====== Sacral Spinal Schwannoma ====== see also [[Giant Sacral Schwannoma]]. ---- Sacral [[spinal schwannoma]]s are very rare, and the incidence of sacral schwannoma ranges from 1-5% of all spinal [[schwannoma]]s, and only around 50 cases are reported in the [[literature]]. There are 3 defined types of sacral schwannomas. These are retroperitoneal or presacral, intraosseous, and [[spinal schwannoma]]s. Patients commonly present with complaints of [[pain]] and [[paresthesia]] due to the spinal schwannoma extending to extra spinal tissues. Direct x-ray, [[CT]], [[MRI]], and [[scintigraphy]] are used for preoperative diagnosis and treatment planning. Local recurrence and transformation to malignancy are very rare. For this reason, the frequently preferred treatments are subtotal removal of the mass or simple enucleation ((Togral G, Arikan M, Hasturk AE, Gungor S. Incidentally diagnosed giant invasive sacral schwannoma. Its clinical features and surgical management without stability. Neurosciences (Riyadh). 2014 Jul;19(3):224-8. PubMed PMID: 24983285; PubMed Central PMCID: PMC4727657. )). ===== Case series ===== 11 sacral schwannoma cases operated at the Second Affiliated Hospital, School of Medicine, Zhejiang University, from 2012 to 2016, were investigated retrospectively and 10 were followed up. All patients were assessed with X-ray, CT and MRI, and underwent an intralesional excision. One patient was male, nine were female and the average age was 48 (ranging between 31 and 63). Three patients suffered from back and leg pain, and seven had no obvious symptoms. The average blood loss during surgery was 980ml (ranging between 100 and 2,000ml). Six patients underwent preoperative biopsy. The surgeries were performed via the combination of an anterior and posterior approach in two patients, a posterior approach in seven patients, and an anterior approach in one patient. Residual tumors were not detected in all patients after surgery. Unfortunately, the postoperative complications occurred in three patients, namely bowel and bladder dysfunction (two patients) and cerebrospinal fluid leakage with secondary intracranial infection (one patient). The average follow-up was 22.7 months (8-44 months). All patients were relieved from preoperative symptoms after the last follow-up. The typical findings of our cases in MRI were a well-circumscribed lesion with a heterogenous signal intensity on T2-weighted image, which may be helpful for preoperative decision-making. Intralesional excision can be successfully performed using single anterior or single posterior or both, and is an important procedure in the treatment of sacral schwannomas ((Pan W, Wang Z, Lin N, Huang X, Liu M, Yan X, Ye Z. Clinical features and surgical treatment of sacral schwannomas. Oncotarget. 