Concurrent spinal nerve root schwannoma and meningioma mimicking single-component schwannoma

K, Baral A. Bilateral vestibular schwannoma with a cooccurring meningioma in a child: a case report and review of literature

Introduction

Meningioma and vestibular schwannoma (VS) are the first and second most common benign central nervous system tumors. The coexistence of VS and meningioma presents a rare clinical scenario, particularly in pediatric patients. This report presents a case of bilateral VS with a cooccurring meningioma in a Nepali child and provides an overview of the literature on this condition.

Case report

A 15-year-old male presented with bilateral sensorineural hearing loss, seizures, and neurological deficits and was ultimately diagnosed with concomitant bilateral acoustic neuroma and meningioma. The patient underwent radiosurgery for bilateral VS and nonoperative management of the meningioma. Long-term follow-up revealed symptomatic improvement, emphasizing the importance of a multidisciplinary approach in managing such complex cases. The management of these tumors requires tailored treatment strategies guided by tumor characteristics and associated risks.

Discussion

Meningioma and VS are common tumors of the central nervous system. Their coexistence is possible in neurofibromatosis type 2 but is exceedingly rare in pediatric age group. The tumors, often coexisting, pose diagnostic challenges. Diagnosis relies on clinical and genetic features, with multidisciplinary management involving various specialists. Treatment aims to preserve function and quality of life, utilizing approaches such as bevacizumab and surgical intervention. The role of radiation therapy remains uncertain. Genetic testing and regular monitoring are vital for early detection and intervention.

Conclusion

The cooccurrence of acoustic neuromas and meningiomas is poorly understood, with limited reported cases and unclear pathophysiological mechanisms. Further research into the genetic and molecular mechanisms underlying the coexistence of these tumors is needed to optimize patient outcomes in this rare clinical entity.

Combined radiomics nomogram of different machine learning models for preoperative distinguishing intraspinal schwannomas and meningiomas: a multicenter and comparative study

AIMS

The objective of our study was to establish and verify a novel combined model based on multiparameter magnetic resonance imaging (MRI) radiomics and clinical features to distinguish intraspinal schwannomas from meningiomas.

MATERIALS AND METHODS

This research analyzed the preoperative magnetic resonance (MR) images and clinical characteristics of 209 patients with intraspinal tumors who received tumor resection at three institutions. 159 individuals from institutions 1 and 2 were randomly assigned into a training group (n=111) and a test group (n=48) in a 7-3 ratio. A nomogram was constructed using the training cohort and was internally and externally verified in the test cohort and an independent validation cohort (n=50). Model performance was assessed utilizing the area under the curve (AUC) of receiver operating characteristics (ROC), decision curve analysis (DCA), and calibration curves.

RESULTS

The nomogram exhibited superior predictive efficacy in distinguishing between spinal schwannomas and meningiomas when compared to both the radiomics model and the clinical model. The nomogram yielded AUCs of 0.994, 0.962, and 0.949 in the training, test, and external validation cohorts, respectively, indicating its exceptional differentiating ability. The DCAs demonstrated that the nomogram yielded the best net benefit. The calibration curves indicated that the nomogram got good agreement between the predicted and the actual observation.

CONCLUSION

This research suggests that the nomogram incorporating clinical and radiomic features may be an effective auxiliary tool for distinguishing between intraspinal schwannomas and meningiomas, and has important clinical significance for clinical decision-making and prognosis prediction.

Concurrent spinal meningioma and giant invasive schwannoma without neurofibromatosis in children: A case report and literature review

BACKGROUND

Spinal meningiomas coexisting with schwannomas in patients without neurofibromatosis are extremely rare lesions. There were only 15 cases reported to date, which were concurrent intradural tumors of different pathological types.

CASE PRESENTATION

Herein, we present a rare case of a 15-year-old child with concurrent spinal dorsal meningioma and ventral giant invasive schwannoma at C7-T3 and T10-S5 spinal levels. Preoperative magnetic resonance imaging and computed tomography indicated the schwannoma across the thoracic and lumbosacral transitional vertebra, with extensive bony erosion of the sacrum. The results of surgical resection were mostly satisfactory.

