Object. Confusion exists regarding the term giant spinal schwannoma. There are a variety of nerve sheath tumors that, because of their size and extent, justify the label “giant schwannoma.” The authors propose a classification system for spinal schwannomas as a means to define these giant lesions. The classification is confined to tumors that are essentially intraspinal, with or without extraspinal components. Lesions that erode the vertebral bodies (VBs) and extend posteriorly and laterally into the myofascial planes are classified as giant “invasive” spinal schwannomas. Methods. The records of patients with giant invasive spinal schwannoma were analyzed. The radiological features, operative approaches, and intraoperative findings were noted. Ten patients with giant invasive tumors were surgically treated over the last 8 years. Six patients were male. Erosion of the posterior surface of the VBs was the diagnostic finding demonstrated on plain x-ray films. Magnetic resonance imaging delineated the extent of the tumors and helped in preoperative planning. Radical excision of the tumors in multiple stages was possible in eight of the 10 patients. Dural reconstruction was required in four patients. All patients required fusion, and an additional stabilization procedure was undertaken in three patients. Conclusions. The authors conclude that giant invasive schwannomas are uncommon lesions and propose a new classification system. Because of their locally “invasive” nature and extension in all directions, careful preoperative planning of the surgical approach is very important. Although radical excision is possible and promises good results, recurrences may occur and multiple surgical procedures may be required.

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Neurinomas are among the commonest extramedullary space-occupying lesions encountered in the spinal canal. The occurrence of such neoplasms in an intramedullary site, however, is rare and raises interesting questions regarding its mode of origin. For this reason the following instance of intramedullary neurinoma is recorded.Case Report K., a 35-year-old farmer (N.S. 350), was admitted to the Neurosurgical Unit, Government General Hospital, Madras, India, in 1951, for inability to move the lower limbs. The onset of his illness dated back to about nine months before admission when he noticed weakness, together with a heavy feeling of the lower limbs progressing to loss of sensation. Both these symptoms progressed so he sought medical advice. He also had difficulty in emptying his bladder completely.Physical examination disclosed that the pertinent findings were restricted to the nervous system. There were no voluntary movements in both lower limbs which were spastic and held in extension. Involuntary movements were not present and there was no muscular wasting. Examination of sensation disclosed a complete loss of appreciation of all modalities of sensation below the level of the xiphisternum. About the xiphisternum and up to about the level of the fourth dorsal dermatome there was a suggestion of dissociated sensory involvement with sparing of touch and loss of temperature and pain sensations. The knee and ankle jerks were exaggerated. An extensor type of plantar response was elicited on both sides. The patient had overflow incontinence of urine. The rest of the neurological and systemic examination was normal.Routine laboratory investigations disclosed no abnormal findings. A cisternal myelogram showed a complete arrest of " lipiodol" at the level of the second dorsal vertebra. A laminectomy was done and the only abnormality was a fusiform enlargement of the spinal cord. An incision along the posterior midline disclosed a fairly well encapsulated tumour that was removed from the substance of the cord without much difficulty. The tumour was about 1 cm. long and i cm. in diameter and tended to be more in the left than in the right half of the cord.Convalescence from surgery was uneventful and in about three months the patient had recovered sufficiently to be able to work eight to 10 hours a day on his farm. However, the loss of pain and temperature sensations between the fourth and the sixth dorsal dermatomes persisted. Four years later, in March, 1955, the patient experienced pain in the front of the chest on coughing and a heavy feeling in the lower limbs. The latter progressed to difficulty in walking and he was admitted on June 30, 1955, with weakness of the lower limbs, more marked on the left.Neurological examination revealed that the cranial nerves and upper limbs were normal. Both the lower limbs were spastic, the left more than the right. Power was markedly diminished on the left and moderately so on the right side. The muscles were not wasted and involuntary movements were absent. Examination of the deep...

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