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.     

Intramedullary spinal schwannoma: case report and review of preoperative magnetic resonance imaging features

Intramedullary schwannomas are rare spinal cord tumours. Correct preoperative diagnosis is essential for proper surgical planning and complete resection. We present a case of cervical intramedullary schwannoma followed by discussion on its preoperative magnetic resonance imaging features and review of the literature.     

Sciatica in a patient with unusual peripheral nerve sheath tumors

BACKGROUND: Other causes such as peripheral schwannomas can mimic lumbar disk disease. CASE DESCRIPTION: We present an unusual case of multiple nerve sheath tumors in a patient with left radicular leg pain accompanied by a Tinel sign. Initial lumbar MR imaging revealed a mass in the right lumbar plexus, side opposite the patient's symptoms. Magnetic resonance neurography subsequently revealed a compressive mass of the sciatic nerve proximal to the popliteal fossa, histologically identified as a schwannoma. CONCLUSION: This case emphasizes the importance of continued investigation when the radiographic findings do not correlate with the patient's history in the presence of localizing signs on physical examination.     

Intraosseous schwannoma of the cervical spine

The authors report a rare case of a cervical intraosseous schwannoma, which was diagnosed following an incidental history of trauma. This is the first case of an intraosseous schwannoma of the cervical vertebra that was diagnosed using magnetic resonance imaging. The authors discuss the radiological imaging, surgical procedure and review the relevant literature.     

Paraplegia in a pregnant thalassemic woman due to extramedullary hematopoiesis: successful management with transfusions

The investigation and treatment of a pregnant thalassemic woman who developed severe paraplegia is presented. Magnetic resonance imaging showed a paravertebral mass infiltrating the epidural space, resulting from extramedullary hematopoiesis (marrow heterotopia). The patient was treated successfully with repeated blood transfusions and made a complete recovery. The literature (36 cases) is reviewed and the magnetic resonance imaging features of spinal extramedullary hematopoiesis are presented. The efficacy of transfusions in the management of spinal cord compression due to marrow heterotopia in thalassemic patients is discussed.     

Chronic spontaneous spinal epidural hematoma simulating a lumbar stenosis

Summary A case of a patient with a clinical picture of lumbar spine stenosis actually caused by a chronic, spontaneous, spinal epidural hematoma is reported. There was no history of major or minor trauma to the lumbar spine. The correct preoperative diagnosis was made by magnetic resonance imaging. The possible etiology and clinical and radiological findings and treatment of this rare entity are discussed.     

Caudal spinal cord ischemia after lumbar vertebral manipulation

Neurological complications after lumbar spine manipulation are uncommon. The cause is usually a herniated disk or displaced bony structure. We report a case of paraplegia that developed a few hours after manipulation of the lumbar spine. Magnetic resonance imaging was consistent with ischemia of the caudal spinal cord. No disk fragment or bony structure impinging on the spinal cord was seen. Spinal cord ischemia may deserve to be added to the list of possible adverse events after lumbar spine manipulation.     

Intraventricular schwannoma: Case report and review of literature

We report here a case of intraventricular schwannoma. This location is rare. Our patient was a 68-year-old female with a large intraventricular lesion of the body of the lateral ventricle on the right side. Brain magnetic resonance imaging (MRI) revealed this lesion. After a right parietotemporal craniotomy, microsurgical excision using neuronavigation was performed to completely remove the tumor. Histological and immunohistochemical examination confirmed the diagnosis of intraventricular schwannoma devoid of atypical features. Postoperative MRI showed macroscopically complete tumor removal with no recurrence after 12 months of follow-up. A review of the literature identified 32 such cases published to date.     

Ischémie de la moelle spinale caudale après manipulation lombaire

Neurological complications after lumbar spine manipulation are uncommon. The cause is usually a herniated disk or displaced bony structure. We report a case of paraplegia that developed a few hours after manipulation of the lumbar spine. Magnetic resonance imaging was consistent with ischemia of the caudal spinal cord. No disk fragment or bony structure impinging on the spinal cord was seen. Spinal cord ischemia may deserve to be added to the list of possible adverse events after lumbar spine manipulation.     

Preoperative diagnosis of an extradural cyst arising from a spinal facet joint: case report.

A case of a lumbar spinal extradural cyst is reported. An accurate preoperative diagnosis was made using magnetic resonance imaging. Characteristic findings on magnetic resonance imaging obviate the need for any additional radiological studies. The clinical features, radiological findings, and pathogenesis of these lesions are discussed.     

