The Management of Sacral Schwannoma: Report of Four Cases and Review of Literature (original) (raw)
Related papers
Neurosciences (Riyadh, Saudi Arabia), 2014
Schwannomas are benign encapsulated tumors of Schwan cells that grow slowly along the peripheral myelin nerve fibers. Sacral spinal schwannomas are very rare, and the incidence of sacral schwannoma ranges from 1-5% of all spinal schwannomas, and only around 50 cases are reported in the literature. There are 3 defined types of sacral schwannomas. These are retroperitoneal or presacral, intra osseous, and spinal schwannomas. Patients commonly present with complaints of pain and paresthesia due to the spinal schwannoma extending to extra spinal tissues. Direct x-ray, CT, MRI, and scintigraphy are used for preoperative diagnosis and treatment planning. Local recurrence and transformation to malignancy is very rare. For this reason, the frequently preferred treatments are subtotal removal of the mass or simple enucleation. In our article, we discuss the clinical features and the surgical treatment we performed without the need for stabilization in an incidentally determined giant invasiv...
Journal of Neuro-Oncology, 2012
Sacral schwannomas are very rare tumors. There are merely around 50 cases reported in the literature most of which are case presentations. In this study we present a 13-case series, which is one of the most extensive series in the literature. Thirteen giant sacral schwannoma cases operated at Ege University, Faculty of Medicine, Neurosurgery Department between 1995 and 2010 are investigated retrospectively. All patients were assessed with direct radiography, computerized tomography (CT) and magnetic resonance imaging (MRI). The patients were operated, after the diagnosis through biopsy patients with Sridhar Type V classification are included in the study. Five patients were male, eight were female and the average age was 37.1 (ranging between 14 and 55). All the patients were suffering from back and leg pain at the time of consultation. Four patients had sphincter problems and three had weakness in the leg. After the biopsy and histological analysis, intralesionary resections were performed. Five patients went through both anterior and posterior interventions, six patients had only posterior and two had just anterior intervention. One patient had iliac vein injury during the anterior surgery. This patient was reoperated for embolectomy and vein graft because of thrombosis. Average follow-up period was 8.1 years (1-15 years). All patients were assessed with MR annually. A small residual tumor was detected in two patients, however they were not reoperated. Although sacral schwannomas are rare tumors, the diagnosis is not so difficult with CT and MRI. In this study, we suggest biopsy for predetermination of the nature of the tumor as it affects the treatment choice and the method of operation. Surgically, a simple intralesionary excision is an appropriate choice.
Journal of Surgical Case Reports, 2021
Schwannomas are mainly benign tumors arising from the Schwann cells of the peripheral nerve sheath. These tumors can often be associated with non-specific symptoms, such as abdominal heaviness. In this article, we present a detailed description of the surgical management of a giant sacral schwannoma in an elderly patient, for which intraoperative neuromonitoring made it possible to distinguish easily the nerves of the sacral plexus from which the tumor originated and to remove it without complications. Treatment of these rare and symptomatic giant tumors is still a challenge for surgeons; to treat adequately these tumors; a multidisciplinary approach is required to ensure an optimal therapeutic approach to reduce the risk of recurrence and, on the other hand, is not associated with unnecessary iatrogenic neurological damage.
Retrorectal Schwannomas: Atypical Presentation and Controversial Surgical Management
2021
Schwannomas also known as neurilemomas are benign tumors. Retrorectal schwannomas are extremely rare, accounting for 1 to 5% of all schwannomas. They are mostly asymptomatic but may present with symptoms such as pelvic pain, back pain, lower extremities pain, or constipation. Physical examination is often poor. Imaging (CT, MRI) and fine needle biopsy can often help orient the diagnosis. The treatment of choice is monoblock resection of the mass. The prognosis is good. Recurrence has been reported especially after intralesional enucleation. We report a case of a 41-year-old male patient consulting for chronic low back pain eventually diagnosed with retrorectal schwannoma. We performed a surgical resection and the histological examination was consistent with the diagnosis of benign (ancient) schwannoma.
