Mobile schwannoma of the cauda equina. Case report

A patient with a mobile schwannoma of the cauda equina is described. The wide discrepancy between the myelographic and surgical locations of the tumor is most unusual. Awareness of the possibility of such an extreme degree of motility is important when dealing with cauda equina tumors.     

Giant cauda equina schwannoma. A case report

STUDY DESIGN: Case report. OBJECTIVES: To present a rare case of a giant schwannoma of the cauda equina. SUMMARY OF BACKGROUND DATA: Giant spinal schwannoma of the cauda equina, which involves many nerve roots, is rare and there is usually no ossification in the schwannoma. It is unknown whether or not complete excision is preferable if the tumor is located in the lumbar lesion. METHODS: A 57-year-old woman had a 10-year history of low back pain. Scalloping of the posterior surface of the vertebral bodies from L3 to the sacrum was found. Magnetic resonance imaging disclosed a giant cauda equina tumor with multiple cysts. Central ossification revealed by computed tomography and an unusual myelogram made the preoperative diagnosis difficult. RESULTS: The patient underwent incomplete removal of the tumor, decompression of cysts, and spinal reconstruction. The tumor was proved to be a schwannoma. The postoperative course was uneventful and she has been almost free from low back pain for 3 years and 4 months. CONCLUSIONS: Giant schwannoma in the lumbar spine region is usually excised incompletely, because complete removal had the risk of sacrificing many nerve roots. In spite of the incomplete removal of the tumor, the risk of recurrence is low.     

Intradural cauda equina schwannoma

Intradural schwannoma is an uncommon tumor, especially in the cauda equina. The value of postmyelographic computed tomography is discussed in this case.     

A giant schwannoma of cauda equina.

A case of giant schwannoma occurring in a woman 23 years of age with deformity of the foot developing at the age of five years is reported. The gross radiological changes of increased interpedicular distance and erosion of the posterior surface of the vertebra suggested the massive size of the tumour (6' x 21/2' x 11/2'). Successful surgical excision of such a large size schwannoma has not been reported previously.     

Elusive tumor of the cauda equina. Case report

A patient with a mobile schwannoma of the cauda equina is described. There was considerable discrepancy between the localization of the tumor at myelography and the findings at both initial surgery and repeat myelography, confirmed by definitive surgery. Such mobility is rare, but should be kept in mind when surgery is performed for a tumor of the cauda equina.     

Multiple cavernous angiomas of the cauda equina. Case report

An 18-year-old male presented with multiple cavernous angiomas of the cauda equina manifesting as acute onset of severe low back pain radiating into the bilateral legs. Magnetic resonance imaging revealed a 20 mm by 15 mm nonenhanced, heterogeneous intensity intradural mass at the L-1 level, which had completely obliterated the spinal canal. After laminectomy at T12-L1 and dural incision, a 20 mm dark-bluish, mulberry-like tumor was seen, displacing the cauda equina circumferentially. After total removal of this tumor, four more small tumors were found adhering to different nerve roots, which were not resected. Histological examination revealed cavernous angioma. Although the postoperative course was uneventful, close observation of the residual tumors is required.     

Cystic schwannoma of the cauda equina mimicking hemangioblastoma

Cystic schwannoma is highly unusual and intraspinal involvement seems to be even more rare. We report a case of intradural lumbar-cystic schwannoma in a 50-year-old man who presented with chronic low-back pain and sciatalgia, which were initially related to a bulging disc. Diagnosis of a tumor origin was suspected two years later on MRI as a hemangioblastoma. The lesion was histologically confirmed to be a schwannoma. Only eight cases of spinal schwannoma with large cyst have been previously reported. Cystic schwannoma should be considered in the differential diagnosis of lumbar intradural-cystic lesion.     

Mobile schwannoma of the cauda equina incarcerated following caudal migration after trauma--case report

A 56-year-old man presented with a very rare case of mobile schwannoma of the cauda equina incarcerated following caudal migration after trauma, manifesting as attack of severe back pain and bilateral sciatica which developed just after a fall. Magnetic resonance imaging demonstrated a large intradural tumor at the L4-5 level with redundant nerve roots below that. Two days before the surgery, his pain unexpectedly lessened without additional treatment. Computed tomography showed that the tumor had migrated cranially and was now located at the L3-4 level. These findings suggest that the severe symptoms were caused by incarceration of a mobile tumor at the L4-5 level following the trauma. The tumor was successfully removed using minimally invasive procedures with guidance provided by the intraoperative myelography. The patient was relieved from pain postoperatively. The histological diagnosis was schwannoma. This case suggests that intraoperative myelography is a useful method for guiding the removal of mobile tumors.     

Giant schwannoma of the cauda equina with dural ectasia: a case report

Ermutigende Ergebnisse bei anderen Tumorentitäten erklären das wachsende Interesse zum Stellenwert des sog. Sentinel-Node-Konzepts auch bei Plattenepithelkarzinomen der oberen Luft- und Speisewege. Wenngleich die bisher zu dieser Thematik publizierten Untersuchungen keine abschließende Beurteilung zum Stellenwert der Sentinel-Lymphonodektomie zulassen, untermauern die frühen Ergebnisse eine Bedeutung dieses neuen Diagnostik- und Therapiekonzepts auch bei vorgenannter Tumorentität. Grundvoraussetzung sind detaillierte Kenntnisse um die in dieser speziellen anatomischen Region vorhandenen methodenspezifischen Limitierungen, die eine kritische und sorgfältige Überprüfung der Übertragbarkeit der für andere Tumorentitäten beschriebenen Methode zwingend erforderlich macht, um eine enttäuschte Abwendung von einem bei korrekter Indikationsstellung hilfreichen Verfahren zu verhindern.     

