Intracranial subfrontal schwannomaの1例 : 放射線学的特徴について
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頭蓋内に限局したsubfrontal schwannomaの1例を報告し, 放射線学的特徴について言及した.症例は27歳の男性.主訴は頭痛と視力障害, 左嗅覚脱失と両側うつ血乳頭を認めた.von Recklinghausen病なし.MRIでは左前頭蓋底からの直径8cm頭蓋内脳実質外腫瘍がT2強調像を高信号を呈し, T1強調造影像で被膜は強く, 内部は不均一に造影された.dural tailはなく, 脳血管写でtumor stainもなかった.頭蓋内subfrontal schwannomaの報告は過去7例にとどまるが, 比較的若年者に多い前頭蓋底腫瘍である.MRI, 脳血管写が嗅窩部髄膜腫との鑑別に有用と思われた.We report a case of intracranial subfrontal schwannoma. A 27-years-old male suffered from a headache and visual disturbance. Neurological examination revealed left-sided anosmia and choked discs bilaterally. The patient had no pigmentation of von Recklinghausen's disease. Pre-contrast computed tomography (CT) showed a low-density mass about 8cm in diameter in the left frontal region. Axial T2-weighted magnetic resonance imaging (MRI) revealed a hyperintensity mass in left anterior cranial fossa, with a deflecting falx to the right, and peritumoral cerebrospinal fluid collection and minimum surrounding edema. Sagittal T1-weighted MRI with Gd-DTPA enhancement showed a heterogenously enhanced mass without dural tail. No lesions were noted in the nasal cavity. The tumor was totally resected. Histological examination revealed schwannoma. Among the reported 14 cases of subfrontal schwannomas, only 7 were fully located in the intracranial cavity without any relation to von Recklinghausen's disease. Most of them were preoperatively diagnosed as olfactory groove meningioma, since it is the most common tumor in the anterior cranial fossa. We reviewed radiological images of previously reported cases and our own, and found some valuable findings to diagnose intracranial subfrontal schwannomas. Anterior floor changes on X-ray films and tumor stains on cerebral angiograms were rarely noted. CT showed low or iso-density on pre-contrast scans and high-density on post-contrast scans. MRI demonstrated hypointensity on T1-weighted image (WI) and hyperintensity on T2 WI. Gd-DTPA enhanced the tumor heterogenously rather than homogenously. No dural tail signs were seen. The angle between the tumor and anterior cranial base was acute. Some of these findings resemble those of acoustic neurinomas. Moreover, intracranial subfrontal schwannomas grew asymmetrically unlike olfactory groove meningiomas. To make differential diagnosis between intracranial subfrontal schwannoma and olfactory groove meningioma, we emphasize : 1) subfrontal schwannomas occurred at a relatively younger age ; 2) radiological findings, especially no dural tail sign, an acute angle between the tumor and the anterior cranial base, asymmetrical growth, and absence of tumor stain, are important, and ; 3) we should keep in mind that schwannoma grows even in the frontal base.rights: 日本脳神経外科コングレスrights: 本文データは学協会の許諾に基づきCiNiiから複製したものであるrelation：isVersionOf: http://ci.nii.ac.jp/naid/110003813369/
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