Presacral schwannoma with purely cystic form

STUDY DESIGN: Case report. OBJECTIVE: To point out that presacral schwannoma can display markedly cystic degeneration. SUMMARY OF BACKGROUND DATA: Benign schwannoma sometimes displays degenerative changes, such as cyst formation, calcification, hemorrhage, and hyalinization. Usually these degenerations are partially seen in the tumors. METHODS: Medical history, physical findings, imaging features, and histologic findings were reviewed in a case with a large presacral schwannoma. RESULTS: A 62-year-old woman presented with an 18-month history of right sciatic pain. Magnetic resonance images detected a large cystic, presacral tumor. Initially the tumor was misdiagnosed as a cystic ovarian tumor. Preoperative diagnostic workup led to the diagnosis of cystic schwannoma. Intralesional curettage achieved good pain relief. CONCLUSIONS: This tumor was unusual in its totally cystic appearance and resemblance to a cystic ovarian tumor or anterior sacral meningocele. Preoperative diagnosis is important to prevent major neurologic deficit at surgery.     

Oncocytoma of the spinal cord causing paraplegia - a case report

STUDY DESIGN: Case report. OBJECTIVES: To describe a rare case of oncocytoma arising from the spinal cord in a 40-year old woman. SETTING: Republic of Korea. METHODS: The patient's history, physical examination, radiological and pathological findings were reviewed. RESULTS: A 40-year-old woman presented with 3-month history of low back pain. Magnetic resonance imaging revealed an intradural extramedullary mass located between L1 and L4. She refused any surgical treatment and so was discharged. At 10 days after discharge, an emergency operation was performed because of sudden paralysis in both lower extremities. The confirmed diagnosis is oncocytoma. At 4 months after surgery, the patient failed to obtain neurological recovery from complete paraplegia. CONCLUSIONS: Since the progression of an intradural extramedullary mass that shows minor neurological symptoms can lead to complete paraplegia in a short time, close observation and early surgical decompression are necessary.     

Acute cauda equina syndrome caused by a gas-containing prolapsed intervertebral disk

Gas production as a part of disk degeneration can occur, but it rarely causes clinical nerve compression syndromes. A rare case of gaseous degeneration in a prolapsed lumbar intervertebral disk causing acute cauda equina syndrome is described. Radiologic features and intraoperative findings are reported. A 78-year-old woman with severe lumbar canal stenosis had acute cauda equina syndrome. Magnetic resonance imaging revealed a large disk protrusion, and she underwent an urgent operation for this. Surgery confirmed the severe lumbar canal stenosis, but the disk prolapse contained gas that had caused the nerve compression.     

Unsuccessful lumbar puncture in a paediatric patient with achondroplasia

We present a case of an unsuccessful lumbar puncture performed on an anaesthetised 17-year-old girl with achondroplasia who was diagnosed with and being treated for acute lymphoblastic leukaemia. Magnetic resonance imaging (MRI) subsequently showed spinal stenosis and no observable cerebrospinal fluid around the nerve roots at the levels of the lumbar pedicles and discs. A recommendation is made to obtain MRI scans before proceeding with lumbar puncture and/or spinal anaesthesia in this patient group to ensure that the anatomical features of the insertion site are favourable to a successful outcome.     

Primary amyloidoma of the thoracic spine presenting with acute paraplegia

BACKGROUND

Primary solitary amyloidoma of the spine is a rare disease characterized by localized deposition of amyloid. To the best of our knowledge, there have been only 14 cases previously reported in the literature. Patients with focal spinal amyloidoma usually have relatively long symptomatic periods preoperatively, ranging from 3 weeks to 6 years (mean: 12 months). Only two reported patients had acute paraplegia. We add a third case of a thoracic spine amyloidoma presenting with acute paraplegia.

CASE DESCRIPTION

A 65-year-old man presented with a three-day history of progressive paraplegia and urinary retention. He was found to have severe cord compression at T2 on magnetic resonance imaging. He underwent emergent decompressive laminectomy with instrumentation for spinal stabilization. Histopathology revealed abundant amyloid deposits. A systemic work-up was negative for amyloidosis. The patient showed marked neurological improvement with residual mild spastic gait after 1 year.

CONCLUSIONS

Primary spinal amyloidoma with acute paraplegia is rare. One-stage surgery combining prompt decompression and stabilization of the spinal column is mandatory in cases of spinal amyloidoma with acute myelopathy, because primary solitary amyloidoma carries a good prognosis.     