2017 Jun 6;8(23):38061-38068. doi: 10.18632/oncotarget.16968. PubMed PMID: 28445126; PubMed Central PMCID: PMC5514972. )). ---- Chandhanayingyong et al. presented the management and outcomes of sacral schwannoma in 4 patients treated with intralesional curettage and postoperative radiation. There were 3 women and one man (average age: 45.5 years) with long duration of lumbosacral pain with or without radiculopathy. Intralesional curettage was performed by posterior approach and adjuvant radiation therapy with dosage of 5000-6600 cGy was given after surgery. The mean follow-up time was 18 months (range 4-23 months). Symptoms of radiculopathy had decreased in all patients. The recent radiographic findings show evidence of sclerosis at the sacrum one year postoperatively, but the size was unchanged. Intralesional curettage and adjuvant radiation therapy can be used in the treatment of sacral schwannoma to relieve symptoms and preserve neurological function ((Chandhanayingyong C, Asavamongkolkul A, Lektrakul N, Muangsomboon S. The management of sacral schwannoma: report of four cases and review of literature. Sarcoma. 2008;2008:845132. doi: 10.1155/2008/845132. PubMed PMID: 18779869; PubMed Central PMCID: PMC2528062. )). ===== Unclassified ===== Last update 28.12.2019 2: Macciò A, Kotsonis P, Aste L, Voicu MA, Madeddu C, Conti C, Camparini S. An interdisciplinary approach for laparoscopic removal of a large retroperitoneal pelvic schwannoma attached to vital vessels: A case report. Medicine (Baltimore). 2019 Dec;98(51):e18149. doi: 10.1097/MD.0000000000018149. PubMed PMID: 31860962. 3: Pennington Z, Reinshagen C, Ahmed AK, Barber S, Goodwin ML, Gokaslan Z, Sciubba DM. Management of presacral schwannomas-a 10-year multi-institutional series. Ann Transl Med. 2019 May;7(10):228. doi: 10.21037/atm.2019.01.66. PubMed PMID: 31297393; PubMed Central PMCID: PMC6595202. 4: Zaidman N, Merve A, Russo V. Intraosseous Thoracic Schwannoma: Case Report and Review of the Literature. World Neurosurg. 2019 Oct;130:313-316. doi: 10.1016/j.wneu.2019.06.222. Epub 2019 Jul 8. PubMed PMID: 31295618. 5: Camacho JE, Usmani MF, Ho CY, Sansur CA, Ludwig SC. Perineal and Radicular Pain Caused by Contralateral Sacral Nerve Root Schwannoma: Case Report and Review of Literature. World Neurosurg. 2019 Sep;129:210-215. doi: 10.1016/j.wneu.2019.06.012. Epub 2019 Jun 14. PubMed PMID: 31203077. 6: Zaninovich O, Ramey W, Eldersveld J, Kasoff WS. Malignant Melanotic Schwannian Tumor Presenting with Spinal Cord Infarction Due to Occlusion of the Artery of Adamkiewicz: Case Report and Review of the Literature. World Neurosurg. 2019 Aug;128:422-425. doi: 10.1016/j.wneu.2019.04.267. Epub 2019 May 17. PubMed PMID: 31108251. 7: Pizzuti V, di Russo P, Esposito V, Morace R. Computed Tomography-Guided Posterolateral Transsacral Ala Approach to Presacral L5 Schwannoma: Technical Note. World Neurosurg. 2019 Aug;128:55-61. doi: 10.1016/j.wneu.2019.04.206. Epub 2019 May 1. PubMed PMID: 31054349. 8: Silva CD, Mateus JE, Silva JO, Vaio T. Sacral schwannoma with intraosseous extension. BMJ Case Rep. 2019 Jan 22;12(1). pii: e227095. doi: 10.1136/bcr-2018-227095. PubMed PMID: 30674491. 9: Stone JJ, Matsumoto JM, Morris JM, Spinner RJ. Preoperative Planning Using 3-Dimensional Printing for Complex Paraspinal Schwannoma Resection: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown). 2019 Mar 1;16(3):E80. doi: 10.1093/ons/opy239. PubMed PMID: 30169700. 