Giant intrasacral schwannomas: Report of six cases
Acta Neurochirurgica, 1997
Only 4 of the 30 previously reported cases of giant sacral schwannomas have been studied with Magnetic Resonance Imaging (MRI). We are reporting 6 more cases, 5 of which had MRI studies. There were 5 women and 1 man (average age 45 years) with long lasting symptoms consisting of lumbosacral and radicular pain accompanied by urinary disturbances and dysaesthetic sensations in the lower limbs. CT clearly defined sacral bone involvement but poorly demonstrated intraspinal tumour extension which was more evident in MRI studies. MRI also clearly showed the intrapelvic extension of the tumour, its relationship with the neighbouring structures and the dumbell growth pattern due to tumour extension through sacral foramina which are important data for making a properative diagnosis and surgical planning. Surgical treatment consisted of piecemeal tumour resection through a posterior approach in four cases. Two patients underwent operation through an abdominal transperitoneal approach followed by a sacral laminectomy. Total intracapsular resection was apparently achieved in 5 cases. Through an average follow-up period of 9.2 years and despite a rather conservative approach, the recurrence rate has been very low in our series and only one patient had to be re-operated on for tumour recurrence.
Turkish Neurosurgery, 2015
tumors, particularly in adults (8). Rarely, SS have possibility of malignancy and therefore the recommended primary treatment of choice is gross-total resection (GTR) with preservation of neurological function. GTR of these lesions, which is the main goal of surgical treatment, leads to good results. Giant dumbbell SS, which extends anteriorly to invade the bones, vascular structures, and soft tissues and fill the abdominal and thoracic cavities as same as extradural location █ InTRODuCTIOn S pinal schwannomas (SS) are well known, macroscopically solid encapsulated, spindle cell mesenchymal tumors which are called neurinomas in the literature. Although they are mostly benign entities derived from neoplastic schwann cells, SS have possibility of malignant transformation (10,15). SS represent the most common intradural extramedullary lesions, accounting for about one fourth of all nerve sheath AIM: Spinal schwannomas (SS) represent the most common intradural extramedullary lesions, accounting for approximately 24% of all nerve sheath tumors in adults. Schwannomas have infrequent, but existent possibility of malignancy. In this study, long-term outcomes of 49 consecutive SS have been presented. MATERIAL and METhODS: Medical records were retrospectively reviewed in 371 cases of spinal tumors who underwent surgery between the years 2005 and 2014. Cases confirmed as schwannoma histopathologically were included in this study. Patients' complaints, localizations, recurrence rate and complications were evaluated. RESuLTS: Forty-nine cases were detected in 47 (26 female, 21 male) patients. The mean age was 45.8±13.7 years. The mean follow-up period was 61.4±21.5 months. The most common complaint was local pain. Eleven were cervical, ten thoracic, twentyfour lumbar, and four in the sacral spine. Thirty-three cases were intradural-extramedullary, fifteen cases were the extradural type, and one case was the extra-intradural type. Recurrence rate was 4.08%. Gross-total resection (GTR) was achieved in forty-seven patients. The most common complications were surgical site infection and intraoperative instability that were seen in three patients each. Posterior instrumentation was performed in two patients. COnCLuSIOn: SS is mostly benign and intradural-extramedullary. To treat patients with SS, there is no need for adjuvant treatments; GTR with preservation of neurological functions is the best treatment to relieve patients' complaints and to reduce the recurrence rate of SS. To avoid serious complications, we recommend intraoperative neurophysiological monitoring and laminoplasty, especially in young patients. Dumbbell SS may require extensive bone resection. Posterior instrumentation can be used if instability occurs.
