A Case of Intra- and Extra- Cranial Hypoglossal Neurinoma.

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A 51-year-old male with a history of palsy and atrophy of the right side of the tongue was admitted to our clinic in April, 1991. General physical examination revealed nothing remarkable, and no cafe au lait spots were found. Ultrasound examinations delineated the size and boundary of the neck mass and its relationship to the great vessels. MRI in short spin echo revealed a low density tumor mass. A 3-dimension CT scan showed destruction and enlargement of the jugular foramen and hypoglossal canal. CAG demonstrated a hypovascular mass and no tumor stain. A biopsy was performed via the oral cavity, and the histopathological report was Antoni type B neurinoma, without malignancy.On July 1991, mastoidectomy and suboccipital craniotomy were performed with a staged extracervical approach. The 10th and 11th cranial nerves were intact, but the 12th nerve was involved in a massive cystic tumor which extended intracranially through the enlarged jugular foramen and hypoglossal canal of the skull base. The extracranial 9th nerve was cut because it was involved in the neck mass. Intracranial hypoglossal neurinoma is a rare lesion, and its dumbbell-like extension to the neck is even more rare.The best treatment of this tumor is total removal. However when it is strongly adherent to the medulla, subtotal removal is essential because of the risk of brain damage, since this tumor is benign.
耳鼻咽喉科臨床学会の論文