Giant Cervicodorsal Schwannoma

Abstract

Schwannomas are benign slow growing tumors that arise from myelin producing Schwann cells. Schwannomas developing in cervical-dorsal region are rare benign neoplasms which are emerges leisurely remains asymptomatic some times and functionally inactive tumours. Giant Schwannomas extending over two or more vertebral levels have been documented and attempts have been made to classify these in available literature, however inadequate. Advancement in imaging modalities and microsurgery has bettered management of these tumors. A rare case of intradural extramedullary cervicodorsal schwannoma extending along seven vertebral levels to thoracic levels is reported in a 55 year old male patient with progressive weakness and numbness of over one and a half years. MRI of cervical spine showed a heterogeneously lesion with cord oedema till D7 level on T1contrast saggital view. Histological examination revealed encapsulated spindle cell lesion with hypocellular and hypercellular areas with verucay bodies, occasional bizzare nuclei, hyalinized blood vessels, with no evidence of necrosis/atypical mitosis, suggestive of schwannoma. In the prone position, C4 to D7 enbloc laminotomy was done and total excision of intradural extramedullary lesion was done. Post-operative CT scans revealed normal spinal canal dimensions with implants in situ. At quarterly follow up upto one year post-operative, the patient had near normal power in all four limbs and normal bladder function.

Keywords: Giant schwannoma; cervico-dorsal; extramedullary; intradural; spinal tumor.