Background

Intramedullary schwannomas of brain stem and spinal cord are extremely rare. In almost all cases, homogeneous, asymmetrical or circular intensive gadolinium enhancement has been demonstrated. However, no cases reported previously with minimal contrast enhancement in cervicomedullary junction.

Case description

A 38-year old man presented with a one-month history of constant, radiative right shoulder and arm pain. There was no pathological finding in his neurological examination. Also, physical evidence or family history of neurofibromatosis was not found. Magnetic resonance imaging of brain and cervical spine showed intramedullary, solid-cystic lesion localized in the cervicomedullary junction with unobvious gadolinium enhancement. The mass was gross totally resected through a sub-occipital craniotomy via midline approach. Postoperative pathological examination confirmed diagnosis of schwannoma. No changes were detected in the neurological examination of the patient after the operation.

Conclusions

There are 3 previously reported intramedullary schwannomas of the cervicomedullary junction in the literature. To the best of our knowledge, this is the first case of unobvious contrast enhancing intramedullary schwannoma of the cervicomedullary junction. The possibility of schwannoma should not be excluded when a mass with slight contrast enhancement is detected in the intramedullary region of the cervicomedullary junction.

中文翻译：

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颈髓交界处髓内神经鞘瘤一例报告

背景

脑干和脊髓的髓内神经鞘瘤极为罕见。在几乎所有情况下，均质、不对称或圆形强化钆增强已被证明。然而，之前没有报道过颈髓交界处对比度增强最小的病例。

案例说明

一名 38 岁男性，因右肩和手臂持续放射性疼痛 1 个月就诊。他的神经系统检查没有病理发现。此外，未发现神经纤维瘤病的物理证据或家族史。脑和颈椎磁共振成像显示位于颈髓交界处的髓内实性囊性病变，钆增强不明显。经中线入路，通过枕下开颅术将肿块完全切除。术后病理检查证实了神经鞘瘤的诊断。术后患者神经系统检查未见变化。

结论

文献中有 3 例先前报道的颈髓交界处的髓内神经鞘瘤。据我们所知，这是首例不明显对比增强的颈髓交界处髓内神经鞘瘤。当在颈髓交界处的髓内区域发现有轻微对比增强的肿块时，不应排除神经鞘瘤的可能性。