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Sakashita K, Koda M, Takahashi H, Funayama T, Yamazaki M. Acute Neurological Aggravation Caused by Intratumoral Hemorrhage of a Cervical Dumbbell Schwannoma: Report of a Rare Case and Literature Review. Cureus 2023; 15:e34682. [PMID: 36909029 PMCID: PMC9994380 DOI: 10.7759/cureus.34682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2023] [Indexed: 02/09/2023] Open
Abstract
Schwannomas are one of the most common types of primary intraspinal tumors. We report a rare case of neurological aggravation due to the intratumoral hemorrhage of a cervical schwannoma. A 65-year-old man presented with lower extremity weakness developing gradually. Tumor resection was performed one week after neurological aggravation occurred. After surgery, he recovered dramatically. There are vascular and mechanical hypotheses for the etiology of intratumoral hemorrhage of schwannoma. In the present case, falling and antiplatelet drugs may have caused the intratumoral hemorrhage. Optimal surgical timing remains controversial. Some reports reveal patients recovered well after urgent surgery. However, even if urgent surgery is performed, some have neurological sequelae. Others reveal patients recovered well after elective surgery without any sequelae. Because previous reports reveal the surgical procedure may damage the spinal cord, urgent surgery may not be compulsory and elective surgery may be a better treatment option. Further investigation is needed to clarify the etiology and optimal timing for surgical treatment of intratumoral hemorrhage.
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Affiliation(s)
- Kotaro Sakashita
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, JPN
| | - Masao Koda
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, JPN
| | - Hiroshi Takahashi
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, JPN
| | - Toru Funayama
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, JPN
| | - Masashi Yamazaki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, JPN
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2
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Fabbri VP, Friso F, Chiarucci F, Gramegna LL, Toni F, Foschini MP, Asioli S, Cremonini A, Acciarri N. Hemorrhagic Schwannoma of the Cauda Equina: Case Report and Review of the Literature. NMC Case Rep J 2022; 8:377-385. [PMID: 35079492 PMCID: PMC8769457 DOI: 10.2176/nmccrj.cr.2020-0186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 11/12/2020] [Indexed: 11/30/2022] Open
Abstract
Spinal intradural hemorrhage is a rare event; the most common causes of spinal bleeding are traumas, medical therapy with anticoagulants and thrombolytics, vascular malformations, and congenital defects of coagulation. Rarely, spinal cord tumors may cause hemorrhage. Herein, we report the case of a patient with acute and quickly worsening lumbar pain: the neurological examination revealed a flaccid paraplegia caused by an intradural lesion extending on the right side of the spinal cord from T1 to L2 vertebral level. Pathological examination revealed an hemorrhagic schwannoma. Acute spinal subdural hemorrhage caused by spinal schwannomas is a very rare occurrence (29 cases only have been previously reported). Review of the literature with clinico-diagnostic features is presented, surgical treatment is explained, and pathological findings with possible etiopathogenesis of hemorrhage are described.
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Affiliation(s)
- Viscardo P Fabbri
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Unit of Anatomic Pathology, Bellaria Hospital, Bologna, Italy
| | - Filippo Friso
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,IRCCS/Institute of Neurological Science of Bologna, Department of Neurologic Surgery, Bellaria Hospital, Bologna, Italy
| | - Federico Chiarucci
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Unit of Anatomic Pathology, Bellaria Hospital, Bologna, Italy
| | - Laura Ludovica Gramegna
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,IRCCS/Institute of Neurological Science of Bologna, Unit of Functional and Molecular Neuroimaging, Bellaria Hospital, Bologna, Italy
| | - Francesco Toni
- IRCCS/Institute of Neurological Science of Bologna, Unit of Neuradiology, Bellaria Hospital, Bologna, Italy
| | - Maria P Foschini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Unit of Anatomic Pathology, Bellaria Hospital, Bologna, Italy
| | - Sofia Asioli
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Unit of Anatomic Pathology, Bellaria Hospital, Bologna, Italy
| | - Anna Cremonini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Unit of Anatomic Pathology, Bellaria Hospital, Bologna, Italy
| | - Nicola Acciarri
- IRCCS/Institute of Neurological Science of Bologna, Department of Neurologic Surgery, Bellaria Hospital, Bologna, Italy
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3
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Karabetsos DA, Tsitsipanis C, Koutserimpas C, Chaniotis V, Vakis A, Samonis G, Alpantaki K. Acute paraplegia due to thoracolumbar schwannoma following trauma: A case report and literature review. Mol Clin Oncol 2021; 15:204. [PMID: 34462660 DOI: 10.3892/mco.2021.2366] [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: 12/30/2020] [Accepted: 05/26/2021] [Indexed: 11/05/2022] Open