10: Naja Z, Naja AS, Rajab O, Mugharbil A, Shatila AR, Al Hassan J. Repetitive nerve block for neuropathic pain management: a case report. Scand J Pain. 2018 Jan 26;18(1):125-127. doi: 10.1515/sjpain-2017-0155. PubMed PMID: 29794280. 11: Khan UA, Ismayl G, Malik I. Giant Sacral Schwannoma Treated with a 360 Approach: A Rare Case and Systematic Review of the Literature. World Neurosurg. 2018 Jul;115:65-72. doi: 10.1016/j.wneu.2018.03.203. Epub 2018 Apr 5. Review. PubMed PMID: 29627632. 12: Liu J, Luo H, Luo F, Li W, Feng K, Yang R, Zhang Z, Jiang Q, Cheng Z. Thoracic and lumbosacral spinal giant schwannoma. J Neurosurg Sci. 2018 Dec;62(6):777-779. doi: 10.23736/S0390-5616.18.04282-0. Epub 2018 Jan 23. PubMed PMID: 29363299. 13: Freitas B, Figueiredo R, Carrerette F, Acioly MA. Retroperitoneoscopic Resection of a Lumbosacral Plexus Schwannoma: Case Report and Literature Review. J Neurol Surg A Cent Eur Neurosurg. 2018 May;79(3):262-267. doi: 10.1055/s-0037-1608814. Epub 2017 Dec 14. Review. PubMed PMID: 29241265. 14: Lee BH, Hyun SJ, Park JH, Kim KJ. Single Stage Posterior Approach for Total Resection of Presacral Giant Schwannoma: A Technical Case Report. Korean J Spine. 2017 Sep;14(3):89-92. doi: 10.14245/kjs.2017.14.3.89. Epub 2017 Sep 30. PubMed PMID: 29017303; PubMed Central PMCID: PMC5642101. 15: Sharifi G, Jahanbakhshi A. Persistent L5 lumbosacral radiculopathy caused by lumbosacral trunk schwannoma. Asian J Neurosurg. 2017 Jan-Mar;12(1):51-54. doi: 10.4103/1793-5482.144158. PubMed PMID: 28413533; PubMed Central PMCID: PMC5379804. 16: Monserrate A, Zussman B, Ozpinar A, Niranjan A, Flickinger JC, Gerszten PC. Stereotactic radiosurgery for intradural spine tumors using cone-beam CT image guidance. Neurosurg Focus. 2017 Jan;42(1):E11. doi: 10.3171/2016.9.FOCUS16356. PubMed PMID: 28041317. 17: Emel E, Abdallah A, Sofuoglu OE, Ofluoglu AE, Gunes M, Guler B, Bilgic B. Long-term Surgical Outcomes of Spinal Schwannomas: Retrospective Analysis of 49 Consecutive Cases. Turk Neurosurg. 2017;27(2):217-225. doi: 10.5137/1019-5149.JTN.15678-15.1. PubMed PMID: 27593781. 18: Wang K, Su Y, Zhang Y, Jin B, Wang H, Liu L. [Microsurgical treatment for giant invasive spinal schwannoma assisted by three-dimensional navigation]. Zhonghua Yi Xue Za Zhi. 2016 Jan 19;96(3):177-80. doi: 10.3760/cma.j.issn.0376-2491.2016.03.005. Chinese. PubMed PMID: 26879717. 20: Fehlings MG, Nater A, Zamorano JJ, Tetreault LA, Varga PP, Gokaslan ZL, Boriani S, Fisher CG, Rhines L, Bettegowda C, Kawahara N, Chou D. Risk Factors for Recurrence of Surgically Treated Conventional Spinal Schwannomas: Analysis of 169 Patients From a Multicenter International Database. Spine (Phila Pa 1976). 2016 Mar;41(5):390-8. doi: 10.1097/BRS.0000000000001232. PubMed PMID: 26555828; PubMed Central PMCID: PMC4769652. 21: Onimaru R, Hida K, Takeda N, Onodera S, Nishikawa Y, Mori T, Shirato H. Three-dimensional conformal fractionated radiotherapy for spinal schwannoma with a paravertebral or an intraosseous component. Jpn J Radiol. 2015 Dec;33(12):757-63. doi: 10.1007/s11604-015-0492-4. Epub 2015 Oct 27. PubMed PMID: 26507984. 