Magnetic Resonance Imaging Features of Intramedullary Schwannomas

Clinical Features and Surgical Management of Intramedullary Schwannoma of the Spinal Cord

BACKGROUND

Intramedullary schwannoma is a relatively rare tumor with only a few literature reports. This study was aimed to report the clinical characteristics of intramedullary schwannoma and discuss imaging findings and treatment strategies.

METHODS

The inclusion criterion was consecutive patients with intramedullary schwannomas who were surgically treated in our institution between 2017 and 2022. Data included clinical characteristics, radiologic features, surgical management, and prognosis. Clinical and follow-up details of all cases were collected and reviewed.

RESULTS

This study included 3 male and 8 female patients. The mean age was 45 years (range 26-77 years). Cervical spine (4 cases, 36.4%), thoracic spine (4 cases, 36.4%), and lumbosacral spine (3 cases, 27.3%) involvement was found. Weakness, numbness and pain of limbs were the main symptoms at administration. Preoperative magnetic resonance imaging demonstrated lesion with spinal cord medullary invasion and well demarcated margins. The postoperative histologic examination showed benign lesions and confirmed the schwannoma.

CONCLUSIONS

This article presented a series of 11 cases of intramedullary schwannoma with sharp margins and well-enhanced features. Prognosis and functional recovery were good after gross total resection.

Spinal intramedullary schwannoma: Report of two cases with review of the literature

INTRODUCTION

Spinal tumors comprise 15 % of all central nervous system tumors, with schwannomas accounting for 30 % of primary intraspinal neoplasms. While predominantly extramedullary-intradural, spinal schwannomas rarely manifest intramedullary occurrences (0.3 % of intraspinal tumors). This study sheds light on two rare cases of thoracic intramedullary schwannomas, emphasizing their diagnostic complexities and surgical management, alongside a literature review.

CASE PRESENTATION

Case 1 involves a 50-year-old female presenting with worsening back pain, right lower limb weakness, and urinary incontinence. MRI revealed an intradural intramedullary soft tissue mass, diagnosed as a schwannoma with an associated organizing hematoma. Surgical removal led to gradual improvement. Case 2 features a 25-year-old male with back pain, partial foot drop, and weakness in the right knee and hip. MRI demonstrated an intradural intramedullary lesion, later confirmed as an intradural intramedullary schwannoma. Surgery resulted in a smooth recovery without adverse effects.

DISCUSSION

This article presents two cases of intradural intramedullary thoracic schwannomas initially misdiagnosed as astrocytomas. Surgical resection confirmed the diagnosis, underscoring challenges in preoperative MRI diagnosis. The review of 174 reported cases reveals an equal distribution between the cervical and thoracic regions, with males affected 1.5 times more frequently than females. The average age of onset is 40, and surgical treatment demonstrates a 90 % improvement rate. The complex pathogenesis encompasses six proposed explanations. Clinical suspicion, considering pain and neurological symptoms, is paramount due to potential misdiagnosis and the imperative for histological confirmation.

CONCLUSION

Although rare, intramedullary schwannomas (IMS) have significant clinical implications, necessitating precise treatment. Surgical resection yields favorable outcomes, with subtotal resection considered based on adhesion factors. Pre-surgical diagnosis requires a comprehensive integration of radiological and clinical data, with intraoperative analysis ensuring optimal treatment strategies.

Multiple thoracic intramedullary schwannoma: A case report

INTRODUCTION AND IMPORTANCE

Schwannoma's are benign but clinically progressive tumours. Mostly, they present as intradural extramedullary and as a single lesion. They are quite rare in the intramedullary region and multiple lesions. We report a rare case of Multiple Intramedullary Schwannoma in the thoracic region. The aim of this study to inform an uncommon case of intramedullary schwannoma and support an appropriate preoperative diagnostic.

CLINICAL PRESENTATION

A 43-year-old female patient was admitted with gradual onset weakness of both lower limbs (4/2) for last two months. Magnetic resonance imaging (MRI) scan disclosed an intramedullary tumour at the thoracal 11th and 12th vertebral levels. It measured 30x20x15 mm and 20x20x12 mm. Complete total resection of multiple lesions was done. Schwanoma's was confirmed based on the histopathological finding. The patient was discharged on 4th day post operative with both leg power 5/5 and needed to medical rehabilitation. Follow-up examination 1 months after surgery revealed favourable, neurological condition (modified McCormick scale: grade I).

CLINICAL DISCUSSION

Intramedullary schwannoma is often misdiagnosed as other types of intramedullary tumour. Schwannomas are usually benign and have well defined cleavage plane. Total resection achievable in most cases, offers the best clinical outcome and avoids subsequent recurrence.

CONCLUSION

Preoperative diagnosis of intramedullary schwannoma will help establish the optimum medical and surgical treatment and the prognosis. Timely surgery before permanent neurological deficit and gross total resection is recommended to achieve good clinical outcome.