CONCLUSIONS

The present case is the youngest patient diagnosed with concurrent intradural tumors at different spinal levels. The pathogenetic mechanism remains unclear. The clinical presentations are always atypical. Surgical resection of the tumors is the first choice. We use the non-fusion surgery to preserve the function of the lumbar spine.

Diagnostic value of MRI in coexistence of schwannoma and meningioma mimicking a single dumbbell-shaped tumor in high cervical level. Case series and literature review

CONTEXT

Concurrent schwannoma and meningioma arising in the high cervical level mimicking a single dumbbell-shaped tumor is significantly rare, most of them were found during the surgeries or postoperative histological findings unexpectedly. The specific feature of schwannoma and meningioma coexistence in high cervical level on MR images has not been clearly described yet.

FINDINGS

We presented four cases of concurrent extradural schwannoma and intradural meningioma mimicking a single dumbbell-shaped tumor arising in the high cervical level. There was no interconnection between intradural and extradural masses in any case. In MRI reviews, the signal intensity between intradural lesions and spinal cord was similar on T2 weighted MR images. However, on contrast-enhanced MR images, the intradural lesions were more enhanced than spinal cord and presented as crescent-shaped intradural minor lesions adjacent to the more significantly enhanced extradural major tumor. These MRI findings could not be easily identified without meticulous observation preoperatively. Postoperative pathological findings confirmed the discrete tumors arising in the same cervical level.

CONCLUSION

The comparison of signal intensity changes among the spinal cord, intradural tumor and extradural tumor between T2 weighted and contrast-enhanced MR images may be helpful to predict coexistent schwannoma and meningioma in the high cervical level preoperatively. Intradural exploration is highly recommended when less enhanced crescent-shaped intradural minor lesion was observed adjacent to the significantly enhanced dumbbell-shaped major tumor in preoperative MRI findings.

Surgical Management of Craniovertebral Junction Schwannomas: A Systematic Review

Background: Craniovertebral junction (CVJ) schwannomas are rare, with surgery and stereotactic radiosurgery (SRS) being effective yet challenging options. We systematically reviewed the literature on CVJ schwannomas. Methods: PubMed, Scopus, Web-of-Science, and Cochrane were searched following the PRISMA statement to include studies reporting CVJ schwannomas. Clinical features, management, and outcomes were analyzed. Results: We collected 353 patients from 101 included articles. Presenting symptoms were mostly neck pain (30.3%) and headache (26.3%), with most cranial neuropathies involving the XII (31.2%) and X (24.4%) nerves. Most tumors originated from C2 (30.9%) and XII (29.4%) nerves, being extracranial (45.1%) and intradural-extradural (44.2%). Erosion of C1–C2 vertebrae (37.1%), the hypoglossal canal (28.3%), and/or jugular foramen (20.1%) were noted. All tumors were operated, preferably with the retrosigmoid approach (36.5%), with the far-lateral approach (29.7%) or with the posterior approach and cervical laminectomy (26.9%), far-lateral approaches (14.2%), or suboccipital craniotomy with concurrent cervical laminectomy (14.2%). Complete tumor resection was obtained most frequently (61.5%). Adjuvant post-surgery stereotactic radiosurgery was delivered in 5.9% patients. Median follow-up was 27 months (range, 12–252). Symptom improvement was noted in 88.1% of cases, and cranial neuropathies showed improvement in 10.2%. Post-surgical complications occurred in 83 patients (23.5%), mostly dysphagia (7.4%), new cranial neuropathies (6.2%), and cerebrospinal fluid leak (5.9%). A total of 16 patients (4.5%) had tumor recurrence and 7 died (2%), with median overall survival of 2.7 months (range, 0.1–252). Conclusions: Microsurgical resection is safe and effective for CVJ schwannomas. Data on SRS efficacy and indications are still lacking, and its role deserves further evaluation.

