Giant lumbosacral nerve sheath tumors

doi:10.1016/0090-3019(92)90187-R

Surgical Neurology

Volume 37, Issue 2, February 1992, Pages 118-122

https://doi.org/10.1016/0090-3019(92)90187-R Get rights and content

Abstract

Cauda equina nerve sheath tumors are usually small, wellencapsulated tumors. Sometimes they may attain very large proportions, cause extensive bony changes, and resemble ependymomas in the cauda equina. They may also infiltrate into adjacent soft tissue planes and retroperitoneal spaces and yet be histologically benign. An awareness of this entity ensures aggressive surgical removal at the time of exploration.

Primary neurofibrosarcomas or malignant changes in primary nerve sheath tumors of the cauda equina are seen in patients with neurofibromatosis.

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Cited by (32)

Giant Sacral Schwannoma Causing Bilateral Hydronephrosis: Case Report and Review of the Literature
2020, World Neurosurgery
Giant sacral schwannomas are very rare, and less than 1%–5% of spinal schwannomas are found in the sacral region. These frequently grow to considerable size because of permissive anatomic location and benign, slow growth of tumor. They can be unnoticed before reaching a huge size.
We report a rare case of a giant sacral schwannoma in a 46-year-old man. The patient presented with difficulty in passing urine, episodic constipation, and swelling of the right lower extremity for 6 months. Magnetic resonance imaging revealed 160 x 110 x 110 mm encapsulated heterogenous solid mass originated from left S1 spinal nerve extending into the pelvis and abdomen. Sigmoid colon and rectum were displaced to the right side, and bladder was displaced anteriorly. Left side of the S1 and S2 vertebral bodies, left S1 and S2 neural foramen were also eroded. It also compressed ureters causing bilateral hydronephrosis. The patient underwent a 2-stage procedure in which complete resection was achieved.
We report the second case of a completely resected giant sacral schwannoma with bilateral hydronephrosis in the literature. Performing a 2-stage procedure is important in giant sacral schwannomas. Morbidity can be minimized, and extent of resection can be maximized with the help of combined anterior/posterior approach.
Perineal and Radicular Pain Caused by Contralateral Sacral Nerve Root Schwannoma: Case Report and Review of Literature
2019, World Neurosurgery
Citation Excerpt :
Similarly, Kim et al.23 analyzed patient outcomes after sacrificing nerve roots and concluded that the sacrificed nerve fibers are often nonfunctional and the procedure carries a minimal risk of debilitating postoperative neurologic deficit. Careful preoperative planning with a multidisciplinary approach improves the likelihood of successful tumor resection and better long-term outcomes.3,5-8,12,15 However, schwannomas still have a low potential for recurrence, which is higher in patients with NF and after a subtotal surgical resection.24,25
Sacral schwannomas are very rare nerve sheath tumors. Patients usually present with a variety of nonspecific symptoms, which often lead to a delay in diagnosis. Although most schwannomas are benign, they present surgical challenges owing to their proximity to neurologic and other anatomic structures.
This 58-year-old female presented with a 2-month old history of left-sided perineal and radicular pain secondary to a right S2 sacral nerve root schwannoma. The sacral mass demonstrated homogenous enhancement with cystic changes in a T2-weighted magnetic resonance imaging sequence. The patient underwent S1–S3 laminectomy and tumor excision through a posterior surgical approach. Intraoperative monitoring was used to distinguish nonfunctional tissue during tumor resection. The patient had an unremarkable postoperative course.
Sacral schwannomas can present with a variety of nonspecific symptoms. They pose unique challenges given their location, size, and involvement of surrounding structures. Complete surgical resection is the main goal of sacral schwannoma treatment. A combined anterior-posterior surgical approach and a multidisciplinary surgical team are associated with improved outcomes.
Giant Sacral Schwannoma Treated with a 360 Approach: A Rare Case and Systematic Review of the Literature
2018, World Neurosurgery
Sacral schwannomas are very rare and typically have a benign nature. They occur in a permissive anatomical location leading to nonspecific symptoms that can result in them going unnoticed before reaching a considerable size.
We report a rare case of a giant sacral schwannoma (130 × 110 × 90 mm) in a 38-year-old man originating from the S2 nerve root, encompassing the neural canal with sacral erosion and extension in to the pelvis. The patient presented with a history of abdominal pain associated with increased urinary frequency and a sensation of incomplete bladder emptying. Magnetic resonance imaging demonstrated a giant pelvic mass with sacral erosion and involvement of the nerve roots. Subsequently, he went on to have a 2-stage procedure in which complete resection of the schwannoma was achieved by both a posterior hemilaminectomy and laparotomy with the aid of neuromonitoring. The postoperative course was uneventful, with complete resolution of symptoms.
We report one of the largest benign sacral schwannoma originating inside the spinal canal with pelvic extension to be resected without complications. We discuss our successful management and conduct a systematic review of the literature to provide the most up to date guidance on managing this tumor, including the application of neuromonitoring and a 360 approach in 2 stages.
