Spontaneous regression of a trochlear nerve schwannoma: A case report.
- 1Department of Neurosurgery, Institute of Medicine, University of Tsukuba, Tsukuba, Japan.
Abstract
Background
Trochlear nerve schwannoma is exceedingly rare. Little is known about its natural history, and, therefore, no consensus has been established regarding its optimal management.Case description
A 60-year-old male presented with diplopia during vertical gaze. The neurological examination demonstrated a positive Bielschowsky head tilt test, with no other neurological abnormalities. The magnetic resonance imaging (MRI) revealed a well-demarcated, multiloculated cystic lesion near the right tentorial incisura that showed heterogeneous enhancement on gadolinium-enhanced T1-WI; the lesion was diagnosed as a trochlear nerve schwannoma. Because the patient had isolated right trochlear nerve palsy and only minimal radiological evidence of brainstem compression, observation with symptomatic treatment using prism glasses was selected. The MRI performed 3 months later showed tumor enlargement, at 6 months tumor had begun to shrink, by 9 months, diplopia had resolved and prism glasses were no longer required, and at 12 months, there was further tumor shrinkage.Conclusion
This case demonstrated that trochlear nerve schwannomas can undergo spontaneous regression. This case demonstrates that, in the absence of brainstem symptoms, initial observation may be a reasonable management strategy, with stereotactic radiosurgery or open surgery being reserved for cases of tumor growth or symptom progression.
Related
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BibTeX
@article{haraguchi2026spontaneous,
title = {{Spontaneous regression of a trochlear nerve schwannoma: A case report.}},
author = {Yuji Haraguchi and Masahide Matsuda and Akinari Yamano and Eiichi Ishikawa},
journal = {Surgical neurology international},
year = {2026},
month = oct,
doi = {10.25259/sni_910_2026},
url = {https://europepmc.org/article/MED/42974247},
note = {CC BY-NC-SA},
}
RIS
TY - JOUR
TI - Spontaneous regression of a trochlear nerve schwannoma: A case report.
AU - Yuji Haraguchi
AU - Masahide Matsuda
AU - Akinari Yamano
AU - Eiichi Ishikawa
PY - 2026
DA - 2026/10/09
JO - Surgical neurology international
DO - 10.25259/sni_910_2026
UR - https://europepmc.org/article/MED/42974247
AB - Background Trochlear nerve schwannoma is exceedingly rare. Little is known about its natural history, and, therefore, no consensus has been established regarding its optimal management.Case description A 60-year-old male presented with diplopia during vertical gaze. The neurological examination demonstrated a positive Bielschowsky head tilt test, with no other neurological abnormalities. The magnetic resonance imaging (MRI) revealed a well-demarcated, multiloculated cystic lesion near the right tentorial incisura that showed heterogeneous enhancement on gadolinium-enhanced T1-WI; the lesion was diagnosed as a trochlear nerve schwannoma. Because the patient had isolated right trochlear nerve palsy and only minimal radiological evidence of brainstem compression, observation with symptomatic treatment using prism glasses was selected. The MRI performed 3 months later showed tumor enlargement, at 6 months tumor had begun to shrink, by 9 months, diplopia had resolved and prism glasses were no longer required, and at 12 months, there was further tumor shrinkage.Conclusion This case demonstrated that trochlear nerve schwannomas can undergo spontaneous regression. This case demonstrates that, in the absence of brainstem symptoms, initial observation may be a reasonable management strategy, with stereotactic radiosurgery or open surgery being reserved for cases of tumor growth or symptom progression.
SN - 2229-5097
SN - 2152-7806
ER -