Intradural Extramedullary Concurrent Schwannoma and Meningothelial Hyperplasia at C2-C3 Cervical Vertebrae: A Case Report and Review of Literature

Concomitant schwannomas and benign meningothelial proliferations, including meningothelial hyperplasia or meningioma, rarely occur at the same location outside the setting of neurofibromatosis. Herein, we present a rare case of concurrent schwannoma and benign meningothelial hyperplasia concomitantly occurring in the cervical spine of a 69-year-old male patient with no history of any genetic disorder.

Coexistent vestibular schwannoma and meningioma in a patient without neurofibromatosis: A case report and review of literature

BACKGROUND

The simultaneous occurrence of schwannoma and meningioma in the absence of neurofibromatosis (NF) or a previous history of irradiation is exceedingly rare, as only 10 intracranial cases have been reported to date. Herein, we report a case of a coexistent cavernous sinus meningioma and ipsilateral vestibular schwannoma (VS) in a female patient without NF or a history of exposure to irradiation.

CASE SUMMARY

A 63-year-old woman presented with progressive left-side hearing loss and tinnitus over the previous year. In the past 6 mo, she developed facial numbness and intermittent headaches. Magnetic resonance imaging showed two lesions that were located on the left side of the cerebellopontine angle and parasellar region. Both lesions were totally resected via the left retrosigmoid approach. Histopathological examination revealed a VS and a meningioma. The patient did not have a family history or clinical or radiological signs of NF.

CONCLUSION

The coincident occurrence of VS and meningioma within close vicinity is very rare, and the pathogenesis is unclear. A careful whole-body examination needs to be conducted to exclude NF. Surgical treatment with the goal of total tumor resection is the best therapy. Additional studies are needed for a better understanding of the mechanisms that lead to the development of tumor growth in multiple locations.

Concurrent dorsal subpial schwannoma and ventral meningioma arising at the same upper cervical level: a case report

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.

Tandem Thoracic Spinal Cord Lesions of Differing Pathologies: Concurrent Metastatic Lung Adenocarcinoma Lesion in Close Proximity to a Intradural Meningioma

Simultaneously having two pathologically distinct neoplastic lesions causing critical spinal stenosis is exceedingly rare. When such lesions are near one another but occupy different spinal compartments, significant challenges arise.

We present the case of a patient with metastatic non-small cell carcinoma to the thoracic spine and an intradural meningioma occurring two spinal segments from each other. A 66-year-old female presented with one month of progressive mechanical back pain and two days of lower extremity weakness and urinary retention. She was found to have a left upper lobe lung mass. An urgent biopsy demonstrated non-small cell lung carcinoma. MRI of her thoracic spine demonstrated a T9 intradural-extramedullary enhancing lesion simultaneously with a destructive lesion of the T11 vertebral body extending into the anterior epidural space with significant cord compression at T9 and T11. The patient was taken for an urgent posterior decompression from T9 to T11, T9 left-sided pediculectomy with resection of intradural tumor, T11 corpectomy with anterior cage reconstruction, and instrumented fixation from T7 to L2. The pathology from the T9 lesion demonstrated findings consistent with a meningioma while the T11 lesion confirmed metastatic non-small cell lung adenocarcinoma. The patient improved neurologically postoperatively and regained the ability to ambulate within one week of surgery.

Pathologically distinct spinal lesions in close anatomic proximity, but in two separate compartments are exceptionally rare. We performed a simultaneous posterior approach for resection of the T9 meningioma and a T11 corpectomy for the metastatic lesion with rapid neurologic recovery.

Neurofibroma and Meningioma within a Single Dumbbell-Shaped Tumor at the Same Cervical Level without Neurofibromatosis: A Case Report and Literature Review

BACKGROUND

Cases of multiple intracranial tumors are common; however, cases of multiple intraspinal tumors are rare. Except for cases of neurofibromatosis, it is very rare for tumors of different pathological types to exist concurrently at the same spinal level. Only 9 cases have been reported to date, with meningioma found with schwannoma in 7 cases and with neurofibroma in 2 cases.

