Journal of neurosurgery. Case lessons · 2026
Hemorrhagic oculomotor nerve schwannoma mimicking a completely thrombosed posterior circulation aneurysm in an adolescent: illustrative case.
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Truong Tinh Thanh, Nguyen Hoa Viet
Аннотация
BACKGROUND: Oculomotor nerve schwannomas are rare intracranial tumors, particularly in adolescents. When associated with intralesional hemorrhage, they may radiologically mimic completely thrombosed aneurysms of the posterior circulation, creating diagnostic and operative challenges.
OBSERVATIONS: A 15-year-old girl presented with progressive headache and acute partial left third nerve palsy. MRI demonstrated a heterogeneous hemorrhagic mass in the left interpeduncular cistern closely abutting the superior cerebellar artery-posterior cerebral artery complex. MRA revealed no aneurysm. Two months later, the patient developed complete third nerve palsy, and repeat MRI showed lesion enlargement with subacute hemorrhage. Digital subtraction angiography excluded aneurysm. Resection via an orbitozygomatic approach revealed a lesion arising from the oculomotor nerve without vascular origin. Histopathological analysis confirmed schwannoma (WHO grade 1) with Antoni A and B areas and diffuse S100 positivity. At the 3-month follow-up, third nerve function showed minimal recovery.
LESSONS: Hemorrhagic oculomotor schwannoma may closely mimic a completely thrombosed aneurysm in the basilar apex region. Multimodal vascular imaging, recognition of nerve continuity, and radiologic-pathological correlation are essential for accurate diagnosis and operative planning. https://thejns.org/doi/10.3171/CASE26215.
OBSERVATIONS: A 15-year-old girl presented with progressive headache and acute partial left third nerve palsy. MRI demonstrated a heterogeneous hemorrhagic mass in the left interpeduncular cistern closely abutting the superior cerebellar artery-posterior cerebral artery complex. MRA revealed no aneurysm. Two months later, the patient developed complete third nerve palsy, and repeat MRI showed lesion enlargement with subacute hemorrhage. Digital subtraction angiography excluded aneurysm. Resection via an orbitozygomatic approach revealed a lesion arising from the oculomotor nerve without vascular origin. Histopathological analysis confirmed schwannoma (WHO grade 1) with Antoni A and B areas and diffuse S100 positivity. At the 3-month follow-up, third nerve function showed minimal recovery.
LESSONS: Hemorrhagic oculomotor schwannoma may closely mimic a completely thrombosed aneurysm in the basilar apex region. Multimodal vascular imaging, recognition of nerve continuity, and radiologic-pathological correlation are essential for accurate diagnosis and operative planning. https://thejns.org/doi/10.3171/CASE26215.