Table of Contents

Giant Sacral Schwannoma

Case series

In 1997 only 4 of the 30 previously reported cases of giant sacral schwannomas have been studied with Magnetic Resonance Imaging (MRI).

Domínguez et al. reported 6 more cases, 5 of which had MRI studies. There were 5 women and 1 man (average age 45 years) with long lasting symptoms consisting of lumbosacral and radicular pain accompanied by urinary disturbances and dysaesthetic sensations in the lower limbs. CT clearly defined sacral bone involvement but poorly demonstrated intraspinal tumour extension which was more evident in MRI studies. MRI also clearly showed the intrapelvic extension of the tumour, its relationship with the neighbouring structures and the dumbbell growth pattern due to tumour extension through sacral foramina which are important data for making a pro-operative diagnosis and surgical planning. Surgical treatment consisted of piecemeal tumour resection through a posterior approach in four cases. Two patients underwent operation through an abdominal transperitoneal approach followed by a sacral laminectomy. Total intracapsular resection was apparently achieved in 5 cases. Through an average follow-up period of 9.2 years and despite a rather conservative approach, the recurrence rate has been very low in our series and only one patient had to be re-operated on for tumour recurrence 1).

Case reports

Giant Invasive Sacral Schwannoma with Aortic Bifurcation Compression and Hydronephrosis 2).

Khan et al. reported 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.

They reported one of the largest benign sacral schwannoma originating inside the spinal canal with pelvic extension to be resected without complications. They discussed the successful management and conducted 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 3).

Giant cystic schwannoma of the sacral spine 4).

Togral et al discussed the clinical features and the surgical treatment they performed without the need for stabilization in an incidentally determined giant invasive schwannoma case 5).

Unclassified

3: 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.

4: 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.

5: 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.

6: Abu-Bonsrah N, Ahmed A, Goodwin CR, Ruiz-Valls A, Sciubba DM. Giant cystic schwannoma of the sacral spine. Spine J. 2016 May;16(5):e323-4. doi: 10.1016/j.spinee.2015.11.042. Epub 2015 Dec 2. PubMed PMID: 26656434.

7: 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.

8: 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.

9: 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.

10: 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.

11: 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.

12: 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.

13: 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.

14: 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.

15: 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.

16: Gottfried ON, Schmidt MH, Stevens EA. Embolization of sacral tumors. Neurosurg Focus. 2003 Aug 15;15(2):E4. Review. PubMed PMID: 15350035.

17: 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.

19: 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.

20: Rengachary SS, O'Boynick P, Batnitzky S, Kepes JJ. Giant intrasacral Schwannoma: case report. Neurosurgery. 1981 Nov;9(5):573-7. PubMed PMID: 7322323.

1)
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.
2)
Dr Ragurajaprakash K, Dr Junya H, Dr Toshiyuki T, Dr Manabu U, Dr Manabu M, Dr Yosuke T, Dr Yoshitaka T, Dr Ryo K. Giant Invasive Sacral Schwannoma with Aortic Bifurcation Compression and Hydronephrosis. World Neurosurg. 2019 Dec 25. pii: S1878-8750(19)33117-1. doi: 10.1016/j.wneu.2019.12.088. [Epub ahead of print] PubMed PMID: 31883482.
3)
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.
4)
Abu-Bonsrah N, Ahmed A, Goodwin CR, Ruiz-Valls A, Sciubba DM. Giant cystic schwannoma of the sacral spine. Spine J. 2016 May;16(5):e323-4. doi: 10.1016/j.spinee.2015.11.042. Epub 2015 Dec 2. PubMed PMID: 26656434.
5)
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.