Jael E Camacho1, M Farooq Usmani1, Cheng-Ying Ho2, Charles A Sansur3, Steven C Ludwig4. 1. Department of Orthopedics, University of Maryland School of Medicine, Baltimore, Maryland, USA. 2. Department of Pathology and Neurology, University of Maryland School of Medicine, Baltimore, Maryland, USA. 3. Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, Maryland, USA. 4. Department of Orthopedics, University of Maryland School of Medicine, Baltimore, Maryland, USA. Electronic address: sludwig@som.umaryland.edu.
Abstract
BACKGROUND: 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. CASE DESCRIPTION: 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. CONCLUSIONS: 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. Published by Elsevier Inc.
BACKGROUND: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. CASE DESCRIPTION: 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. CONCLUSIONS: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. Published by Elsevier Inc.
Authors: William Mualem; Abdul-Karim Ghaith; Deja Rush; Ryan Jarrah; Yohan Alexander; Cameron Zamanian; John L D Atkinson; Michael J Yaszemski; William E Krauss; Robert J Spinner; Mohamad Bydon Journal: J Neurooncol Date: 2022-06-25 Impact factor: 4.506