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Decharin P, Suvithayasiri S, Nivatpumin P, Trathitephun W. Subpial Schwannoma of the Cervical Spinal Cord: A Case Report and Its Intraoperative Finding Supporting a Theory of the Pathogenesis of an Intramedullary Schwannoma. Asian J Neurosurg 2022; 17:108-111. [PMID: 35873852 PMCID: PMC9298576 DOI: 10.1055/s-0042-1748785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Because of its tumor origin from nerve sheath cells (the Schwann cells), the pathogenesis of an extraordinary rare intramedullary schwannoma, which should not have any Schwann's cells in nature, is controversial and still in debate. We report a case of a 63-year-old man diagnosed with a cervical cord intramedullary schwannoma with an interesting intraoperative finding that could support one of the theories on its genesis.
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Affiliation(s)
- Payothorn Decharin
- Department of Neurosurgery, Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Siravich Suvithayasiri
- Department of Orthopedic Surgery, Spinal Surgery Unit, Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Padungcharn Nivatpumin
- Department of Neurosurgery, Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Warayos Trathitephun
- Department of Orthopedic Surgery, Spinal Surgery Unit, Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok, Thailand
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Tahta A, Cetinkal A, Cakir A, Sekerci Z. Intramedullary schwannoma of cervicomedullary junction: A case report. Neurochirurgie 2021; 68:331-334. [PMID: 33845116 DOI: 10.1016/j.neuchi.2021.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/14/2021] [Accepted: 03/06/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Intramedullary schwannomas of brain stem and spinal cord are extremely rare. In almost all cases, homogeneous, asymmetrical or circular intensive gadolinium enhancement has been demonstrated. However, no cases reported previously with minimal contrast enhancement in cervicomedullary junction. CASE DESCRIPTION A 38-year old man presented with a one-month history of constant, radiative right shoulder and arm pain. There was no pathological finding in his neurological examination. Also, physical evidence or family history of neurofibromatosis was not found. Magnetic resonance imaging of brain and cervical spine showed intramedullary, solid-cystic lesion localized in the cervicomedullary junction with unobvious gadolinium enhancement. The mass was gross totally resected through a sub-occipital craniotomy via midline approach. Postoperative pathological examination confirmed diagnosis of schwannoma. No changes were detected in the neurological examination of the patient after the operation. CONCLUSIONS There are 3 previously reported intramedullary schwannomas of the cervicomedullary junction in the literature. To the best of our knowledge, this is the first case of unobvious contrast enhancing intramedullary schwannoma of the cervicomedullary junction. The possibility of schwannoma should not be excluded when a mass with slight contrast enhancement is detected in the intramedullary region of the cervicomedullary junction.
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Affiliation(s)
- A Tahta
- Department of neurosurgery, Istanbul Medipol University, School of medicine, TEM Goztepe exit, Bagcilar/Istanbul, Turkey.
| | - A Cetinkal
- Department of neurosurgery, Istanbul Medipol University, School of medicine, TEM Goztepe exit, Bagcilar/Istanbul, Turkey
| | - A Cakir
- Department of pathology, Istanbul Medipol University, School of medicine, Istanbul, Turkey
| | - Z Sekerci
- Department of neurosurgery, Istanbul Medipol University, School of medicine, TEM Goztepe exit, Bagcilar/Istanbul, Turkey
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Tripathi M, Dandpat S, Kaur G, Radotra B, Joshi A, Mohindra S. Cervico Medullary Junction “Intramedullary Schwannoma” Masquerading As Glioma: A Surprise During Surgery. Neurol India 2021; 69:1747-1752. [DOI: 10.4103/0028-3886.333465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Suematsu Y, Tsuji O, Nagoshi N, Nori S, Suzuki S, Okada E, Yagi M, Kameyama K, Fujita N, Watanabe K, Nakamura M, Matsumoto M. Concurrent dorsal subpial schwannoma and ventral meningioma arising at the same upper cervical level: a case report. Spinal Cord Ser Cases 2020; 6:64. [PMID: 32669553 DOI: 10.1038/s41394-020-0308-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 06/18/2020] [Accepted: 06/18/2020] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Multiple spinal cord tumors rarely occur without genetic predisposition, and concurrent tumors with discrete pathologies developed at the same spinal level are most rare. Here, we report a case of concurrent dorsal schwannoma and ventral meningioma arising at the same upper cervical level (C1-C2). CASE PRESENTATION A 55-year-old woman presented with neck pain and upper and lower extremity numbness for 1 year. Magnetic resonance imaging of the cervical spine showed a partially circumferential C-shaped intradural extramedullary tumor at C1-C2. The preoperative diagnosis based on imaging was intradural extramedullary meningioma with circumferential development. Surgical resection was performed, and dorsal subpial and ventral tumors were detected. Intraoperative pathological diagnosis was schwannoma for the dorsal tumor and meningioma for the ventral tumor. Both tumors were completely resected, followed by circumferential durotomy and duroplasty (Simpson grade 1 resection). Although symptoms related to cerebrospinal fluid hypovolemia occurred immediately after surgery, they disappeared within several days. At 2 years postoperatively, no local recurrence has been identified with mild kyphotic cervical malalignment. DISCUSSIONS Only nine cases of concurrent multiple spinal tumors with discrete histopathological types at the same cervical level have been reported to date, however, this is the first case of meningioma combined with subpial schwannoma. Furthermore, although the ventral location of meningioma often compelled inadequate resection leaving behind a dura mater from which meningioma originated, a gross total resection including dura mater was achieved accompanied with circumferential duroplasty. Careful and sequential postoperative follow-up is ongoing for this individual.