Surgical management of a giant plexiform neurofibroma of the lower extremity
2011, World Neurosurgery
Citation Excerpt :
Giant neurofibroma is a poorly defined term used to describe a neurofibroma that has grown to a significant but undefined size. There are a number of case reports and series in the literature discussing giant neurofibromas (2-4, 7, 16, 20, 21, 24, 26, 27, 32). Some of these authors use the term giant neurofibroma to describe tumors weighing only a few kilograms whereas the largest giant neurofibroma reported in the literature was 90 kg (198 lb) (25).
The authors review their experience with the management of a giant 49-kg (108 lb) neurofibroma of the lower extremity in a 37-year-old male with NF1. The patient presented with right thigh pain, paresthesias, increasing edema, and accelerated growth of the mass. The patient was taken to the operating room, where approximately 39 kg (86 lb) of tumor and 10 L (22 lb) of interstitial fluid was removed. The postoperative course was complicated by cellulitis, delayed wound closure, and recurrent lymphedema. Complications were managed with antibiotics, ultrasound-guided drainage, surgical revision of closure, compressive dressings, passive drainage, and vacuum-assisted wound closure. Giant neurofibromas similar to this tumor require complex intraoperative and postoperative management strategies. Surgical closure is best managed with local flaps, and postoperative lymphedema is best managed with passive drainage and compressive dressings.
Giant schwannoma of the lumbar spine. A case report
2010, Neurologia i Neurochirurgia Polska
Citation Excerpt :
Problems related to the operative treatment of giant lumbosacral schwannomas with bony destruction are discussed in some casuistic reports [6,14–16]. Bhatia reported 10 cases treated surgically due to giant lumbosacral schwannomas [1]. A literature review from 1988 to 2007 done by Chiang et al. [8] revealed 51 giant schwannomas with vertebrae destruction.
Giant “invasive” schwannomas of the spine occur occasionally, most frequently in the lumbar region. We present the case of a 46-year-old woman with giant “invasive” schwannoma of the lumbar spine, with a 12-year history of illness. The tumour originated in the vertebral canal and passed through the paraspinal muscles and retroperitoneal area to the abdominal cavity. The part of the tumour which was in the abdominal cavity was removed by means of laparotomy during the first operation. In the second one, the remaining part of the tumour was removed completely from the vertebral canal and retroperitoneal area through posterior-lateral access. The spine was stabilized with metal implants. Histological examination revealed cellular schwannoma. During the follow-up the pain resolved while paresis of the right quadriceps muscle of the thigh was still present.
Cellular schwannoma is a benign form of schwannoma, but it may cause a local recurrence if not removed completely.
Olbrzymie „inwazyjne” nerwiaki osłonkowe kręgosłupa występują sporadycznie, najczęściej w odcinku lędźwiowym. W pracy przedstawiono przypadek 46-letniej chorej z olbrzymim „inwazyjnym” nerwiakiem osłonkowym odcinka lędźwiowego kręgosłupa, z 12-letnim wywiadem chorobowym. Guz wychodził z kanału kręgowego, a poprzez mięśnie przy-kręgosłupowe i okolicę zaotrzewnową przechodził do jamy brzusznej. Podczas pierwszej operacji drogą laparotomii usunięto część guza znajdującego się w jamie brzusznej. W drugim etapie, z dojścia tylno-bocznego, usunięto doszczętnie pozostałą część guza z kanału kręgowego, przestrzeni zaotrzewnowej i dokonano stabilizacji kręgosłupa implantami metalowymi. Badanie histologiczne wykazało nerwiak osłonkowy komórkowy.
W okresie obserwacji u chorej ustąpił ból, nadal utrzymuje się niedowład prawego mięśnia czworogłowego uda.
Nerwiak komórkowy jest łagodną postacią nerwiaka osłonkowego, może być jednak przyczyną miejscowej wznowy, jeżeli nie zostanie całkowicie usunięty.
Giant nerve sheath tumour: Report of six cases
2005, Clinical Neurology and Neurosurgery
Giant nerve sheath tumour is a rare tumour originating from the nerve sheath. It differs from the conventional nerve sheath tumour only by the size these tumours can reach. There are two main type of tumours that occur in the nerve sheath which include neurofibroma and schwannoma. The current views are that schwannomas arise from the progenitor of the schwann cell. Whereas the neurofibroma series probably arise from a mesenchymal origin closer to a fibroblast. We report on six cases of nerve sheath tumour that occur in the spinal and paraspinal region that presented to us over a 5 year period.

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Giant lumbosacral nerve sheath tumors

Abstract

Surgical management of giant sacral schwannomas

J Neurosurg

Tumors involving the cauda equina: a review of their clinical features and differential diagnosis

J Neurol Psychopathol

Epidemiology of CNS tumors 1974–1978

Painless tumors of the cauda equina: a case report

Neurology (NY)

Sacral neurofibrosarcoma-a case report

Australas Radiol

Schwannoma of the CNS

Am J Roentgenol

Editorial: Cauda equina tumors

Br Med J

Cauda equina tumors

Trans Med Soc Lond

Tumors of the cauda equina

J Neurol Neurosurg Psychiatry

Clinical aspects of spinal neurofibromas

Brain

Low back pain

Ciba Clin Symp