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Case Reports
. 2011:2:186.
doi: 10.4103/2152-7806.91141. Epub 2011 Dec 26.

Minimally invasive removal of a giant extradural lumbar foraminal schwannoma

Alexander G Weil  1 , Sami Obaid, Mohammed Shehadeh, Daniel Shedid
Affiliations
Case Reports

Minimally invasive removal of a giant extradural lumbar foraminal schwannoma

Alexander G Weil et al. Surg Neurol Int. 2011.

Abstract

Background: Purely extradural lumbar schwannomas are rare lesions. Resection traditionally requires an open laminectomy and ipsilateral complete facectomy. Recent reports have demonstrated safety and efficacy of removal of these tumors using mini-open access devices with expandable retractors. We report a case of a giant L3 schwannoma successfully resected through a minimally invasive approach using the non-expandable Spotlight tubular retrator (Depuy Spine).

Case description: A 77-year-old woman presented with a history of chronic right leg pain, paresthesias and proximal right leg weakness. Magnetic Resonance imaging (MRI) scan revealed a large dumbbell-shaped extradural foraminal lesion at the L3-L4 level with significant extraforaminal extension. The patient underwent a minimally invasive gross total resection (GTR) of the tumor using an 18-mm Spotlight tubular retractor system. Pathology confirmed the lesion to be a benign schwannoma. Postoperatively, the patient's symptoms resolved and she was discharged from the hospital on the second postoperative day. Postoperative MRI showed no residual tumor. The patient returned to normal activities after 2 weeks and remained asymptomatic with no neurological deficits at final 6 months follow-up.

Conclusion: Giant lumbar extradural schwannomas can be safely and completely resected using minimally invasive surgery without the need for facectomy or subsequent spinal fusion.

Keywords: Giant schwannoma; minimally invasive surgery; spinal neoplasm.

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Figures

Figure 1
Figure 1
Magnetic resonance images: Preoperative T2-weighted MRI. (a) Axial and (b) sagittal images reveal a right L3-L4 extradural foraminal dumbbell-shaped mass with extraforaminal extension into the right psoas muscle. The patient underwent minimally invasive resection. Postoperative T2-weighted MRI. (c) Axial and (d) sagittal images demonstrate gross total resection and postoperative changes
Figure 2
Figure 2
Intraoperative fluoroscopy: (a) AP and (b) lateral X-rays confirm adequate placement of the tubular retractor in between the L3 and L4 spinous process lateral to the L3–L4 facet complex
Figure 3
Figure 3
Illustration depicting resection of the giant extraforaminal schwannoma through a minimally invasive transmuscular tube retractor placed lateral to the facet complex
See this image and copyright information in PMC

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