Surgical Management of Multiple-Level Lumbar Spinal Schwannomas: A Case Report

Abstract

The increase in benign spinal tumors among adults over the last decade has been a major cause of concern. This worrisome trend has been attributed to many factors, including improved detection techniques, enhanced access to medical care, and the aging population. The research primarily focuses on Schwannoma, which is a rare type of tumor that arises from Schwann cells, which are responsible for producing the myelin sheath that surrounds and protects nerves. Although the majority of schwannomas are benign, there have been instances where they have transformed into malignant tumors, potentially leading to significant morbidity and mortality. We report a case of a 68-year-old woman who presented with progressive back pain and weakness in both lower limbs over the past months. The pain was initially localized to the lower back but gradually intensified and radiated down to the legs. The patient reported difficulty walking and a sensation of tingling and numbness in the feet. She denied any recent trauma or significant medical history. On physical examination, there was reduced muscle strength (3/5) in both lower limbs. The patient exhibited hyporeflexia in the knees and ankle. A magnetic resonance imaging (MRI) of the spine was performed, revealing a well-defined mass lesion located in the lumbar region, compressing the spinal cord from L2 to L5. The patient was counseled and prepared for surgical resection of the tumor. Histopathological findings revealed features of peripheral nerve sheath tumors and cellular schwannomas. The patient recovered well postoperatively. The surgeon operating should be mindful of the potential presence of a mobile schwannoma, even though it is rarely mentioned in the literature. Being aware of this possibility can help prevent unnecessary surgical dissection, which can lead to higher rates of complications and morbidity. Although it is plausible that this case could have involved a mobile schwannoma, there was not enough evidence to support it as we performed a laminectomy on multiple levels due to the tumor's size.

Keywords: benign spinal tumor; benign tumors; extradural schwanomma; schwanomma; spinal cord tumors.

Figure 1. Exposure of the surgical site after resection of spinal tumor (white arrow).

Image used with permission from the patient.

Figure 2. Exposure and excision of spinal tumor (white arrow).

Image used with permission from the patient.

Figure 3. Benign spinal tumor with pressure on L2 to L5.

(A) Left (red arrow) before resection of the mass with pressure on L2 to L5. (B) Right (red arrow) after resection of the mass with relief of pressure from L2 to L5. Images are original and were used with permission from the patient.

Figure 4. Cellular schwannoma demonstrating numerous whorls.

Referenced from morphologic and immunohistochemical features of peripheral nerve sheath tumors and cellular schwannomas [19].