The management of sacral schwannoma: report of four cases and review of literature

Abstract

Sacral schwannoma is a rare retrorectal tumor in adults. Postoperative sacral neurological deficit is difficult to avoid. Currently, there is no established consensus regarding best treatment options. We present the management and outcomes of sacral schwannoma in 4 patients treated with intralesional curettage and postoperative radiation. There were 3 women and one man (average age: 45.5 years) with long duration of lumbosacral pain with or without radiculopathy. Intralesional curettage was performed by posterior approach and adjuvant radiation therapy with dosage of 5000-6600 cGy was given after surgery. The mean follow-up time was 18 months (range 4-23 months). Symptoms of radiculopathy had decreased in all patients. The recent radiographic findings show evidence of sclerosis at the sacrum one year postoperatively, but the size was unchanged. Intralesional curettage and adjuvant radiation therapy can be used in the treatment of sacral schwannoma to relieve symptoms and preserve neurological function.

Figure 1

Plain radiograph shows osteolytic bony destruction at body of sacrum and bilateral neural foramens.

Figure 2

MR examination of pelvis demonstrates bony destruction at sacrum and neural foramen from S1–S4 levels with soft tissue mass formation. This mass appears as low signal intensity on sagittal T1-weighted MR image (Figure 2(a)), heterogeneous increased signal intensity on sagittal and axial T2-weighted MR image (Figures 2(b) and 2(c)). Tumor extended and displaced uterus and urinary bladder anteriorly, but not invaded, evidenced by fat plane (arrows).

Figure 3

Sagittal (Figure 3(a)) and axial (Figure 3(b)) T1-weighted/GD/FS MR images show a well-defined extradural cystic mass with multiple enhanced septations and thin enhanced solid nodule, originating from the posterior aspect of S1–S3 region.

Figure 4

Coronal (Figure 4(a)) and axial (Figure 4(b)) T2-weighted MR images show tumor with heterogeneous signal intensity involving left S1 foramen.

Figure 5

Axial T1-weighted MR image demonstrates dumbbell-shaped tumor which arising from sacral foramen and extended anteriorly to pelvic cavity in patient no. 4.

Figure 6

Plain radiograph, 1 year post operative shows sclerosis of bony destruction at sacrum. MR examination of pelvis one year after surgery demonstrates no significant change in size and aggressiveness of the tumor, but not increase.