• Maria M Santos, Ângela Timóteo, Domingos Coiteiro, and José Pimentel.
• Department of Neurological Surgery, Centro Hospitalar Lisboa Norte, Entidade Pública Empresarial, Lisbon, Portugal. Electronic address: mariamanesantos@gmail.com.
• World Neurosurg. 2015 Nov 1;84(5):1493.e9-13.

ObjectiveWe report an uncommon case of a surgical resection of a fourth ventricle tumor in an adult that proved to be a schwannoma.MethodsA 53-year-old man presented with a 1.5-year history of gait unsteadiness and vertigo and a few-week history of headache, emesis, and neurogenic dysphagia. A brain magnetic resonance imaging revealed a large, heterogeneously contrast enhancing mass located within the fourth ventricle, compressing the brainstem and causing supratentorial ventricle enlargement. A suboccipital craniotomy and a telovelar approach were performed to resect the tumor. The ventricular system was repermeabilized at the end of the operation.ResultsA postoperative magnetic resonance imaging confirmed complete tumor removal. There was an initial worsening of the preoperative deficits, which progressively improved. The tumor was classified as a fourth ventricle schwannoma. There has been no evidence of tumor recurrence during the 6 years of follow-up. At present, the patient is ambulatory and reports an intermittent diplopia on conjugated gaze.ConclusionThis case report intends to reveal the eighth case of a fourth ventricle schwannoma since 1957. Schwannomas of the fourth ventricle are infrequent but should be accounted in the differential diagnosis of space-occupying lesions in this location. Gross total resection might be the definite treatment of these tumors if deemed possible.Copyright © 2015 Elsevier Inc. All rights reserved.

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