Presacral Giant Schwannoma : Removal by a Combined Anterior and Posterior Approach

Ho-Won Jung; Suk-Bum Lim; Dong-Won Kim; Byung-Joon Shin; Yon-Il Kim

doi:10.4184/jkss.2001.8.3.259

Journal List > J Korean Soc Spine Surg > v.8(3) > 1035952

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Jung, Lim, Kim, Shin, and Kim: Presacral Giant Schwannoma : Removal by a Combined Anterior and Posterior Approach

A Case Report

Journal of Korean Spine Surg 2001;8(3):259-263.

Published online: 21 February 2001

DOI: https://doi.org/10.4184/jkss.2001.8.3.259

Presacral Giant Schwannoma : Removal by a Combined Anterior and Posterior Approach

Ho-Won Jung, M.D., Suk-Bum Lim, M.D., Dong-Won Kim, M.D.^∗, Byung-Joon Shin, M.D., Yon-Il Kim, M.D.

Department of Orthopedic Surgery, College of Medicine, Soonchunhyang University, Seoul, Korea

^∗Clinical Pathology, College of Medicine, Soonchunhyang University, Seoul, Korea

Address reprint requests to Ho-Won Jung, M.D. Department of Orthopaedic Surgery, College of Medicine, Soonchunhyang University #657 Hannam-dong, Yongsan-ku, Seoul 140-743, Korea Tel : 82-2-709-9250, Fax : 82-2-794-9414, E-mail : junghowon@zaigen.co.kr

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Study Design

This case report presents a rare case of presacral giant schwannoma which originates from the S1 nerve root.

Objectives

To discuss a surgical approach for removal of presacral giant schwannoma and review the pertinent literatures.

Summary of Literature Review

Pre- sacral tumors are unusual neoplasms that cause approximately one in 40,000 hospital admissions. Schwannoma represents only a small fraction of the many types of tumors that may be present in this region. Less than 1% of all spinal schwannomas occur in the sacrum. The treatment of this lesion is complete removal, which is curative.

Materials and Methods

A 46- year- old woman developed gradual back pain and radiating pain on her left lower extremity for about a year. There was no noted improvement with the use of conservative treatment. T1- weighted sagittal MRI reveals a large homogeneous low- signal intensity mass on left presacral area and intrasacral extension of the tumor forming a dumbbell shaped mass.

Results

The tumor was completely removed by a combined anterior and posterior approach. The excised mass was cylindrical, measuring 8x4x3 cm in size, which had originated from the S1 nerve root. It was histologically diagnosed as benign schwannoma. Satisfactory result was obtained after the complete removal of the mass.

Conclusions

We report a case of the successful and complete removal of a presacral giant schwannoma and the affected nerve root through a combined anterior and posterior approach.

Keywords: Pre- sacral, Schwannoma, Combined anterior and posterior approach

REFERENCES

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3). Das Gupta TK, Brasfield RD, Strong EW, Hajolu SI. Benign solitary schwannomas. Cancer. 24(2):355–366. Aug. 1969.

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5). Kim P, Ebersold MJ, Onofrio BM, Quast LM. Surgery of spinal nerve schwannoma. Risk of neurological deficit after resection of involved root. J Neurosurg. 71:810–814. 1989.

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7). Rengachary SS, O'Boynick P, Batnitzky S, Kepes JJ. Giant intrasacral schwannoma: Case report. Neurosurgery. 9(5):573–577. Nov. 1981.

Fig. 1-A.

T1-weighted sagittal MR image showing a large homogenous low signal intensity mass. The large tumor is located at the left presacral area and intrasacral extension of the tumor forming a dumbbell shaped mass. Fig. 1-B. T2-weighted sagittal MR image showing a large inhomogenous high signal intensity mass. Fig. 1-C. T1-weighted coronal MR image showing a well demarcated homogenous low signal intensity mass arising from S1 nerve root.

Fig. 2.

Cross section of the tumor showing a well encapsulated solid cylinderic mass originates from S1 nerve root, measuring 8× 4× 3 cm.

Fig. 3-A.

Photomicrography of the tumor showing compact cellular Antoni type A and loose myxoid Antoni type B areas(H-E stain,× 100). Fig. 3-B. Tumor cells of the cellular and loose areas showing elongated bipolar cells dispersed in fascicles(H-E stain, × 200).

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