Middle cranial fossa cystic schwannoma

Abstract

The authors present the unusual case of a 37-year-old man, with a history of hepatitis C, presenting with a 3 year history of progressive trigeminal, facial and vestibular nerve defects. Intracranial imaging demonstrated a cystic middle and posterior fossa lesion, that was ultimately diagnosed as a cystic trigeminal schwannoma. Due to the uncertainties of diagnosis he was managed in two stages with an open biopsy and then a subsequent partial resection. Surveillance of the tumour remnant is planned. The rare nature of this diagnosis is discussed, along with the more common findings in intracranial schwannoma, and the wide differential to be considered. Briefly, the authors describe the surgical option for a complex multi-fossa schwannoma and the importance of the multi-disciplinary team in the diagnosis and management of such patients.

Figure 1

Three different views of the cystic lesion in the middle cranial fossa

Figure 2

An intraoperative view with frontal and temporal lobes retracted, demonstrating the initial fenestration of the tumour cyst.

Figure 3

Histological image of tumour showing bundles of elongate cells with a fibrous background (H&E stain, x100 magnification).