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Thoracic Nerve Root Schwannoma Filling the Spinal Canal Almost Entirely Without any Neurological Deficits.

Godlewski B, Klauz G, Czepko R - Anesth Pain Med (2016)

Bottom Line: A histological examination confirmed a benign schwannoma lesion (WHO G1).Appropriate imaging studies, even in patients presenting with no neurological deficits, may help detect pathologies than can lead to severe disability.A spinal canal tumour filling the spinal canal almost entirely and displacing the spinal cord could cause spinal cord damage at any time with all the dire consequences such as paraplegia and loss of the ability to walk.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Scanmed-St. Raphael Hospital, Cracow, Poland.

ABSTRACT

Introduction: Spinal tumours may be classified in three groups: 1) extradural, 2) intradural extramedullary and 3) intramedullary spinal cord tumours. Intradural extramedullary tumours arise from the leptomeninges or nerve roots and include schwannomas. A schwannoma is usually a firm grey-whitish tumour growing near a nerve trunk or ramus. It can be separated from the nerve without damaging neural tissue. Schwannomas are usually solitary tumours.

Case presentation: We present the case of a 37-year-old male who underwent surgery for a tumour in the upper thoracic segment of the spinal canal. Although the tumour filled the spinal canal almost entirely, the patient did not manifest any neurological deficits. During the surgery, the tumour was removed completely. A histological examination confirmed a benign schwannoma lesion (WHO G1).

Conclusions: The question whether doctors are keen to order more diagnostic investigations (including both laboratory and imaging studies) than are necessary is often asked in clinical practice. The cost factor is also important. Not every patient with back pain is referred for an MRI study in the absence of characteristic neurological signs. The case of our patient, however, speaks in favour of early referral for such diagnostic modalities. Appropriate imaging studies, even in patients presenting with no neurological deficits, may help detect pathologies than can lead to severe disability. A spinal canal tumour filling the spinal canal almost entirely and displacing the spinal cord could cause spinal cord damage at any time with all the dire consequences such as paraplegia and loss of the ability to walk.

No MeSH data available.


Related in: MedlinePlus

A histology slide of the resected tumour (schwannoma, WHO G1) showing spindle-shaped cells with band-like nucleiThe cells tend to form palisade patterns where the nuclei are seen on the same level in the palisade. This microscopic feature is significant for these tumours (haematoxylin and eosin [H & E], original magnification x40).
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fig26788: A histology slide of the resected tumour (schwannoma, WHO G1) showing spindle-shaped cells with band-like nucleiThe cells tend to form palisade patterns where the nuclei are seen on the same level in the palisade. This microscopic feature is significant for these tumours (haematoxylin and eosin [H & E], original magnification x40).

Mentions: Radiologically, the tumour could be classified as a meningioma, neuroma or neurofibroma. The patient was qualified for urgent surgery and referred to the Neurosurgery Department, where the tumour was surgically excised two days later. The tumour was removed by laminectomy of Th1 and Th2. It was located at the level of the Th1/Th2 intervertebral foramen. Following an incision of the dura mater, the tumour mass was exposed which had the gross appearance of a neuroma. The tumour arose from a spinal nerve at the Th1/Th2 level on the left. It was found both intradurally and protruded through the intervertebral foramen outside of the spinal canal, where a part of it could be seen extradurally. In order to completely separate the tumour from the nerve with a view to removing it, the dura mater incision had to be extended towards the point of departure of the spinal nerve and the external sheath of the spinal nerve had to be dissected. A macroscopically radical resection was performed and the tumour was sent for histology. The tumour was accessed by laminectomy and it was not necessary to remove the intervertebral joints. Thus, the spinal column was not destabilised and did not need to be instrumented internally to ensure stability. Following removal of the tumour, dural sac plasty was performed (suturing + additional sealants). No neurological deficits were noted post-operatively. After the surgery, preoperative pain symptoms subsided. The patient was ambulated after another three days and has been able to ambulate smoothly and unassisted. He was discharged home on the 5th postoperative day, with sutures removed on the 8th post-operative day and good healing of the surgical wound. The histological examination revealed a schwannoma (WHO G1) (Figure 2).


