Neurinoma in Childhood

Case Report

Abstract

A rare case of a surgically verified parasellar neurinoma in a child is presented. The patient, a 10-year-old girl, noticed congestion of the conjunctiva of the left side 2 months prior to admission. A left sixth nerve palsy was pointed out by an ophthalmologist. The results of a neurological examination on admission were otherwise normal. A computed tomogram showed a round parasellar mass on the left side. The tumor was heterogeneously hypodense and showed a marked, homogeneous enhancement. Carotid angiography revealed tiny abnormal vessels originating from the middle meningeal artery. At operation, a solid tumor lying under the dura mater was found. It lay medially and anteriorly to Meckel's cavity, in contiguity with the cavernous sinus. Nerves IV, V, and VI were not visible even after total dissection of the tumor, and the connections to these nerves were not revealed. Histologically, the tumor was a neurinoma of the Antoni type A. The patient was discharged 3 weeks after operation with a full recovery except for a slight diplopia.
In this case the exact origin of the neurinoma could not be identified even with the use of an operating microscope. The fact that the sixth nerve palsy disappeared in a short time after removal of the tumor may suggest that the tumor did not originate from the sixth nerve. Consequently it is thought that a sensory or vasomotor nerve distributed in the dura mater may be the site of the tumor origin.