BACKGROUND Fibrocartilaginous embolism (FCE) is a rare cause of ischemic myelopathy that occurs when the material of the nucleus pulposus migrates into vessels supplying the spinal cord. The authors presented a case of pediatric FCE that was successfully managed by adapting evidence-based recommendations used for spinal cord neuroprotection in aortic surgery. OBSERVATIONS A 7-year-old boy presented to the emergency department with acute quadriplegia and hemodynamic instability that quickly progressed to cardiac arrest. After stabilization, the patient regained consciousness but remained in a locked-in state with no spontaneous breathing. The patient presented a diagnostic challenge. Traumatic, inflammatory, infectious, and ischemic etiologies were considered. Eventually, the clinical and radiological findings led to the presumed diagnosis of FCE. Treatment with continuous cerebrospinal fluid drainage (CSFD), pulse steroids, and mean arterial pressure augmentation was applied, with subsequent considerable and consistent neurological improvement. LESSONS The authors proposed consideration of the adaptation of spinal cord neuroprotection principles used routinely in aortic surgery for the management of traumatic spinal cord ischemia (FCE-related in particular), namely, permissive arterial hypertension and CSFD. This is hypothesized to allow for the maintenance of sufficient spinal cord perfusion until adequate physiological blood perfusion is reestablished (remodeling of the collateral arterial network and/or clearing/absorption of the emboli).

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Highlights Schwannomatosis is defined as multiple schwannomas without presence of neurofibromatosis and this is a relatively rare pathology. In vast majority of cases the schwannomas grew from different nerve roots. We present the case of a patient with six schwannomas of the cauda equina that grew from a single spinal root as well as discuss the treatment strategy. Multiple spinal cord schwannomas that are growing along the same part of the vertebral column can be safely removed by one side hemilaminectomy using a high-speed diamond drill with preservation of the integrity of the muscles and ligaments on the opposite side and thus maintain spinal stability. Neuromonitoring is mandatory for the surgical procedure to allow successful results and to prevent any neurological damage. The 30 degree endoscope can be a good tool for visual exploration of the spinal canal.