High cervical spinal schwannoma; microneurosurgical management: an experience of 15 cases
Acta Neurologica Taiwanica, 2013
PURPOSE: Schwannoma arising from high cervical spinal root are common among the spinal schwannomas.Here, we prospectively recorded the clinical features, radiological features, surgical approaches & findings,postoperative follow up & ultimate neurological outcome of high cervical spinal schwannomas and then we evaluated the records retrospectively.METHOD: Here, schwannomas arising from C1, C2 and C3 spinal nerve roots were regarded as high cervical spinal schwannoma. All patients with high cervical spinal schwannomas that were consecutively operated micro-neurosurgically from 2006-2010 were included in the study. Postoperatively all patients were followed up regularly both clinically and neuro-radiologically (MRI of cervical spine).RESULTS: Average follow up was 31.5 months. The mean age of the series was 35.8 years (range 10-61 years). There were 8 male and 7 female patients. The mean duration of symptoms at the time of presentation was 32 months (range 06 months-5 years). Two schwannomas were completely extradural, seven were intradural and rest six were interdural or hourglass type (both extra and intradural) as identified during surgery. The standard midline posterior approach was used in all patients. A C2 hemilaminectomyor C2 laminectomy with or without cutting of posterior arch of atlas was used for most intradural and large interdural C2 schwannomas. Tumor removal was complete in all cases. Preservation of the nerve root fibers was not possible in 9 cases and was possible only in 3 cases. In two patients CSF leak developed after operation. One patient who had severe myelopathic features with bed sore failed toimprove and expired 5 months after operation. Rest of the patients showed postoperative improvement in their preoperative symptoms and returned to their normal life by the end of sixth month. There was no tumor recurrence in any patient till last follow up.CONCLUSION: Proper 3-D anatomical orientation & physiological knowledge, deep neuro-radiological observation,pathological appreciations and micro-neurosurgical skill and expertization can make the surgical management of these tumors ( in a surgically complex site) simple with gratifying result (i.e.neurological outcome) without extensive bone removal or soft tissue manipulation through a standard midline posterior approach.
Spine, 2015
Retrospective analysis of 169 adult patients operated for a conventional spinal schwannoma from the AOSpine Multicenter Primary Spinal Tumors Database. To identify risk factors for local recurrence of conventional spinal schwannoma in patients who had surgery. Schwannomas account for up to 30% of all adult spinal tumors. Total resection is the gold standard for patients with sensory or motor deficits. Local recurrence is reported to be approximately 5% and usually occurs several years after surgery. Rates and time of local recurrence of spinal schwannoma were quantified. Predictive value of various clinical factors was assessed, including age, gender, tumor size, affected spinal segment, and type of surgery. Descriptive statistics and univariate regression analyses were performed. Nine (5.32%) out the 169 patients in this study experienced local recurrence approximately 1.7 years post-operatively. Univariate analyses revealed that recurrence tended to occur more often in younger pat...
Spinal Schwannoma : Scrutinizing the Armamentarium of a Single Institute
Journal of the Royal Medical Services, 2018
Objectives: To investigate the clinical characteristics, epidemiological features of spinal schwannomas diagnosed at a single institution. Methods: A retrospective study carried out of all consecutives 67-patients presented with spinal schwannoma treated at the neurosurgery department in King Hussein Medical Center. Clinical information, imaging studies, and biopsy results were compiled from all consecutive patients (all cases were included) treated in our setup over a period of 10-years from January 2006 to January 2016. Results: Study cohort consisted of 38-females (56.71%) and 29-males (43.28%), with ages ranging from 17 to 75 years (mean: 41.45 ± 13.74 yr). The most common initial symptom was radicular pain (46 patients, 68.65%). The most common regions of involvement were the lumbar spine (37 patients, 55.22%), followed by cervical (16 patients, 23.88%), thoracic segments (12 patients, 17.91%) and sacral region (2 patients, 2.98%). In the total population of 67-cases, the schwannomas were intradural extramedullary in 65-cases (97.01%) and in 2-cases it was extradural (2.98%). Three cases (4.47%) recurred locally. Conclusion: Spinal schwannomas are benign tumors that can cause significant neurological deficits. Lumbar spine is the most common site of spinal schwannomas according to this study. Surgery for spinal schwannomas usually results in excellent postoperative clinical outcomes. Schwannoma is generally separable from the underlying nerve. In cases of subtotal removal, there could be a recurrence.