Frontal lobe perivascular schwannoma. Case report

Area of Science:

• Neurosurgery
• Neuropathology
• Pediatric Neurology

Background:

• Subarachnoid hemorrhage (SAH) in adolescents can be caused by various factors, including aneurysms.
• Initial diagnostic imaging may not always reveal the underlying pathology, necessitating further investigation.
• Schwannomas are typically benign nerve sheath tumors, but their presentation in the brain parenchyma is uncommon.

Purpose of the Study:

• To report a rare case of a pediatric patient with subarachnoid hemorrhage.
• To highlight the diagnostic challenges and delayed identification of an intracranial schwannoma.
• To describe the surgical findings and management of a leathery schwannoma involving the frontal lobe.

Main Methods:

• Case report of a 15-year-old male presenting with symptoms and CT findings suggestive of SAH.
• Initial conservative management due to negative aneurysm screening.
• Delayed reevaluation with surgical exploration 15 months post-initial presentation.

Main Results:

• Computerized tomography (CT) initially indicated subarachnoid hemorrhage.
• No aneurysm was identified on initial diagnostic workup.
• Surgical intervention revealed a firm, leathery schwannoma adherent to the frontal lobe and extending into the cortex via Virchow-Robin spaces.

Conclusions:

• Intracranial schwannomas, though rare, should be considered in the differential diagnosis of pediatric subarachnoid hemorrhage, especially when initial aneurysm workup is negative.
• Delayed diagnosis and management can occur if the underlying tumor is not identified promptly.
• The intimate relationship of the tumor with the brain parenchyma and Virchow-Robin spaces underscores the complexity of surgical resection.