Microexcision of intramedullary schwannoma at the thoracic vertebra

Abstract

Intramedullary schwannoma is often misdiagnosed as other types of malignant tumour prior to surgery due to its atypical imaging appearance and low incidence. In the present study, a case of small intramedullary schwannoma was analysed using clinical and imaging data. Data concerning the surgery and follow-up process of this case were collected. Instead of performing the traditional surgical procedure of cutting the central and posterior rhizotomies of the patient, minimally invasive hemilaminectomy was performed to maintain spinal stability. This procedure was selected since the small mass would be removed completely via minimally invasive hemilaminectomy. Intramedullary schwannoma was confirmed following surgery. The patient recovered well and no recurrence of the tumour was detected during the two-year follow-up period. In conclusion, the treatment strategy for intramedullary schwannoma was determined based on its atypical symptoms and imaging characteristics.

Keywords: follow-up; intramedullary schwannoma; spinal cord; treatment.

Figure 1.

MRI images prior to surgery. (A) Abnormal ovoid long T1 and (B) long T2 soft tissue mass was observed at the level of third and fourth thoracic vertebra (white arrows). The size of the lesion was 1.3x1.1x2.4 cm with a clear margin and heterogenous intensity. (C) The lesion showed heterogenous contrast enhancement and compression of the adjacent subarachnoid space (white arrow).

Figure 2.

MRI images following tumour incision (T1-contrast). No lesion was observed in follow-up MRI at (A) 3 months, (B) 6 months, (C) 12 months and (D) 18 months after surgery. There was a small myelomalacia in the spinal cord.