22: Attiah MA, Syre PP, Pierce J, Belyaeva E, Welch WC. Giant cystic sacral schwannoma mimicking tarlov cyst: a case report. Eur Spine J. 2016 May;25 Suppl 1:84-8. doi: 10.1007/s00586-015-4128-2. Epub 2015 Jul 21. PubMed PMID: 26195080. 23: Emohare O, Stapleton M, Mendez A. A minimally invasive pericoccygeal approach to resection of a large presacral schwannoma: case report. J Neurosurg Spine. 2015 Jul;23(1):81-5. doi: 10.3171/2014.11.SPINE14396. Epub 2015 Apr 24. PubMed PMID: 25909273. 24: Zang J, Guo W, Yang R, Tang X, Li D. Is total en bloc sacrectomy using a posterior-only approach feasible and safe for patients with malignant sacral tumors? J Neurosurg Spine. 2015 Jun;22(6):563-70. doi: 10.3171/2015.1.SPINE14237. Epub 2015 Mar 27. PubMed PMID: 25815809. 25: Tan LA, Takagi I, Straus D, O'Toole JE. Management of intended durotomy in minimally invasive intradural spine surgery: clinical article. J Neurosurg Spine. 2014 Aug;21(2):279-85. doi: 10.3171/2014.3.SPINE13719. Epub 2014 May 9. PubMed PMID: 24867211. 26: Cho DY, Hur JW, Shim JH, Kim JS. Cystic giant sacral schwannoma mimicking aneurysmal bone cyst : a case report and review of literatures. J Korean Neurosurg Soc. 2013 Oct;54(4):350-4. doi: 10.3340/jkns.2013.54.4.350. Epub 2013 Oct 31. PubMed PMID: 24294462; PubMed Central PMCID: PMC3841281. 27: Chakravarthy H. Melanotic cyst of L5 spinal root: A case report and review of literature. Asian J Neurosurg. 2012 Oct;7(4):217-9. doi: 10.4103/1793-5482.106659. PubMed PMID: 23559992; PubMed Central PMCID: PMC3613647. 28: Labędź W, Kubaszewski L, Adamek J. Operative treatment of Schwannoma, the primary sacral tumor--case presentation. Pol Orthop Traumatol. 2012 May 30;77:10-6. PubMed PMID: 23306280. 29: Gerszten PC, Chen S, Quader M, Xu Y, Novotny J Jr, Flickinger JC. Radiosurgery for benign tumors of the spine using the Synergy S with cone-beam computed tomography image guidance. J Neurosurg. 2012 Dec;117 Suppl:197-202. doi: 10.3171/2012.8.GKS12981. PubMed PMID: 23205810. 30: Lee JH, Jang JW, Kim SH, Moon HS, Lee JK, Kim SH. Surgical results after unilateral laminectomy for the removal of spinal cord tumors. Korean J Spine. 2012 Sep;9(3):232-8. doi: 10.14245/kjs.2012.9.3.232. Epub 2012 Sep 30. PubMed PMID: 25983821; PubMed Central PMCID: PMC4431008. 31: Çağlı S, Işık HS, Yıldırım U, Akıntürk N, Zileli M. Giant sacral schwannomas. J Neurooncol. 2012 Oct;110(1):105-10. doi: 10.1007/s11060-012-0941-1. Epub 2012 Jul 18. PubMed PMID: 22806341. 32: Parreira Jde S, Ferreira A, Pontes FT, Antonucci AT, Santiago NM, Oliveira Bde A, Lopes LH, Lopes PG. Tactics for the surgical handling of neurogenic sacral tumors. Arq Neuropsiquiatr. 2012 Jun;70(6):470. PubMed PMID: 22699547. 33: Hyun SJ, Rhim SC. Giant cauda equina schwannoma with dystrophic calcifications : case report and review of the literature. J Korean Neurosurg Soc. 2012 Feb;51(2):105-8. doi: 10.3340/jkns.2012.51.2.105. Epub 2012 Feb 29. PubMed PMID: 22500204; PubMed Central PMCID: PMC3322206. 34: Yu NH, Lee SE, Jahng TA, Chung CK. Giant invasive spinal schwannoma: its clinical features and surgical management. Neurosurgery. 2012 Jul;71(1):58-66. doi: 10.1227/NEU.0b013e31824f4f96. PubMed PMID: 22353794. 