Giant Invasive Lumbosacral Spinal Schwannoma

Abstract

Schwannoma is a tumor that comes from neural crest-derived Schwann cells. It comprises about 25%–30% of all spinal tumors. Giant invasive schwannoma of the spine is a neoplasm that extends in two or more levels of vertebrae, makes an erosion of vertebral bodies, and extends also into the extraspinal space. We report a case of giant invasive lumbosacral spinal schwannoma, clinical pictures, surgical procedures, and outcomes. A 25-year-old female came to our hospital with weakness of both lower extremities with progressive pin-and-needle sensation in both legs, followed by numbness that gets worsened for the past 2 years ago. Physical examination revealed paresthesia at dermatome L4, L5, S1 on both sides and physiological reflexes diminished on both sides. Motor examination showed decreasing activities of knee extension, ankle dorsiflexion, great toe extension, and ankle plantar flexion on both sides. Contrast lumbosacral magnetic resonance imaging showed hypointense and hyperintense lesion at L2–L3–L5–S1 extending to corpus L4 that enhanced with contrast administration on T1- and T2-weighted image. Myelogram showed obliteration of subarachnoid cerebro-spinal fluid (CSF) space. The patient underwent tumor resection and posterior stabilization. 90% of the tumor was resected. Good result was achieved after surgery. Surgery is the gold standard for this tumor, the goal of which is decompression of the nerve. Because of extensions of this tumor, careful preoperative planning and careful resection are very important. Gross total removal should improve neurological deficits. Further follow-up is required.