Thoracic Nerve Root Schwannoma Filling the Spinal Canal Almost Entirely Without any Neurological Deficits.

Godlewski B, Klauz G, Czepko R - Anesth Pain Med (2016)

A histology slide of the resected tumour (schwannoma, WHO G1) showing spindle-shaped cells with band-like nucleiThe cells tend to form palisade patterns where the nuclei are seen on the same level in the palisade. This microscopic feature is significant for these tumours (haematoxylin and eosin [H & E], original magnification x40).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4834741&req=5

fig26788: A histology slide of the resected tumour (schwannoma, WHO G1) showing spindle-shaped cells with band-like nucleiThe cells tend to form palisade patterns where the nuclei are seen on the same level in the palisade. This microscopic feature is significant for these tumours (haematoxylin and eosin [H & E], original magnification x40).
Mentions: Radiologically, the tumour could be classified as a meningioma, neuroma or neurofibroma. The patient was qualified for urgent surgery and referred to the Neurosurgery Department, where the tumour was surgically excised two days later. The tumour was removed by laminectomy of Th1 and Th2. It was located at the level of the Th1/Th2 intervertebral foramen. Following an incision of the dura mater, the tumour mass was exposed which had the gross appearance of a neuroma. The tumour arose from a spinal nerve at the Th1/Th2 level on the left. It was found both intradurally and protruded through the intervertebral foramen outside of the spinal canal, where a part of it could be seen extradurally. In order to completely separate the tumour from the nerve with a view to removing it, the dura mater incision had to be extended towards the point of departure of the spinal nerve and the external sheath of the spinal nerve had to be dissected. A macroscopically radical resection was performed and the tumour was sent for histology. The tumour was accessed by laminectomy and it was not necessary to remove the intervertebral joints. Thus, the spinal column was not destabilised and did not need to be instrumented internally to ensure stability. Following removal of the tumour, dural sac plasty was performed (suturing + additional sealants). No neurological deficits were noted post-operatively. After the surgery, preoperative pain symptoms subsided. The patient was ambulated after another three days and has been able to ambulate smoothly and unassisted. He was discharged home on the 5th postoperative day, with sutures removed on the 8th post-operative day and good healing of the surgical wound. The histological examination revealed a schwannoma (WHO G1) (Figure 2).

Bottom Line: A histological examination confirmed a benign schwannoma lesion (WHO G1).Appropriate imaging studies, even in patients presenting with no neurological deficits, may help detect pathologies than can lead to severe disability.A spinal canal tumour filling the spinal canal almost entirely and displacing the spinal cord could cause spinal cord damage at any time with all the dire consequences such as paraplegia and loss of the ability to walk.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Scanmed-St. Raphael Hospital, Cracow, Poland.

ABSTRACT

Introduction: Spinal tumours may be classified in three groups: 1) extradural, 2) intradural extramedullary and 3) intramedullary spinal cord tumours. Intradural extramedullary tumours arise from the leptomeninges or nerve roots and include schwannomas. A schwannoma is usually a firm grey-whitish tumour growing near a nerve trunk or ramus. It can be separated from the nerve without damaging neural tissue. Schwannomas are usually solitary tumours.

Case presentation: We present the case of a 37-year-old male who underwent surgery for a tumour in the upper thoracic segment of the spinal canal. Although the tumour filled the spinal canal almost entirely, the patient did not manifest any neurological deficits. During the surgery, the tumour was removed completely. A histological examination confirmed a benign schwannoma lesion (WHO G1).

Conclusions: The question whether doctors are keen to order more diagnostic investigations (including both laboratory and imaging studies) than are necessary is often asked in clinical practice. The cost factor is also important. Not every patient with back pain is referred for an MRI study in the absence of characteristic neurological signs. The case of our patient, however, speaks in favour of early referral for such diagnostic modalities. Appropriate imaging studies, even in patients presenting with no neurological deficits, may help detect pathologies than can lead to severe disability. A spinal canal tumour filling the spinal canal almost entirely and displacing the spinal cord could cause spinal cord damage at any time with all the dire consequences such as paraplegia and loss of the ability to walk.

No MeSH data available.


Related in: MedlinePlus