Surgical and histological observations of trochlear neurinoma: case report.

A 47-year-old woman presented with an extremely rare case of trochlear nerve neurinoma manifesting as left hemiparesis. Magnetic resonance imaging demonstrated a cystic tumor, 4 cm in diameter, in the right ambient and cerebellopontine cisterns, compressing the midbrain and upper pons. The preoperative diagnosis was trigeminal neurinoma. However, the tumor was identified arising from the trochlear nerve, and was totally removed via the posterior transpetrosal approach. The histological diagnosis was neurinoma. The patient's hemiparesis improved postoperatively. Preoperative diagnosis of trochlear neurinoma must distinguish the neurological presentations of trochlear and trigeminal neurinomas and to analyze the microanatomy of the tumor and skull base structures on neuroimaging.