Multiple Schwannomas of the Spine: Review of the Schwannomatosis or Congenital Neurilemmomatosis: A Case Report

Single root multiple spinal schwannomas: Case report, treatment strategy and review of literature

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Schwannomatosis is defined as multiple schwannomas without presence of neurofibromatosis and this is a relatively rare pathology.

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In vast majority of cases the schwannomas grew from different nerve roots.

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We present the case of a patient with six schwannomas of the cauda equina that grew from a single spinal root as well as discuss the treatment strategy.

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Multiple spinal cord schwannomas that are growing along the same part of the vertebral column can be safely removed by one side hemilaminectomy using a high-speed diamond drill with preservation of the integrity of the muscles and ligaments on the opposite side and thus maintain spinal stability.

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Neuromonitoring is mandatory for the surgical procedure to allow successful results and to prevent any neurological damage.

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The 30 degree endoscope can be a good tool for visual exploration of the spinal canal.

Introduction

Schwannomatosis is defined as multiple schwannomas without presence of neurofibromatosis and is a rare pathology. In vast majority of cases the schwannomas grow from different nerve roots or peripheral nerves.

Presentation of case

A 52-year-old woman presented with multiple intradural schwannomas arranged in a chain along the spinal canal causing significant compression. The lesions were successfully removed using a left side en-bloc hemilaminectomy technique in order to preserve maximal stability of the posterior column. Back and leg pain resolved completely. Tendon reflexes returned to normal shortly. There was decreased pain sensation in the distribution of the left L3 spinal root.

Discussion

The traditional surgical strategy for posterior approach by laminectomy or laminotomy is sometimes complicated with instability or deformation of the vertebral column that requires surgical stabilization. We performed a one side en-bloc hemilaminectomy thus maintaining the integrity of the muscles and ligaments on the opposite side and preserving maximal stability of the vertebral column. Densely adherent tumors required careful sharp dissection and separation under neurosurgical monitoring and stimulation for recognition and preservation of spinal roots. An additional tumor was discovered by exploration of the spinal canal using an endoscope.

Conclusion

Multiple spinal cord schwannomas that are growing along the same part of the vertebral column can be safely removed by one-sided hemilaminectomy with preservation of the integrity of the muscles and ligaments on the opposite side and thus maintain spinal stability. The 30° endoscope can be a good tool for visual exploration of the spinal canal.