35: Gerszten PC, Quader M, Novotny J Jr, Flickinger JC. Radiosurgery for benign tumors of the spine: clinical experience and current trends. Technol Cancer Res Treat. 2012 Apr;11(2):133-9. PubMed PMID: 22335407. 36: Alfieri A, Campello M, Broger M, Vitale M, Schwarz A. Low-back pain as the presenting sign in a patient with a giant, sacral cellular schwannoma: 10-year follow-up. J Neurosurg Spine. 2011 Feb;14(2):167-71. doi: 10.3171/2010.10.SPINE1015. Epub 2011 Jan 7. PubMed PMID: 21214314. 37: Mizutani A, Yokota N, Kawaji H, Yamaguchi-Okada M, Miyagawa T, Namba H. Intraosseous schwannoma of the cervical vertebral body: A case report and review of the literature. Br J Neurosurg. 2010 Oct;24(5):604-6. doi: 10.3109/02688697.2010.495168. Review. PubMed PMID: 20632880. 38: Ozdemir N, Bezircioğlu H, Akar O. Giant erosive spinal schwannomas: surgical management. Br J Neurosurg. 2010 Oct;24(5):526-31. doi: 10.3109/02688697.2010.487129. PubMed PMID: 20515264. 39: James G, Crocker M, King A, Bodi I, Ibrahim A, Chitnavis BP. Malignant triton tumors of the spine. J Neurosurg Spine. 2008 Jun;8(6):567-73. doi: 10.3171/SPI/2008/8/6/567. Review. PubMed PMID: 18518679. 40: Gerszten PC, Burton SA, Ozhasoglu C, McCue KJ, Quinn AE. Radiosurgery for benign intradural spinal tumors. Neurosurgery. 2008 Apr;62(4):887-95; discussion 895-6. doi: 10.1227/01.neu.0000318174.28461.fc. PubMed PMID: 18496194. 41: Gerszten PC, Burton SA. Clinical assessment of stereotactic IGRT: spinal radiosurgery. Med Dosim. 2008 Summer;33(2):107-16. doi: 10.1016/j.meddos.2008.02.003. Epub 2008 Mar 31. PubMed PMID: 18456162. 42: Stevanato G, Vazzana L, Daramaras S, Trincia G, Saggioro GC, Squintani G. Lumbosacral plexus lesions. Acta Neurochir Suppl. 2007;100:15-20. PubMed PMID: 17985537. 43: D'Andrea G, Caroli E, Capponi MG, Scicchitano F, Osti MF, Bellotti C, Ferrante L. Retroperitoneal mesenchymal chondrosarcoma mimicking a large retroperitoneal sacral schwannoma. Neurosurg Rev. 2008 Apr;31(2):225-9. Epub 2007 Oct 3. PubMed PMID: 17912561. 44: Kobayashi S, Uchida K, Kokubo Y, Yayama T, Nakajima H, Inukai T, Nomura E, Baba H. A schwannoma of the S1 dural sleeve was resected while the intact nerve fibers were preserved using a microscope. Report of a case with early MRI findings. Minim Invasive Neurosurg. 2007 Apr;50(2):120-3. PubMed PMID: 17674301. 45: Yang CC, Chen HC, Chen CM. Endoscopic resection of a presacral schwannoma. Case report. J Neurosurg Spine. 2007 Jul;7(1):86-9. PubMed PMID: 17633494. 46: Sengöz A, Taşdemiroğlu E, Togay H. Is clear cell sarcoma a malignant form of psammomatous melanotic schwannoma? Case report. Neurosurg Focus. 2006 Dec 15;21(6):E11. Review. PubMed PMID: 17341045. 47: Bhatnagar AK, Gerszten PC, Ozhasaglu C, Vogel WJ, Kalnicki S, Welch WC, Burton SA. CyberKnife Frameless Radiosurgery for the treatment of extracranial benign tumors. Technol Cancer Res Treat. 2005 Oct;4(5):571-6. PubMed PMID: 16173828. 48: Deutsch H, Mummaneni PV, Haid RW, Rodts GE, Ondra SL. Benign sacral tumors. Neurosurg Focus. 2003 Aug 15;15(2):E14. Review. PubMed PMID: 15350045. 49: Klimo P Jr, Rao G, Schmidt RH, Schmidt MH. Nerve sheath tumors involving the sacrum. Case report and classification scheme. Neurosurg Focus. 