Abstract
Spinal schwannomas account for one third of primary spinal neoplasms. Clinical presentation is related to the tumor location. An atypical case of acute paraplegia following a fall, on the ground of a thoracolumbar schwannoma, without intratumoral hemorrhage, in a previously asymptomatic patient is reported. A 58-year-old male patient presented with acute paraplegia, and urinary and bowel incontinence, following a fall. The patient had no previous history of back and/or leg pain or neurological symptoms. Magnetic resonance imaging revealed a subdural mass, as well as a fracture of the right T12-L1 facet joint and the right transverse process. The patient underwent emergency T11-L1 wide laminectomy, exploration of the subdural space and T10-L2 posterolateral transpedicular stabilization and fusion. An intradural, extramedullary mass, causing severe cord compression, was found and excised. Pathology revealed schwannoma, without intratumoral hemorrhage. The patient recovered completely 6 months postoperatively. To the best of our knowledge, this is the first report of spinal intradural schwannoma causing sudden paraplegia in a previously asymptomatic patient in the setting of trauma, without intratumoral hemorrhage. Emergency canal decompression and complete excision of the tumor represent the optimal management of such cases.
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Affiliation(s)
| | - Christos Tsitsipanis
- Department of Neurosurgery, University Hospital of Crete, Heraklion 71500, Greece
| | - Christos Koutserimpas
- Department of Orthopaedics and Traumatology, '251' Hellenic Air Force General Hospital of Athens, Athens 11525, Greece
| | - Vrettos Chaniotis
- Department of Pathology, General Hospital of Chania, Chania 73300, Greece
| | - Antonios Vakis
- Department of Neurosurgery, University Hospital of Crete, Heraklion 71500, Greece
| | - George Samonis
- Department of Internal Medicine, University Hospital of Crete, Heraklion 71500, Greece
| | - Kalliopi Alpantaki
- Department of Orthopaedics and Trauma, Venizeleion General Hospital of Heraklion, Heraklion 71409, Greece
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4
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Matos D, Pereira R. Thoracic spine schwannoma presenting with traumatic spinal cord injury: A case report. Surg Neurol Int 2021; 12:251. [PMID: 34221582 PMCID: PMC8247680 DOI: 10.25259/sni_856_2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 04/16/2021] [Indexed: 12/02/2022] Open
Abstract
Background: The presentation of a thoracic spinal tumor due to high-impact trauma is quite rare and we found no other case reported. Case Description: This is a case report and literature review. A patient presented with severe paraparesis on day 4 after trauma. Thoracic MRI showed an oval image centered to T4-T5 suggestive of hemorrhage. The patient underwent a bilateral T4 and T5 laminectomy and microsurgically assisted intradural exploration. After laminectomy, we found no extradural lesions, so we proceeded to dural opening, after which we found a large extramedullary lesion which was completely removed. Pathology revealed a schwannoma. The patient had a very good recovery after surgery and motor rehabilitation. At 6 months after surgery, inferior limbs muscle strength was completely normal. We found no other case reported. Conclusion: Thoracic spine schwannomas are difficult to early diagnose unless there is a clinical suspicion. Initial presentation as bleeding after trauma was not described before. This presentation should be kept in the differential diagnosis of any patient with an acute neurological deficit without trauma signs on admission imaging.
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Affiliation(s)
- Daniela Matos
- Department of Neurosurgery, Coimbra University Hospital Centre, Coimbra, Portugal.,Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Ricardo Pereira
- Department of Neurosurgery, Coimbra University Hospital Centre, Coimbra, Portugal.,Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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Jung GS, Lee YM, Kim YZ, Kim JS. Intratumoral Hemorrhage of the Cervical Spinal Schwannoma Presenting: Acute Quadriparesis. Brain Tumor Res Treat 2019; 7:160-163. [PMID: 31686450 PMCID: PMC6829079 DOI: 10.14791/btrt.2019.7.e34] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 07/03/2019] [Accepted: 07/23/2019] [Indexed: 12/27/2022] Open
Abstract
Schwannomas are the most common extramedullary spinal tumors, with chronic progressive symptoms being the most common presenting features. The acute hemorrhagic onset of a spinal schwannoma is a rare occurrence. Here, we report the case of a 37-year-old male who presented with complaint of neck pain and an acute onset of quadriparesis. MRI of his cervical spine revealed an intradural extramedullary lesion in the C2 to C3 cervical segment, with features of acute hemorrhage but mild enhancement. He was operated in emergency and complete microsurgical resection of tumor was achieved. Histopathology revealed features of an ancient schwannoma with hemorrhage. Postoperatively, the patient showed significant improvement.
