y, Wada T , et al. Trochlear and abducens nerve neurinomas accompanied by a cerebellopontine angle meningioma—case report. Neurol Med Chir (Tokyo) 1997; 37 (5) 416-421
    CrossrefPubMedGoogle Scholar
  • 7 Boggan JE, Rosenblum ML, Wilson CB. Neurilemmoma of the fourth cranial nerve. Case report. J Neurosurg 1979; 50 (4) 519-521
    CrossrefPubMedGoogle Scholar
  • 8 Celli P, Ferrante L, Acqui M, Mastronardi L, Fortuna A, Palma L. Neurinoma of the third, fourth, and sixth cranial nerves: a survey and report of a new fourth nerve case. Surg Neurol 1992; 38 (3) 216-224
    CrossrefPubMedGoogle Scholar
  • 9 Dolenc VV, Coscia S. Cystic trochlear nerve neurinoma. Br J Neurosurg 1996; 10 (6) 593-597
    CrossrefPubMedGoogle Scholar
  • 10 Du R, Dhoot J, McDermott MW, Gupta N. Cystic schwannoma of the anterior tentorial hiatus. Case report and review of the literature. Pediatr Neurosurg 2003; 38 (4) 167-173
    CrossrefPubMedGoogle Scholar
  • 11 Garen PD, Harper CG, Teo C, Johnston IH. Cystic schwannoma of the trochlear nerve mimicking a brain-stem tumor. Case report. J Neurosurg 1987; 67 (6) 928-930
    CrossrefPubMedGoogle Scholar
  • 12 Gerganov V, Amir S, Koerbel A, Brandes A, Stan A, Madjid S. Cystic trochlear nerve schwannoma. Case report. Surg Neurol 2007; 68 (2) 221-225
    CrossrefPubMedGoogle Scholar
  • 13 Grigorian IuA, Korobova AN. Neurinomas of the trochlear nerve. [in Russian]. Vopr Neirokhir 2008; 1 (1) 50-52
    PubMedGoogle Scholar
  • 14 Jackowski A, Weiner G, O'Reilly G. Trochlear nerve schwannomas: a case report and literature review. Br J Neurosurg 1994; 8 (2) 219-223
    CrossrefPubMedGoogle Scholar
  • 15 King JS. Trochlear nerve sheath tumor; case report. J Neurosurg 1976; 44 (2) 245-247
    CrossrefPubMedGoogle Scholar
  • 16 Kohama M, Murakami K, Endo T, Watanabe M, Tominaga T. Surgical and histological observations of trochlear neurinoma: case report. Neurol Med Chir (Tokyo) 2009; 49 (5) 217-220
    CrossrefPubMedGoogle Scholar
  • 17 Lanotte M, Giordana MT, Forni C, Pagni CA. Schwannoma of the cavernous sinus. Case report and review of the literature. J Neurosurg Sci 1992; 36 (4) 233-238
    PubMedGoogle Scholar
  • 18 Leunda G, Vaquero J, Cabezudo J, Garcia-Uria J, Bravo G. Schwannoma of the oculomotor nerves. Report of four cases. J Neurosurg 1982; 57 (4) 563-565
    CrossrefPubMedGoogle Scholar
  • 19 Matsui T, Morikawa E, Morimoto T, Asano T. Presigmoid transpetrosal approach for the treatment of a large trochlear nerve schwannoma—case report. Neurol Med Chir (Tokyo) 2002; 42 (1) 31-35
    CrossrefPubMedGoogle Scholar
  • 20 Maurice-Williams RS. Isolated schwannoma of the fourth cranial nerve: case report. J Neurol Neurosurg Psychiatry 1989; 52 (12) 1442-1443
    CrossrefPubMedGoogle Scholar
  • 21 Murakawa T, Sakai H, Ueda T, Yokoyama K, Takada M, Yamada H. Trochlear neurinoma: case report. [in Japanese]. Takayama Red Cross Hosp Kiyou 1988; 12: 163-167
    PubMedGoogle Scholar
  • 22 Nadkarni TD, Goel A. Trochlear nerve neurinoma presenting as pathological laughter. Br J Neurosurg 1999; 13 (2) 212-213
    CrossrefPubMedGoogle Scholar
  • 23 Ohba S, Miwa T, Kawase T. Trochlear nerve schwannoma with intratumoral hemorrhage: case report. Neurosurgery 2006; 58 (4) E791 ; discussion E791
    CrossrefPubMedGoogle Scholar
  • 24 Samii M, Draf W. Surgery of the Skull Base: An Interdisciplinary Approach. Berlin, Germany: Springer-Verlag; 1989: 335-337