Spinal epidural cavernous angioma: case report.

Epidural cavernous angiomas are apparently rare lesions. We present a case of paraplegia with acute onset secondary to spinal epidural cavernous angioma at levels C7 and T1. Magnetic resonance imaging gave the clinician the opportunity to diagnose the lesion preoperatively. In this article, we present and discuss this rare case with a review of the literature.     

Ancient schwannoma of the hand

Ancient schwannoma is a schwannoma subtype, characterized by extensive degeneration and diffuse hypocellular areas. These changes are believed to occur because it takes a long time for ancient schwannomas to develop. Schwannomas with these degenerative changes can be misdiagnosed as sarcomas or other soft-tissue neoplasms. We present a case of a slowly enlarging ancient schwannoma of the thenar area in a 67-year-old woman. The differential diagnosis included atypical soft tissue sarcomas and tumors of neural origin. The combination of ultrasound and magnetic resonance imaging findings provided features that narrowed the differential diagnosis, and histology confirmed the presence of an encapsulated schwannoma with extensive myxomatous degeneration and multiple vessel thrombosis. The clinical, radiological, and histological features and the diagnostic approach of this rare entity are described.     

Brown-Séquard syndrome following removal of a cerebrospinal fluid drainage catheter after thoracic aortic surgery

Neurological deficit remains a devastating complication of thoracic aortic surgery despite advances in methods to protect the spinal cord from ischemia. Various techniques have been used, including the combination of cerebrospinal fluid (CSF) drainage and distal aortic perfusion to decrease the incidence of postoperative neurological deficit. These deficits are usually bilateral and result in paraplegia. In this case report we present a patient with Type B aortic dissection and thoracoabdominal aortic aneurysm repair with insertion of a lumbar CSF drainage catheter. Postoperatively, the patient developed unilateral neurological features consistent with Brown-Séquard syndrome after removal of the CSF catheter. The lumbar cerebrospinal fluid catheter was reinserted and the CSF was drained. Medullary T6-7 signal abnormalities were seen on spinal cord magnetic resonance imaging, and we suggest that the spinal cord suffered a direct injury during catheter removal. The patient had an uneventful recovery. IMPLICATIONS: We describe a patient who developed unilateral neurologic features suggestive of Brown-Sequard syndrome following removal of a cerebrospinal fluid catheter after thoracic aortic surgery. We suggest that the spinal cord was injured during catheter removal. The catheter was reinserted and the patient had a full neurologic recovery.     

Neurological deterioration in a patient with a spinal arteriovenous malformation following lumbar puncture. Case report

The mechanism of nonhemorrhagic neurological deterioration from spinal arteriovenous malformation (AVM) and the role of acute surgical intervention in this setting are not well understood. The case is described of a 65-year-old man who presented with a 2-year history of mild gait spasticity and vague sensory complaints affecting both lower extremities. Following a diagnostic lumbar puncture, these symptoms progressed painlessly over a 4-day period to total motor paraplegia, urinary retention, and hypesthesia in all modalities with a midthoracic sensory level. Magnetic resonance imaging showed a probable spinal AVM but no evidence of hemorrhage or cord compression. Spinal angiography confirmed the diagnosis of spinal AVM fed by radicular branches of left T-7 and T-8 segmental intercostal arteries. Drainage was via long dorsal veins caudally. Emergency laminectomy with intradural exploration was performed. There was no evidence of prior hemorrhage or focal mass effect, although the cerebrospinal fluid pressure was elevated. The dural component of the spinal AVM was excised, and its communications with the spinal cord were disconnected intradurally. Neurological function started improving within 6 hours of the patient awakening from anesthesia. He had achieved antigravity strength in every muscle group of the lower extremities by the time of discharge to a rehabilitation center 10 days after surgery. Three months postoperatively, he was ambulating with a walker and was continent of urine and stool. Possible pathophysiological mechanisms are discussed in light of the favorable response to timely surgical intervention.     

Chance-type flexion-distraction fracture of lumbar spine

A case of a twenty years old male who had been hit by a van at the lower back, presented two weeks later with complete paraplegia and double incontinence is presented. Radiological imaging revealed shearing of spine with fracture line slicing through the second lumbar (L2) vertebra going across all the three vertebral columns with complete retrolisthesis of upper fragment. He was managed conservatively with immobilization and rehabilitation.