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Affiliation(s)
- Gyu Seo Jung
- Department of Neurosurgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Young Min Lee
- Department of Neurosurgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea.
| | - Young Zoon Kim
- Department of Neurosurgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Joon Soo Kim
- Department of Neurosurgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
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Gotecha S, Punia P, Patil A, Chugh A, Kotecha M, Raghu V, Mubashshir A, Shobhit C, Kashyap D. A Rare Chronic Presentation of Schwannoma with Hemorrhage. Asian J Neurosurg 2019; 14:897-900. [PMID: 31497123 PMCID: PMC6703075 DOI: 10.4103/ajns.ajns_277_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Spinal schwannomas are slow-growing benign tumors arising from the nerves. In the spinal cord, they arise most commonly from cervical and lumbar levels. They are mostly intradural extramedullary (IDEM) accounting for 30% of intradural tumors showing a female preponderance. They are seen occurring between 25 and 50 years of age. Most of these cases show acute presentation as hemorrhage within the tumor with weakness. This is a rare presentation by itself reported by only 12 cases world over. It is even rarer to see them show chronic presentation. We are reporting one such case of a 61-year-old female who presented to us with chronic low backache for 3 years with radicular symptoms in the bilateral lower limbs following a fall on her back. Magnetic resonance imaging was done which showed a well-defined IDEM lesion from L3 to L5 vertebral level which was isointense on T1 and hyperintense on T2 with a peripheral rim and short inversion time inversion-recovery showed fluid-fluid level within. Gradient-recalled echo showed blooming with no suppression on fat-sat and no diffusion restriction. A computed tomography angiography was done which ruled out vascular malformation. Intraoperatively, a large feeding vessel with a tumor was visualized after laminectomy was done for the corresponding levels. Postoperatively, the patient showed a significant decrease in radicular symptoms and was discharged after 2 weeks with an uneventful postoperative period. HPE of the lesion showed sheets of fascicles of elongated spindle cells arranged in loose myxoid matrix with hyperchromatic nuclei and scanty hemorrhage and lymphocytic infiltrates suggestive of schwannoma with myxoid degeneration. Immunohistochemistry also confirmed a diagnosis of schwannoma. From this case, it is seen that the diagnosis of a spinal schwnnoma showing delayed presentation with atypical imaging findings is a challenge and must needs a high index of suspicion and appropriate surgical planning.
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Affiliation(s)
- Sarang Gotecha
- Department of Neurosurgery, Dr. D. Y. Patil Medical College and Hospital, Pune, Maharashtra, India
| | - Prashant Punia
- Department of Neurosurgery, Dr. D. Y. Patil Medical College and Hospital, Pune, Maharashtra, India
| | - Anil Patil
- Department of Neurosurgery, Dr. D. Y. Patil Medical College and Hospital, Pune, Maharashtra, India
| | - Ashish Chugh
- Department of Neurosurgery, Dr. D. Y. Patil Medical College and Hospital, Pune, Maharashtra, India
| | - Megha Kotecha
- Department of Neurosurgery, Dr. D. Y. Patil Medical College and Hospital, Pune, Maharashtra, India
| | - Vybhav Raghu
- Department of Neurosurgery, Dr. D. Y. Patil Medical College and Hospital, Pune, Maharashtra, India
| | - Ali Mubashshir
- Department of Neurosurgery, Dr. D. Y. Patil Medical College and Hospital, Pune, Maharashtra, India
| | - Chhabra Shobhit
- Department of Neurosurgery, Dr. D. Y. Patil Medical College and Hospital, Pune, Maharashtra, India
| | - Dushyant Kashyap
- Department of Neurosurgery, Dr. D. Y. Patil Medical College and Hospital, Pune, Maharashtra, India
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Dobran M, Nasi D, Della Costanza M, Formica F. Intralesional and subarachnoid bleeding of a spinal schwannoma presenting with acute cauda equina syndrome. BMJ Case Rep 2019; 12:12/7/e229251. [PMID: 31302617 DOI: 10.1136/bcr-2019-229251] [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: 11/03/2022] Open
Abstract
We present an unusual case of spinal neurinoma with intralesional and subarachnoid bleeding with acute cauda equina syndrome. A 38-year-old man was admitted to our department after a minor thoracic spinal trauma with right lower limb plegia and urinary retention. MRI showed a T11 intradural tumour with intralesional and subarachnoid haemorrhage. The patient was operated of spinal cord decompression and complete tumour resection. The histological examination documented a schwannoma with large haemorrhagic intratumoural areas. A full neurological recovery was documented at 6-month follow-up.
