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Giant schwannoma with extensive scalloping of the lumbar vertebral body treated with one-stage posterior surgery: a case report.

Iizuka Y, Iizuka H, Kobayashi R, Mieda T, Takagishi K - J Med Case Rep (2014)

Bottom Line: X-ray and computed tomography myelography of the lumbar spine showed an extremely large erosive lesion at the L3 vertebral body.Magnetic resonance imaging of the lumbar spine showed a large soft-tissue mass in the spinal canal at L2-L3 and the vertebral body at L3.A one-stage complete tumor resection and instrumented circumferential fusion were performed via a posterior approach, and a good outcome was achieved after the surgery.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showa, Maebashi, Gunma 371-8511, Japan. yoiizuka@gunma-u.ac.jp.

ABSTRACT

Introduction: Schwannoma is a relatively common benign spinal cord and/or cauda equina tumor; however, giant cauda equina schwannoma with extensive scalloping of the lumbar vertebral body is a rare pathology, and the treatment strategy, including the use of surgical procedures, is controversial. In this report, we present a rare case of a giant lumbar schwannoma of the cauda equina with extremely large scalloping of the vertebral body, and we discuss the surgical strategy we used to treat this pathology.

Case presentation: A 42-year-old Japanese man presented to our department with complaints of a gait disturbance and muscle weakness in the left lower limb. His muscle strength in the proximal part of the left lower limb was grade 2 or 3/5, and he exhibited a mild urinary disturbance on the first visit. X-ray and computed tomography myelography of the lumbar spine showed an extremely large erosive lesion at the L3 vertebral body. Magnetic resonance imaging of the lumbar spine showed a large soft-tissue mass in the spinal canal at L2-L3 and the vertebral body at L3. A one-stage complete tumor resection and instrumented circumferential fusion were performed via a posterior approach, and a good outcome was achieved after the surgery.

Conclusions: We performed one-stage posterior surgery in a patient with a giant cauda equina schwannoma with extensive scalloping of the vertebral body, and a good post-operative outcome was achieved.

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Related in: MedlinePlus

Intra-operative photograph obtained after tumor resection. During the patient’s surgery, we found extensive scalloping of the vertebral body and a large defect in the ventral dura mater due to tumor invasion. The arrow identifies the scalloping of the vertebral body.
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Fig3: Intra-operative photograph obtained after tumor resection. During the patient’s surgery, we found extensive scalloping of the vertebral body and a large defect in the ventral dura mater due to tumor invasion. The arrow identifies the scalloping of the vertebral body.

Mentions: A 42-year-old Japanese man presented to our department with the chief complaints of gait disturbance and muscle weakness in the left lower limb of a few months’ duration. He had no previous medical or surgical history. A physical examination performed at the first visit revealed that his muscle strength was grade 2-3/5 in the proximal portion of the left lower limb. He had full muscle strength in his right lower limb and the distal portion of his left lower limb. In addition, we observed a mild urinary disturbance. X-rays and computed tomography (CT) myelography images of the lumbar spine showed large scalloping of the L3 vertebral body (Figure 1). Magnetic resonance imaging (MRI) of the lumbar spine demonstrated a large soft-tissue mass in the spinal canal at L2-L3 and in the vertebral body at L3 (Figure 2). Surgery was performed to treat the spinal lesion. During the first step, laminectomy at L2-L3 with left L2-L3 total facetectomy was performed. In the next step, the dura mater was opened, and the tumor was completely resected at the branch of the two nerve roots entering the tumor with the assistance of combined motor-evoked potentials (MEPs) and somatosensory-evoked potentials (SEPs). After resecting the tumor, we found a large defect in the ventral dura mater due to tumor invasion and observed that most of the nerve roots ran laterally in the spinal canal due to tumor compression (Figure 3). In the third step, circumferential fusion was performed. Anterior vertebral body reconstruction was carried out using a titanium cage placed to treat the scalloping of the L3 vertebral body via the posterior transdural approach through the ventral defect in the dura mater. Right-sided posterolateral fusion was added at L1-L5 using instrumentation, including pedicle screws (Figure 4). In the final step, duraplasty was performed to reconstruct the resected tumor site using artificial dura mater. The pathological findings of the tumor were compatible with those of benign schwannoma. Although a mild sensory disturbance of the left lower limb persisted, the patient’s muscle strength in the proximal portion of the left lower limb recovered from 2-3/5 to 4-5/5, and we found that his gait status and urinary disturbance had resolved without local recurrence at the 2-year post-operative follow-up examination.Figure 1


Giant schwannoma with extensive scalloping of the lumbar vertebral body treated with one-stage posterior surgery: a case report.

