ReviewChild's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery2026
Giant cystic intraventricular schwannoma with chronic haemorrhage in an adolescent: diagnostic pitfalls and targeted literature review.
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Abstract
backgroundIntraventricular schwannomas are exceptionally rare; fewer than fifty cases have been documented since 1957. We report an adolescent case with massive cystic degeneration and chronic intratumoural haemorrhage, and synthesise the current literature.
methodsClinical, radiological, operative, and histopathological data for a 16-year-old male were collected prospectively. A targeted literature review (1957-2025) was performed. To ensure diagnostic accuracy, imaging characteristics were analysed exclusively in cases with documented CT or MRI findings.
resultsA 16-year-old male presented with headache and left-arm tremor. CT/MRI demonstrated a 9.2 cm cystic, haemorrhagic mass in the right lateral ventricle. Gross-total resection was achieved; histology confirmed benign schwannoma (Ki-67 5%). A review of 46 cases (mean age 33.4 years; 63% ≤ 40 years; 65% male) revealed 95.7% had benign histology, and 74% of cases underwent gross-total excision, with no recurrence at a mean follow-up of 32 months. Among them, 42 cases had detailed CT/MRI data available; in this subgroup, 17 (40.5%) showed cystic degeneration, and 13 (31.0%) showed haemorrhage.
conclusionChronic haemorrhage and massive cystic degeneration can obscure the diagnosis of intraventricular schwannoma. Although these features may mimic malignant ventricular neoplasms, identifying specific signs such as haemosiderin deposition may provide critical clues for differential diagnosis. Accurate diagnosis requires clinico-radiological-pathological correlation. Complete microsurgical excision offers an excellent prognosis; however, elevated Ki-67 index warrants vigilant surveillance.
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