Hypoglossal schwannoma presenting only with headache

Area of Science:

• Neuro-oncology
• Skull Base Surgery
• Neurosurgery

Background:

• Hypoglossal schwannomas are rare nerve sheath tumors typically involving both intracranial and extracranial components.
• This case presents a unique instance of a purely extracranial hypoglossal schwannoma.

Observation:

• A patient presented with persistent headache, later diagnosed as a purely extracranial hypoglossal schwannoma.
• Magnetic resonance imaging revealed a cystic and solid mass at the skull base, characteristic of a nerve sheath tumor.

Findings:

• The tumor was surgically removed via a cervical approach.
• Complete resection led to the sacrifice of the hypoglossal nerve, resulting in temporary or permanent palsy.

Implications:

• This case underscores the diagnostic and surgical challenges posed by purely extracranial hypoglossal schwannomas.
• Management requires careful consideration of potential functional deficits, such as hypoglossal nerve palsy.