Iizuka Y, Iizuka H, Kobayashi R, Mieda T, Takagishi K - J Med Case Rep (2014)

Intra-operative photograph obtained after tumor resection. During the patient’s surgery, we found extensive scalloping of the vertebral body and a large defect in the ventral dura mater due to tumor invasion. The arrow identifies the scalloping of the vertebral body.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4307628&req=5

Fig3: Intra-operative photograph obtained after tumor resection. During the patient’s surgery, we found extensive scalloping of the vertebral body and a large defect in the ventral dura mater due to tumor invasion. The arrow identifies the scalloping of the vertebral body.
Mentions: A 42-year-old Japanese man presented to our department with the chief complaints of gait disturbance and muscle weakness in the left lower limb of a few months’ duration. He had no previous medical or surgical history. A physical examination performed at the first visit revealed that his muscle strength was grade 2-3/5 in the proximal portion of the left lower limb. He had full muscle strength in his right lower limb and the distal portion of his left lower limb. In addition, we observed a mild urinary disturbance. X-rays and computed tomography (CT) myelography images of the lumbar spine showed large scalloping of the L3 vertebral body (Figure 1). Magnetic resonance imaging (MRI) of the lumbar spine demonstrated a large soft-tissue mass in the spinal canal at L2-L3 and in the vertebral body at L3 (Figure 2). Surgery was performed to treat the spinal lesion. During the first step, laminectomy at L2-L3 with left L2-L3 total facetectomy was performed. In the next step, the dura mater was opened, and the tumor was completely resected at the branch of the two nerve roots entering the tumor with the assistance of combined motor-evoked potentials (MEPs) and somatosensory-evoked potentials (SEPs). After resecting the tumor, we found a large defect in the ventral dura mater due to tumor invasion and observed that most of the nerve roots ran laterally in the spinal canal due to tumor compression (Figure 3). In the third step, circumferential fusion was performed. Anterior vertebral body reconstruction was carried out using a titanium cage placed to treat the scalloping of the L3 vertebral body via the posterior transdural approach through the ventral defect in the dura mater. Right-sided posterolateral fusion was added at L1-L5 using instrumentation, including pedicle screws (Figure 4). In the final step, duraplasty was performed to reconstruct the resected tumor site using artificial dura mater. The pathological findings of the tumor were compatible with those of benign schwannoma. Although a mild sensory disturbance of the left lower limb persisted, the patient’s muscle strength in the proximal portion of the left lower limb recovered from 2-3/5 to 4-5/5, and we found that his gait status and urinary disturbance had resolved without local recurrence at the 2-year post-operative follow-up examination.Figure 1

Bottom Line: X-ray and computed tomography myelography of the lumbar spine showed an extremely large erosive lesion at the L3 vertebral body.Magnetic resonance imaging of the lumbar spine showed a large soft-tissue mass in the spinal canal at L2-L3 and the vertebral body at L3.A one-stage complete tumor resection and instrumented circumferential fusion were performed via a posterior approach, and a good outcome was achieved after the surgery.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showa, Maebashi, Gunma 371-8511, Japan. yoiizuka@gunma-u.ac.jp.

ABSTRACT

Introduction: Schwannoma is a relatively common benign spinal cord and/or cauda equina tumor; however, giant cauda equina schwannoma with extensive scalloping of the lumbar vertebral body is a rare pathology, and the treatment strategy, including the use of surgical procedures, is controversial. In this report, we present a rare case of a giant lumbar schwannoma of the cauda equina with extremely large scalloping of the vertebral body, and we discuss the surgical strategy we used to treat this pathology.

Case presentation: A 42-year-old Japanese man presented to our department with complaints of a gait disturbance and muscle weakness in the left lower limb. His muscle strength in the proximal part of the left lower limb was grade 2 or 3/5, and he exhibited a mild urinary disturbance on the first visit. X-ray and computed tomography myelography of the lumbar spine showed an extremely large erosive lesion at the L3 vertebral body. Magnetic resonance imaging of the lumbar spine showed a large soft-tissue mass in the spinal canal at L2-L3 and the vertebral body at L3. A one-stage complete tumor resection and instrumented circumferential fusion were performed via a posterior approach, and a good outcome was achieved after the surgery.

Conclusions: We performed one-stage posterior surgery in a patient with a giant cauda equina schwannoma with extensive scalloping of the vertebral body, and a good post-operative outcome was achieved.

Show MeSH
Related in: MedlinePlus