Giant intrasacral schwannomas: Report of six cases

Abstract

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 dumbbell growth pattern due to tumour extension through sacral foramina which are important data for making a pro-operative 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.

MR imaging features of giant pre-sacral schwannomas: a report of four cases

“…This is typically anteriorly into the pelvic cavity [3,5,9,11,12] but can be posteriorly [2] or combined [6,8]. In contrast, giant presacral schwannomas (GPSS), as illustrated in this small series and a recent case report [12], presumably arise from a peripheral nerve in or adjacent to an anterior sacral foramen.…”

“…The largest published series of 13 cases of GSS collected over 33 years predated the routine use of MR imaging [3]. A more recent study describes the use of MR imaging in 5 of 6 cases but, as in many of the reported cases, the tumours were primarily intra-rather than presacral in origin [9]. The purpose of this report is to describe the MR features of giant presacral schwannomas (GPSS) which arise on the surface rather than within the sacrum.…”

“…One to 5% of spinal axis schwannomas arise in the sacrum [2] and frequently grow to considerable size before detection; hence, the term giant sacral schwannoma (GSS). To date, less than 40 cases of GSS have been described, often single case reports, predominantly in the orthopaedic and neurosurgical literature [2,3,4,5,6,7,8,9,10,11,12]. The largest published series of 13 cases of GSS collected over 33 years predated the routine use of MR imaging [3].…”

Presacral Schwannoma Resected Via Anterior Trans Peritoneal Approach: A Case Report

“…Presacral schwannomas are rare accounting for 1-5% of spinal schwannomas [2][3][4]. Less than 30 cases of presacral schwannoma have been reported in English literature [5].…”

Ancient Schwannoma of the Cauda Equina: Our Experience and Review of the Literature

“…To the best of our knowledge, there are only 2 cases previously reported of AS involving cauda equina [1, 2], an exceedingly rare schwannoma subtype for an extremely uncommon location. Although reported to affect head and neck, cervical region, limbs, pelvis, and retroperitoneum [1–5], it is uncommon is the spinal cord [6–10] but cauda equina involvement is exceptional.…”