Cavernous angioma of the cauda equina producing subarachnoid hemorrhage. Case report

A case of a cavernous angioma of the cauda equina is presented. The patient was a 28-year-old man who experienced sudden low-back pain and headache without neurological symptoms. Lumbar puncture revealed subarachnoid hemorrhage. He had suffered a similar episode 3 years previously. Selective spinal angiography did not demonstrate any abnormal vascularity. Metrizamide myelography and magnetic resonance imaging were useful in demonstrating the presence of a tumor. Laminectomy at L1-3 and total removal of the tumor were performed without neurological deficit.     

Spinal arteriovenous fistulae with a concomitant cauda equina schwannoma.

BACKGROUND: Perimedullary spinal arteriovenous malformations or direct spinal arteriovenous fistulaes (AVFs) may be associated with other vascular abnormalities, such as arteriovenous malformations, venous ectasis, and aneurysms, but rarely have been reported with intraspinal intradural tumors. PURPOSE: The authors present an interesting case of type IV-A spinal AVF concomitant with a cauda equina schwannoma. STUDY DESIGN: The diagnostic procedures and surgical outcome were described. METHODS: The patient underwent surgery, the vessel feeding the AVFs was identified and cauterized, and the spinal tumor was removed. The fistula was small and located inside the tumor. The pathology revealed AVF and schwannoma, respectively. RESULTS: After surgery, the patient's symptoms began to improve and subside. Two years after surgery, follow-up magnetic resonance imaging showed no vascular lesion and tumor in the spinal canal. CONCLUSIONS: The association of spinal AVFs and cauda equina schwannoma has not been reported previously in any literature. The patient presents the symptoms of myelopathy associated with a spinal vascular lesion; it has to be noted that a concomitant and related intradural spinal tumor may exist.     

Concurrent schwannoma and intradural neuroma after resection of a cauda equina schwannoma. A case report and first description

Purpose  

We present the case of a 33-year-old female complaining of recurrent pain and sensory disturbance in both legs, 3 years after the removal of a schwannoma at the level of L2/3.     

Paraganglioma of the cauda equina with associated syringomyelia: Case report

We present an association not previously described in which the rare entity of paraganglioma of the cauda equina was found in association with syringomyelia of the cervico-thoracic cord. The patient, a 50-year-old woman presented with a long history of lower back pain with recent onset of sciatic pain and altered sensation in the right leg. Surgical resection of the tumor with intraoperative syringostomy of the syrinx has led to eradication of all symptoms and at 5 months shows no evidence of residual pathology.     

Spinal subarachnoid hemorrhage attributable to schwannoma of the cauda equina

BACKGROUND: Cauda equina syndrome occurring as a result of spontaneous spinal subarachnoid hemorrhage (SAH) from a spinal tumor is reported to be rare. CASE DESCRIPTION: A 28-year-old woman presented at our clinic with a history of severe back pain for 10 days, progressive paraparesis, and urinary retention. Her physical examination revealed a mass located intradurally at the level of L1-2 and a massive SAH. An L1-L2, laminectomy and a hemilaminectomy from D9 to D12 were performed and the SAH was evacuated and the cord was decompressed. CONCLUSION: At the first year follow-up, her restricted dorsal and plantar flexion continued. Post-gadolinium magnetic resonance imaging revealed no mass.     

Paraganglioma in the cauda equina. A case report

Paraganglioma of the cauda equina is rare, and diagnosis is difficult. A 47-year-old woman presented with backache, with a 2-year history of pain radiating in her right lower extremity. Initial neurologic examination revealed mild hypaesthesia in the L4 dermatome on both sides. Spine MRI showed a well-delinated intradural extramedullary mass compressing the spinal cord. It extended from L2 to L4, with anterior compression of the spinal cord which was displaced posteriorly. Clinical and radiological findings suggested an ependymoma. Surgical decompression was performed from L2 to L4 through lumbar laminectomy under microscope. Intraoperatively, the patient experienced unexplained paroxysmal hypertension while manipulating the tumour, which was not relieved by hypotensive medication but resolved immediately after resection of the mass. Postoperatively, the neurologic status improved and the radiating pain was relieved. Histopathologic examination showed cellular perivascular arrangement which looked like 'pseudorosettes'. Taken together, these histologic and radiologic findings suggested a benign myxopapillary ependymoma. However, immunohistochemical examination showed reactivity with synaptophysin and chromogranin. Finally, histological examination of the specimen revealed a 'Zellballen' pattern of paraganglioma, and the final diagnosis of paraganglioma with secreting function was confirmed. Paraganglioma is a rare tumour that can exhibit a secreting function causing paroxysmal hypertension which may be life threatening. Therefore, the differential diagnosis is important. The diagnosis is based on close examination of the clinical, radiologic and pathologic findings.