CASE DESCRIPTION

We have reported another rare case in which neurofibroma and meningioma were identified within a single dumbbell-shaped tumor at the same cervical level without neurofibromatosis. The preoperative magnetic resonance imaging findings indicated a single extra- and intradural extramedullary dumbbell-shaped neurogenic tumor on the left ventral side of the cervical spine. Intraoperatively, we found that the mass consisted of 2 pathologically different tumors. The results of surgical resection were mostly satisfactory.

CONCLUSIONS

To the best of our knowledge, the present case is the first reported case of intradural neurofibroma (not meningioma) and extradural meningioma growing mixed together at the same spinal level without neurofibromatosis. The precise mechanism underlying the formation of the tumor is unknown, and multidirectional differentiation of a common progenitor cell is one possibility. Intra- and extradural exploration and component biopsies are useful for treatment planning, especially when the magnetic resonance imaging is not sufficiently sensitive for the diagnosis of coexisting tumor types.

Differentiation between intraspinal schwannoma and meningioma by MR characteristics and clinic features

OBJECTIVES

To retrospectively review the MRI characteristics and clinic features and evaluate the effectiveness of MR imaging in differentiating intraspinal schwannomas and meningiomas, with the excised histopathologic findings as the reference standard.

MATERIALS AND METHODS

One hundred and four schwannomas (M/F, 57:47) and 53 meningiomas (M/F, 13:40) underwent MR examinations before surgical treatment. Simple clinic data and imaging findings were considered:(a) location (craniocaudal and axial), (b) size, (c) morphology, (d) dural contact, (e) signal characteristics, (f) enhancement degree and patterns. The usefulness of the algorithm for differential diagnosis was examined between the two tumors.

RESULTS

Interobserver agreement was good (κ = 0.7-0.9). Ten cases meningiomas demonstrated multiple lesions. There was a female predominance in the meningiomas (P < 0.001). Meningiomas predominantly were located in the ventral or anterolateral areas of thoracic regions, while schwannomas in the posterolateral areas of the thoracic and the lumbar regions (P < 0.001). Mean size of the lesions was 1.47 ± 0.36 cm for meningioma, and 2.02 ± 1.13 cm for schwannoma (P < 0.001). A dumbbell shape with intervertebral foramen widening could detect schwannomas, while the "dural tail sign" did meningiomas (P < 0.001). Hypointense and miscellaneous signal implied meningioma on T₁WIs (P < 0.001). Isointense was more frequently observed in the meningiomas, while the fluid signal intensity and miscellaneous signal in the schwannomas on T₂WIs (P < 0.001). Schwannomas usually manifested rim enhancement, while meningiomas diffuse enhancement (P = 0.005). There were six variables including the logistic equation (age, size, dural tail sign, morphology, T₂WI, and axial location). The accuracy of the algorithm in diagnosis of schwannomas was 87.1%.

CONCLUSIONS

Combination of clinic data and MRI performs significantly for differentiating between intraspinal meningiomas and schwannomas.

Concurrent Schwannoma and Meningioma Arising in the Same Spinal Level: A Report of Two Cases

Concurrent multiple tumors developing in the spinal cord are rare, except for in genetic disorders, such as neurofibromatosis and von Hippel-Lindau disease. Furthermore, concurrent tumors arising in the same spinal level with discrete histopathology are much rarer. We report two such cases. Case 1: A 53-year-old man presented with intracranial hemorrhage that manifested as disturbed consciousness and right hemiparesis. Magnetic resonance (MR) angiography demonstrated severe stenosis of the terminal portion of the bilateral internal carotid arteries, implying Moyamoya disease. Cranial MR images showed a hematoma in the left basal ganglia perforating into the lateral ventricle, which was incidentally detected as a spinal tumor compressing the cervical cord at the C2 level. After conservative management for cerebral hemorrhage, the patient underwent total removal of the spinal tumor. Surgical findings showed that the tumor consisted of extra- and intradural components. Histopathological findings showed that the extra- and intradural components were schwannoma and meningioma, respectively. Case 2: A 70-year-old man presented with progressive left hemiparesis and numbness in both lower extremities. Craniocervical MR images demonstrated a paraspinal tumor compressing the spinal cord at C2 level. Surgical findings disclosed that the tumor consisted of major extradural- and minor intradural components. Histopathological study showed that these components had discrete histological findings: extradural lesion was schwannoma and intradural lesion was meningioma. Concurrent tumors with discrete histopathology should be considered in tumors with extra- and intradural components, particularly, when they are located in the high cervical spine.

