Upper thoracic spinal schwannoma leading to intracranial hypertension and hydrocephalus: A case report and literature review.

RATIONALE: Hydrocephalus is predominantly caused by intracranial hemorrhage, infections, tumors, genetic metabolic disorders, and congenital malformations. Hydrocephalus secondary to spinal cord tumors is exceedingly rare; these tumors are predominantly located in the upper cervical spinal region or near the conus medullaris. Hydrocephalus and elevated intracranial pressure caused by upper thoracic spinal schwannomas have not previously been reported.

PATIENT CONCERNS: We report the first case in a 71-year-old female patient who presented with bilateral lower limb weakness for 6 months, accompanied by headache, dizziness, and urinary incontinence for 1 month.

DIAGNOSES: This patient was diagnosed with schwannomas located in the upper cervical spinal region.

INTERVENTIONS: Based on preoperative examination results, it was difficult to distinguish a schwannoma from a spinal meningioma. Subsequently, a microsurgical operation was performed, and the whole tumor was removed via a posterior approach. Tumor tissue histopathological results revealed a whole capsule; under a light microscope, the tumor mainly consisted of sheath cells, which were arranged in a palisade or swirl shape. Antoni A and Antoni B regions constituted a large part of the whole tumor. Moreover, cytologic atypia and necrosis or mitosis were absent. Immunohistochemical staining revealed strong positivity staining for S-100 and SOX 10. Hence, a histopathological diagnosis of schwannomas was finally confirmed. The patient's symptoms of intracranial hypertension, hydrocephalus, and spinal cord dysfunction were significantly alleviated after the operation.

OUTCOMES: Follow-up magnetic resonance image (1 month after being discharged from the hospital) of the thoracic spine and brain revealed complete resection of the upper thoracic spinal schwannoma, a significant reduction in the size of ventricles, and marked alleviation of periventricular interstitial edema.

LESSONS: The findings emphasize the importance of considering spinal tumors in cases of unexplained hydrocephalus and may guide early microsurgical intervention.