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Affiliation(s)
- Yu Suematsu
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Osahiko Tsuji
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan.
| | - Narihito Nagoshi
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Satoshi Nori
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Satoshi Suzuki
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Eijiro Okada
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Mitsuru Yagi
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Kaori Kameyama
- Division of Diagnostic Pathology, Keio University School of Medicine, Tokyo, Japan
| | - Nobuyuki Fujita
- Department of Orthopaedic Surgery, Fujita Health University, Aichi, Japan
| | - Kota Watanabe
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Masaya Nakamura
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Morio Matsumoto
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
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Dhake RP, Chatterjee S. Recurrent thoracic intramedullary schwannoma: report of two cases with long term follow up. Br J Neurosurg 2019; 36:647-650. [PMID: 30836024 DOI: 10.1080/02688697.2019.1566516] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Occurrence of intramedullary schwannomas is rare as Schwann cells are generally present in the nerve root and not in the spinal cord. To date, approximately around 60 cases of intramedullary schwannoma in patients without neurofibromatosis have been reported in the English literature, of which only eight were children. We describe two cases of thoracic intramedullary schwannomas that recurred after primary excision. A 10 years old boy presented with weakness of both lower limbs. Magnetic resonance imaging showed a D10 to D12 intramedullary lesion, which was excised near totally and confirmed to be a schwannoma on histopathological examination. The tumour recurred twice after that and was re operated both times. Another 57 years old lady presented with weakness of both lower limbs and a history of being operated in the past for D9-D10 intramedullary lesion. She was re-operated with total removal of the lesion confirmed to be schwannoma on histopathological examination. Intramedullary schwannoma may recur after resection.
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Yang T, Wu L, Deng X, Yang C, Xu Y. Clinical features and surgical outcomes of intramedullary schwannomas. Acta Neurochir (Wien) 2014; 156:1789-97. [PMID: 25052458 DOI: 10.1007/s00701-014-2168-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Accepted: 06/20/2014] [Indexed: 11/24/2022]
Abstract
OBJECT Intramedullary schwannomas are exceedingly rare. Most previous studies are case reports with an associated literature review. The aim of this study was to discuss the clinical features and the outcomes of microsurgery for these rare lesions. METHODS The authors retrospectively reviewed the data of twenty patients with intramedullary schwannomas. All patients had performed preoperative and postoperative magnetic resonance imaging (MRI) and underwent microsurgery. The diagnosis of intramedullary schwannomas was based on radiological and pathological criteria. Modified McCormick classification was applied to assess neurological function. RESULTS There were 15 males and five females with a mean age of 44.7 years. Ten tumors were located in the cervical cord, five in the thoracic cord, two in the cervicothoracic cord, two in the thoracolumbar cord and one in the conus medullaris. Patients presented with nonspecific symptoms and the mean duration of symptoms was 37.4 months. Intraoperatively, the tumor was connected to the dorsal rootlet in four cases. Gross total resection (GTR) of the tumor with a well-demarcated dissection plane was achieved in 16 cases, and subtotal resection (STR) was achieved in four cases. No patients received postoperative radiotherapy. During a mean follow-up period of 67.9 months, no recurrence or regrowth of the residual tumors was observed on MRI. Ninety percent of patients experienced an improvement in the McCormick grade and 10 % of patients maintained their preoperative status. CONCLUSIONS Intramedullary schwannomas are benign but clinically progressive lesions. The accurate diagnosis depends on pathology. For symptomatic patients, early surgery should be performed before neurological deficits deteriorate. When GTR cannot be achieved, STR of the tumor for decompression is advised. Postoperative radiotherapy is not recommended for these benign tumors. A good clinical outcome after GTR or STR can be expected.
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Affiliation(s)
- Tao Yang
- Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, No.6 Tiantan Xili, Dongcheng District, Beijing, 100050, China,
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Hayashi F, Sakai T, Sairyo K, Hirohashi N, Higashino K, Katoh S, Yasui N. Intramedullary schwannoma with calcification of the epiconus. Spine J 2009; 9:e19-23. [PMID: 19138570 DOI: 10.1016/j.spinee.2008.11.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2008] [Revised: 11/02/2008] [Accepted: 11/17/2008] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT There have been few reports on intramedullary ancient schwannoma. Schwann cells are generally present in the nerve root, not in the spinal cord. Thus, intramedullary schwannomas are rare, and in most cases there is cyst formation without calcification. PURPOSE To report a patient with intramedullary ancient schwannoma at the epiconus together with a review of the previously published cases. STUDY DESIGN Case report. PATIENT A 78-year-old woman. METHODS Retrospective case review. DESCRIPTION OF THE CASE A 78-year-old woman had presented with severe weakness of the lower extremities, increased patellar reflex, and sensory disturbance of the entire lower extremities. Magnetic resonance imaging showed a tumorous mass in the intramedullary region of epiconus at T11-L1, and computed tomography revealed calcification in the tumor. She underwent total resection of the tumor. Histopathological findings were consistent with the diagnosis of ancient schwannoma. After the operation, although lower extremities weakness and sensory disturbance deteriorated transiently, lower leg pain disappeared. At the final follow-up of 10 months after the operation, lower leg pain did not relapse. CONCLUSION We reported a rare case presenting epiconus syndrome due to intramedullary ancient schwannoma, which should be considered for the differential diagnosis of a tumor that shows calcification.
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Affiliation(s)
- Fumio Hayashi
- Department of Orthopedics, Institute of Health Biosciences, The University of Tokushima Graduate School, Tokushima, Japan
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