Expert: Claes-Gustaf Nordquist, M.D. - 9/12/2009

Question
My daughter is 2 and 1/2.  She has been complaining that her head hurts in the back lower part of her head and has been very moody for about two weeks.  Two days ago her daycare teacher called and said she was stumbling around and didn't "seem to be herself."  We took her to the ER where she had an MRI and a CT scan.  They found two things on the MRI, a Chiari malformation and a mass, described as golf ball size.  The ER doc said it looked like a mass in the sinuses, possibly mucus or sinus fluid, and referred us to an ENT.  We saw him yesterday, and he thinks it is a schwannoma on the trigeminal nerve, but is scheduling a biopsy to be sure.  On the MRI and CT, it looks like it is pushing against the sinus cavity and is pressing up against the left eye orbit. Is this a difficult location to operate in, and have you ever heard of that size schwannoma on a 2 year old? The doctor said it was very unusual to see something that size in a child her age.
Thanks!

Answer
Yes it is most unusual. How big is it? The treatment here is surgical - unless the tumor is small enough to allow stereotactic radiation therapy - so you should discuss the surgical procedures with her ENT dr as that is outside my area of expertise here. Please do keep me posted!