Giant spinal schwannoma
Giant spinal schwannomas are defined as intradural extramedullary spinal tumors that span >2 vertebral body lengths. Although uncommon, these lesions can cause significant mass effect on the spinal cord and subsequent neurologic compromise.
Treatment
Gross total resection is the goal of operative intervention, however, is extremely challenging in cases where the tumor occupies a ventral, midline position within the lower cervical thecal sac.
Various approaches have been described for treating these tumors 1) 2) 3) 4) 5) 6) 7) 8) 9) 10).
Case reports
Hussain et al. describe an adult male with insidious progression of upper extremity radicular pain and paresthesias, found to have a ventral, solid/cystic C5-C7 giant schwannoma. They demonstrate the step-by-step surgical technique for an anterior approach 2-level cervical corpectomy, microsurgical resection of an intradural giant schwannoma, watertight dural closure, and lastly 360-degrees instrumented stabilization of the cervicothoracic spine. In addition we incorporate the utilization of a portable intraoperative computed tomography for stereotactic localization and 3-dimensional navigation-guided screw implantation. Finally, we discuss various preoperative, perioperative, and postoperative considerations that can have profound impact on successful outcomes 11).