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Affiliation(s)
- Mauro Dobran
- Department of Neurosurgery, Università Politecnica delle Marche, Ancona, Italy
| | - Davide Nasi
- Department of Neurosurgery, Università Politecnica delle Marche, Ancona, Italy
| | | | - Francesco Formica
- Department of Neurosurgery, Università Politecnica delle Marche, Ancona, Italy
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8
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Hemorrhagic Spinal Schwannoma in Thoracolumbar Area with Total Paraplegia. Case Rep Med 2019; 2019:7190739. [PMID: 30719046 PMCID: PMC6334320 DOI: 10.1155/2019/7190739] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 12/12/2018] [Accepted: 12/17/2018] [Indexed: 11/17/2022] Open
Abstract
Hemorrhagic schwannoma in the medulla spinalis is a rare occurrence. It is a variant of the slow-growing nerve sheath tumor that usually has subtle clinical symptoms. Injury to the spinal schwannoma that was previously suspected by spinal manipulations may accelerate the progression of symptoms and cause an acute presentation of paraplegia. We report a case of a patient that was suspected of an intradural tumor with paraparesis that initially refused treatment. Spinal manipulation procedures were performed outside of the hospital setting with subsequent advancement of paraparesis. A surgical intervention was performed, which found that the tumor mass has grown along with hemorrhage within the schwannoma. The bleeding within the mass may have caused the acute paraplegia that is rarely reported. The patient had a fair improvement on her lower motor extremity function from 1-2 to 3-4 out of 5 at six-month follow-up.
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Kimura R, Miyakoshi N, Suzuki T, Kido T, Chiba M, Kobayashi T, Shimada Y. Traumatic intratumoral hemorrhage of schwannoma of the cauda equina: A report of two cases. J Orthop Sci 2018; 23:1105-1109. [PMID: 27769599 DOI: 10.1016/j.jos.2016.09.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Revised: 08/13/2016] [Accepted: 09/30/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Ryota Kimura
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan.
| | - Naohisa Miyakoshi
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Tetsuya Suzuki
- Department of Orthopedic Surgery, Akita Red Cross Hospital, Akita, Japan
| | - Tadato Kido
- Department of Orthopedic Surgery, Akita Rosai Hospital, Odate, Japan
| | - Mitsuho Chiba
- Department of Orthopedic Surgery, Akita Rosai Hospital, Odate, Japan
| | - Takashi Kobayashi
- Department of Orthopedic Surgery, Akita Kousei Medical Center, Akita, Japan
| | - Yoichi Shimada
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
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Hdeib A, Goodwin CR, Sciubba D, Bydon A, Wolinsky JP, Witham T, Gokaslan ZL. Hemorrhagic thoracic schwannoma presenting with intradural hematoma and acute paraplegia after spinal manipulation therapy. Int J Spine Surg 2016; 10:42. [PMID: 28377856 DOI: 10.14444/3042] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Hemorrhagic conversion of spinal schwannomas represents a rare occurrence; also rare is the development of a spinal intradural hematoma after spinal manipulation therapy. We report a unique presentation of paraplegia in a patient who underwent spinal manipulation therapy and was found to have a hemorrhagic thoracic schwannoma at time of surgery in the setting of anti-platelet therapy use. In patients with spinal schwannomas, tumor hemorrhage is a rare occasion, which can be considered in the setting of additive effects of spinal manipulation therapy and antiplatelet therapy.