Differentiating spinal intradural-extramedullary schwannoma from meningioma using MRI T2 weighted images

OBJECTIVE:

Prior studies advocate the subjective visual differences between meningioma and schwannoma on T₂ weighted images, however objective measurement of signal intensity differences may be useful in certain cases. The aim of this study was to investigate whether an objective evaluation of SIs on T₂ weighted images would be useful to differentiate spinal schwannomas from meningiomas.

METHODS:

The patients with spinal MRIs demonstrating path proven and subsequently treated intradural extramedullary spinal tumors were selected between April 2008 and May 2017. Regions of interest (ROIs) were measured in the tumor and subcutaneous fat on the same image, and we calculated the SI ratio between tumor and fat ROIs.

RESULTS:

Twenty patients each with meningioma and schwannoma were enrolled. The SI ratios of schwannomas were significantly higher than those of meningiomas (both researcher 1 and 2: p = 0.002). The areas under the curve by researchers 1 and 2 were 0.780. The cutoff value of SI ratio by both of researchers 1 and 2 to differentiate between schwannomas from meningiomas was 0.420 (sensitivity: 80.0%, specificity: 70.0-75.0%).

CONCLUSION:

The SI ratio, calculated from the SIs of the tumor and fat on T₂ weighted images, is useful for differentiating spinal schwannomas from meningiomas to obtain an accurate diagnosis.

ADVANCES IN KNOWLEDGE:

Signal intensity ratio of the spinal tumor and fat on T₂ weighted images is useful for differentiating schwannomas from meningiomas to obtain an accurate diagnosis.

Spinal Schwannoma and Meningioma Mimicking a Single Mass at the Craniocervical Junction Subsequent to Remote Radiation Therapy for Acne Vulgaris

BACKGROUND

Schwannomas and meningiomas are relatively common tumors of the nervous system. They have been reported in the literature as existing concurrently as a single mass, but very rarely have they been shown to present at the craniocervical junction.

CASE DESCRIPTION

We present a rare and interesting case of a patient previously treated with radiation therapy for acne vulgaris and who presented to us with a concurrent schwannoma and meningioma of the craniocervical junction mimicking a single mass.

CONCLUSIONS

These tumors can be solitary or mixed masses, and are known to be associated with certain disease processes such as long-term sequelae of radiation therapy and neurofibromatosis type 2. The precise mechanism behind the formation of these tumors is unknown; however, molecular cues in the tumor microenvironment may play a role.

Concurrent spinal schwannoma and meningioma mimicking a single cervical dumbbell-shaped tumor: case report

Dumbbell-shaped tumors consisting of 2 different tumors are extremely rare. Herein, the authors present a case of concurrent spinal schwannoma and meningioma mimicking a single cervical dumbbell-shaped tumor. A 64-year-old man presented with a 5-year history of gradually exacerbating left occipital pain without clinical evidence of neurofibromatosis. Magnetic resonance imaging showed an extradural tumor along the left C-2 nerve root with a small intradural component. The tumor was approached via a C-1 hemilaminectomy. The intradural tumor was resected together with the extradural tumor after opening the dura mater. The intradural tumor was attached to the dura mater around the exit point of the C-2 nerve root. Intraoperative biopsy revealed that the extradural tumor was a schwannoma and that the intradural tumor was a meningioma. The dura mater adjacent to the tumor was then coagulated and resected. Postoperative pathological examination confirmed the same diagnoses with no evidence of continuity between the intra- and extradural components. The patient's postoperative clinical course was uneventful. Clinicians should be aware that cervical dumbbell-shaped tumors can consist of 2 different tumors.