2003 Aug 15;15(2):E12. PubMed PMID: 15350043. 50: Gerszten PC, Ozhasoglu C, Burton SA, Welch WC, Vogel WJ, Atkins BA, Kalnicki S. CyberKnife frameless single-fraction stereotactic radiosurgery for tumors of the sacrum. Neurosurg Focus. 2003 Aug 15;15(2):E7. PubMed PMID: 15350038. 51: Gottfried ON, Schmidt MH, Stevens EA. Embolization of sacral tumors. Neurosurg Focus. 2003 Aug 15;15(2):E4. Review. PubMed PMID: 15350035. 52: Conti P, Pansini G, Mouchaty H, Capuano C, Conti R. Spinal neurinomas: retrospective analysis and long-term outcome of 179 consecutively operated cases and review of the literature. Surg Neurol. 2004 Jan;61(1):34-43; discussion 44. Review. PubMed PMID: 14706374. 53: Yano S, Hida K, Seki T, Yasuda K, Oonishi K, Okushiba S, Iwasaki Y. [Surgical treatment of retroperitoneal presacral large schwannoma by the anterior transabdominal approach: two cases reports]. No Shinkei Geka. 2003 Jul;31(7):795-800. Japanese. PubMed PMID: 12884795. 54: Huang J, Mobbs R, Teo C. Multiple schwannomas of the sciatic nerve. J Clin Neurosci. 2003 May;10(3):391-3. PubMed PMID: 12763357. 55: Kitamura J, Hida K, Seki T, Iwasaki Y. [Giant, invasive sacral schwannoma extending to the 4th lumbar spine]. No Shinkei Geka. 2002 Nov;30(11):1203-8. Review. Japanese. PubMed PMID: 12428354. 56: Domínguez J, Lobato RD, Ramos A, Rivas JJ, Gómez PA, Castro S. Giant intrasacral schwannomas: report of six cases. Acta Neurochir (Wien). 1997;139(10):954-9; discussion 959-60. PubMed PMID: 9401656. 57: Acciarri N, Staffa G, Poppi M. Giant sacral schwannoma: removal by an anterior, transabdominal approach. Br J Neurosurg. 1996 Oct;10(5):489-92. PubMed PMID: 8922709. 58: Anson KM, Byrne PO, Robertson ID, Gullan RW, Montgomery AC. Radical excision of sacrococcygeal tumours. Br J Surg. 1994 Mar;81(3):460-1. PubMed PMID: 8173931. 59: Kato T, George B, Mourier KL, Lot G, Gelbert F, Mikol J. Intraforaminal neurinoma in the lumbosacral region. Neurol Med Chir (Tokyo). 1993 Feb;33(2):86-91. Review. PubMed PMID: 7682671. 60: Schiffer J, Reif R, Lahat E, Bar-Iojai A, Starinski R. Intraosseous neurilemmoma of skull--single case report. Neurochirurgia (Stuttg). 1991 Nov;34(6):178-9. PubMed PMID: 1775208. 61: Nishida K, Ueda S, Matsumoto K, Kusaka K, Takeuchi R. Cauda equina neurinoma associated with normal pressure hydrocephalus--case report. Neurol Med Chir (Tokyo). 1990 Apr;30(4):258-62. Review. PubMed PMID: 1696696. 62: Viard H, Sautreaux JL, Haas O, Bernard A, Goudet P, Barry P. [Dumbbell neurogenic tumors. 5 cases (4 thoracic, 1 lumbar)]. Chirurgie. 1989;115(8):521-4; discussion 524-5. French. PubMed PMID: 2637110. 63: Benzel EC, Morris DM, Fowler MR. Nerve sheath tumors of the sciatic nerve and sacral plexus. J Surg Oncol. 1988 Sep;39(1):8-16. PubMed PMID: 3419170. 64: Iizuka H, Nakamura T, Kadoya S. [Spinal melanotic schwannoma: report of a case]. No Shinkei Geka. 1988 Sep;16(10):1199-205. Review. Japanese. PubMed PMID: 3060751. 65: Rengachary SS, O'Boynick P, Batnitzky S, Kepes JJ. Giant intrasacral Schwannoma: case report. Neurosurgery. 1981 Nov;9(5):573-7. PubMed PMID: 7322323.