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Affiliation(s)
- Alia Hdeib
- Johns Hopkins University School of Medicine, Department of Neurological Surgery, Baltimore, MD; University Hospitals Case Medical Center, Department of Neurosurgery, Case Western Reserve University School of Medicine, Cleveland, OH
| | - C Rory Goodwin
- Johns Hopkins University School of Medicine, Department of Neurological Surgery, Baltimore, MD
| | - Daniel Sciubba
- Johns Hopkins University School of Medicine, Department of Neurological Surgery, Baltimore, MD
| | - Ali Bydon
- Johns Hopkins University School of Medicine, Department of Neurological Surgery, Baltimore, MD
| | - Jean-Paul Wolinsky
- Johns Hopkins University School of Medicine, Department of Neurological Surgery, Baltimore, MD
| | - Timothy Witham
- Johns Hopkins University School of Medicine, Department of Neurological Surgery, Baltimore, MD
| | - Ziya L Gokaslan
- Johns Hopkins University School of Medicine, Department of Neurological Surgery, Baltimore, MD; The Warren Alpert Medical School of Brown University, Department of Neurosurgery, Providence, RI
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Prasad GL, Kongwad LI, Valiathan MG. Spinal Intradural Schwannoma with Acute Intratumoural Haemorrhage: Case Report and Review. J Clin Diagn Res 2016; 10:PD01-3. [PMID: 26894121 DOI: 10.7860/jcdr/2016/16187.7015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Accepted: 11/19/2015] [Indexed: 11/24/2022]
Abstract
Schwannomas account for around half of all intradural spinal tumours, with chronic progressive symptoms as the most common presenting features. Intratumoural haemorrhage as a presenting feature of spinal schwannoma is very rare and only 11 cases have been reported till date. Authors here report a previously asymptomatic 40-year-old male who presented with acute onset paraplegia 12 hours after a minor trauma. MR imaging revealed a C7-D3 intradural-extramedullary lesion with features of acute blood and showing no enhancement. Emergency laminectomy and complete removal of the mass was performed and histopathology revealed features of schwannoma with haemorrhage. Patient had modest improvement of his neurological deficits at a follow-up of 6 months. Pertinent literature is reviewed in brief.
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Affiliation(s)
- G Lakshmi Prasad
- Assistant Professor, Department of Neurosurgery, Kasturba Medical College, Manipal University , Manipal, India
| | - Lakshman I Kongwad
- Registrar, Department of Neurosurgery, Kasturba Medical College, Manipal University , Manipal, India
| | - Manna G Valiathan
- Professor, Department of Pathology, Kasturba Medical College, Manipal University , Manipal, India
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12
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Attiah MA, Syre PP, Pierce J, Belyaeva E, Welch WC. Giant cystic sacral schwannoma mimicking tarlov cyst: a case report. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2015. [PMID: 26195080 DOI: 10.1007/s00586-015-4128-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE To present a rare case of a giant schwannoma of the sacrum mimicking a Tarlov cyst. METHODS A 58-year-old woman had a 1-year history of low back pain. MRI revealed a large cystic mass in the sacral canal with bony erosion. Radiological diagnosis of Tarlov cyst was made. RESULTS The patient underwent surgical treatment for the lesion, which revealed a solid mass. Histopathological examination of the tumor confirmed the diagnosis of schwannoma. The postoperative course was uneventful and the patient has had significant improvement in her pain 1 month postoperatively. CONCLUSION Giant cystic schwannoma of the sacrum is a very rare diagnosis overlooked by practitioners for more common cystic etiologies, but its treatment is significantly different. Care should be taken to include this diagnosis in a differential for a cystic sacral mass.
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Affiliation(s)
- Mark A Attiah
- Department of Neurosurgery, University of Pennsylvania, 3400 Spruce St., Philadelphia, PA, 19104, USA.
| | - Peter P Syre
- Department of Neurosurgery, University of Pennsylvania, 3400 Spruce St., Philadelphia, PA, 19104, USA
| | - John Pierce
- Department of Neurosurgery, University of Pennsylvania, 3400 Spruce St., Philadelphia, PA, 19104, USA
| | | | - William C Welch
- Department of Neurosurgery, University of Pennsylvania, 3400 Spruce St., Philadelphia, PA, 19104, USA
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Kukreja S, Ambekar S, Sharma M, Nanda A. Cauda equina schwannoma presenting with intratumoral hemorrhage and intracranial subarachnoid hemorrhage. J Neurosurg Spine 2014; 21:357-60. [DOI: 10.3171/2014.5.spine131014] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The authors report the case of a spinal intradural schwannoma presenting with intracranial subarachnoid hemorrhage (SAH). Cerebral angiography did not show any intracranial lesion; however, MRI revealed two separate tumors in the lower segment of the spinal cord. The proximal lesion arising from the conus medullaris was well circumscribed and homogeneously enhanced, whereas the tumor in the cauda equina revealed hemorrhagic signals on MRI. This case also illustrates an unusual presentation of intracranial SAH simultaneously with intratumoral hemorrhage in a spinal cord schwannoma. The absence of hemorrhagic changes in the lesion arising proximal to the cauda equina region supports the mechanical theory proposed for the pathogenesis of hemorrhagic complications in spinal cord tumors.
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