Spinal intramedullary schwannomas-report of a case and extensive review of the literature

Intramedullary schwannomas (IMS) represent exceptional rare pathologies. They commonly present as solitary lesions; only five cases of multiple IMS have been described so far. Here, we report the sixth case of a woman with multiple IMS. Additionally, we performed the first complete systematic review of the literature for all cases reporting IMS. We performed a systematic review of the literature in PubMed, EMBASE and Cochrane Central Register of Controlled (CENTRAL) to retrieve all relevant studies and case reports on IMS. In a second step, we analysed all reported studies with respect to additional cases, which were not identified through the database search. Studies published in other languages than English were included. One hundred nineteen studies including 165 reported cases were included. In only five cases, the patients harboured more than one IMS. Gender ratio showed a ratio of nearly 3:2 (male:female); mean age of disease presentation was 40.2 years; 11 patients suffered from neurofibromatosis (NF) type 1 or 2 (6.6%). IMS are rare. Our first systematic review on this pathology revealed 166 cases, including the here reported case of multiple IMS. Our review offers a basis for further investigation on this disease.

Intramedullary Schwannoma of Cervical Spinal Cord Presenting Inconspicuous Enhancement with Gadolinium

BACKGROUND

Intramedullary schwannomas of the spinal cord are extremely rare. Most previous studies are case reports, which have found that intramedullary schwannomas could be homogeneous or asymmetrically enhanced with gadolinium. However, intramedullary schwannomas with minimal enhancement have not been reported.

CASE DESCRIPTION

This article describes a 34-year-old patient who presented with nonradiative neck pain, progressive weakness of the left limbs, and sensory deficit of both lower extremities. Preoperative examinations such as magnetic resonance imaging (MRI) were performed, and the patient underwent surgical treatment. MRI showed that the lesion presented unsharp enhancement with gadolinium on T1-weighted images. Histopathologic findings were consistent with the diagnosis of schwannoma.

CONCLUSIONS

We report a case of intramedullary schwannoma that presented inconspicuous enhancement with gadolinium. MRI is useful but cannot be used to differentiate schwannomas from other intramedullary spinal tumours. Surgical resection is the most vital factor for the treatment of intramedullary schwannoma.

Pediatric intramedullary schwannoma with syringomyelia: a case report and literature review

Background

Intramedullary schwannomas without neurofibromatosis are exceedingly rare. They are rarer in children with only 8 cases reported so far. The association of intramedullary schwannomas with syringomyelia is also rare. Here, we present a case of intramedullary schwannoma with syringomyelia treated surgically in an 9-year-old boy.

Case presentation

We reviewed the clinical course of a 9-year-old boy, who presented with both lower extremity weakness of 6-month duration. Neurophysical examination revealed a decreased sensation below the T10 dermatome. Magnetic resonance imaging (MRI) showed an well-demarcated intramedullary lesion located at the level of T8 vertebra with isointensity on T2WI and hypointensity on T1WI, which was homogeneous enhanced after gadolinium injection. There was associated syringomyelia extending from T7 down to the level of T10. A mild scoliotic deformity was also observed. The lesion was totally resected after an T7-T8 laminoplasty. Histopathological findings were consistent with schwannoma. Postoperative MRI did not reveal the presence of a residual tumor with syringomyelia reducted. By 2 weeks after treatment, the patient had experienced nearly complete recovery. Management with external bracing was performed on this patient for 3 months after surgery to prevent spinal deformity. However, mild spinal kyphosis occurred 5 months after surgery, and a progressive postoperative spinal kyphosis was observed during these 3 years of follow-up. Continued conservative management with observation was performed as there is no association with functional decline and impairment in health-related quality-of-life measures.

Conclusion

Although extremely rare and uncommonly associated with syringomyelia, schwannomas need to be considered in the preoperative diagnosis of solitary intramedullary tumors in children as total resection can be achieved improving surgical outcome; Pediatric patients should be monitored closely for the development of spinal deformity following resection of intramedullary schwannoma, particularly possessing preoperative scoliotic deformity and/or tumor-associated syringomyelia.

Isolated Pediatric Intramedullary Schwannoma: Case Report and Review of Literature

BACKGROUND

Intramedullary (IM) schwannomas are rare entities representing 0.3%-1% of intramedullary tumors and 1.1% of spinal schwannomas. Beside many theories proposed, their rare occurrence might be related to the absence of Schwann cells in the spinal cord. Pediatric IM schwannomas are uncommon, and in the absence of neurofibromatosis they are extremely rare. To date, few cases have been reported in the literature.

CASE DESCRIPTION

We describe the case of an 8-year-old female affected by a progressive paraparesis. Neuroradiologic investigations showed an oval-shaped mass at the level of T10-T11. The patient underwent surgery, performed under neurophysiologic monitoring. The patient was operated on with complete removal of the lesion. The postoperative course was uneventful.

CONCLUSIONS

The clinical, neuroradiologic, and intraoperative findings are presented, along with a review of the literature. Despite the number of lesions potentially compressing the spinal cord, IM schwannoma is rare but should be taken into account in the differential diagnosis.