    CrossrefGoogle Scholar
  • 25 Santoreneos S, Hanieh A, Jorgensen RE. Trochlear nerve schwannomas occurring in patients without neurofibromatosis: case report and review of the literature. Neurosurgery 1997; 41 (1) 282-287
    CrossrefPubMedGoogle Scholar
  • 26 Shenouda EF, Ghosh A, Coakham HB. Trochlear nerve schwannoma removed by combined petrosal approach. Br J Neurosurg 2002; 16 (6) 600-604
    CrossrefPubMedGoogle Scholar
  • 27 Shenoy SN, Raja A. Cystic trochlear nerve neurinoma mimicking intrinsic brainstem tumour. Br J Neurosurg 2004; 18 (2) 183-186
    CrossrefPubMedGoogle Scholar
  • 28 Tokuriki Y, Yamashita J, Kikuchi H, Asato R, Handa H. Trochlear nerve neurinoma—case report. Neurol Med Chir (Tokyo) 1988; 28 (1) 70-73
    CrossrefPubMedGoogle Scholar
  • 29 Türe U, Ozduman K, Elmaci I, Pamir MN. Infratentorial lateral supracerebellar approach for trochlear nerve schwannoma. J Clin Neurosci 2002; 9 (5) 595-598
    CrossrefPubMedGoogle Scholar
  • 30 Veshchev I, Spektor S. Trochlear nerve neuroma manifested with intractable atypical facial pain: case report. Neurosurgery 2002; 50 (4) 889-891 ; discussion 891–892
    CrossrefPubMedGoogle Scholar
  • 31 Yamamoto M, Jimbo M, Ide M, Kubo O. Trochlear neurinoma. Surg Neurol 1987; 28 (4) 287-290
    CrossrefPubMedGoogle Scholar
  • 32 Younes WM, Hermann EJ, Krauss JK. Cisternal trochlear nerve schwannoma: improvement of diplopia after subtotal tumour excision. Br J Neurosurg 2012; 26 (1) 107-109
    CrossrefPubMedGoogle Scholar
  • 33 Kolodzik PW, Eilers MA. Hiccups (singultus): review and approach to management. Ann Emerg Med 1991; 20 (5) 565-573
    CrossrefPubMedGoogle Scholar
  • 34 Samuels L. Hiccup; a ten year review of anatomy, etiology, and treatment. Can Med Assoc J 1952; 67 (4) 315-322
    PubMedGoogle Scholar
  • 35 Kobayashi Z, Tsuchiya K, Uchihara T , et al. Intractable hiccup caused by medulla oblongata lesions: a study of an autopsy patient with possible neuromyelitis optica. J Neurol Sci 2009; 285 (1-2) 241-245
    CrossrefPubMedGoogle Scholar
  • 36 Nagayama T, Kaji M, Hirano H, Niiro M, Kuratsu J. Intractable hiccups as a presenting symptom of cerebellar hemangioblastoma. Case report. J Neurosurg 2004; 100 (6) 1107-1110
    CrossrefPubMedGoogle Scholar
  • 37 Park MH, Kim BJ, Koh SB, Park MK, Park KW, Lee DH. Lesional location of lateral medullary infarction presenting hiccups (singultus). J Neurol Neurosurg Psychiatry 2005; 76 (1) 95-98
    CrossrefPubMedGoogle Scholar
  • 38 Witter F, Dipietro J, Costigan K, Nelson P. The relationship between hiccups and heart rate in the fetus. J Matern Fetal Neonatal Med 2007; 20 (4) 289-292
    CrossrefPubMedGoogle Scholar
  • 39 Niknafs YS, Wang AC, Than KD, Etame AB, Thompson BG, Sullivan SE. Hemorrhagic vestibular schwannoma: review of the literature. World Neurosurg 2013; 13: 00379-3
    PubMedGoogle Scholar
  • 40 Brady AP, Stack JP. Case report: magnetic resonance demonstration of haemorrhagic acoustic neuroma. Clin Radiol 1994; 49 (1) 61-63
    CrossrefPubMedGoogle Scholar
  • 41 Lee JP, Wang AD. Acoustic neurinoma presenting as intratumoral bleeding. Neurosurgery 1989; 24 (5) 764-768
    CrossrefPubMedGoogle Scholar
  • 42 Propp JM, McCarthy BJ, Davis FG, Preston-Martin S. Descriptive epidemiology of vestibular schwannomas. Neuro-oncol 2006; 8 (1) 1-11
    PubMedGoogle Scholar