Imaging features and treatment of an intradural lumbar cystic schwannoma

Borges, Guilherme; Bonilha, Leonardo; Proa, Marcílio; Fernandes, Yvens Barbosa; Ramina, Ricardo; Zanardi, Verônica A.; Menezes, J. R.

doi:10.1590/s0004-282x2005000400025

Cited by 16 publications

(9 citation statements)

References 19 publications

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“…Although schwannomas are more likely to undergo cystic degeneration than neurofibromas, this appearance is rarely seen in the spinal cohort. (15) Nonetheless, the cystic appearance may simulate the imaging appearance of synovial or perineural cysts. (15) Arising from the dorsal sensory roots, the majority of these lesions (70%-75%) are intraduralextramedullary in location, 15% are purely extradural, and a further 15% have both intradural and extradural components -the classic 'dumbbell' lesions.…”

Section: Discussionmentioning

confidence: 99%

“…(15) Nonetheless, the cystic appearance may simulate the imaging appearance of synovial or perineural cysts. (15) Arising from the dorsal sensory roots, the majority of these lesions (70%-75%) are intraduralextramedullary in location, 15% are purely extradural, and a further 15% have both intradural and extradural components -the classic 'dumbbell' lesions. (16) In this instance, the administration of MR contrast allows PNST to be distinguished from synovial and perineural cysts.…”

Section: Discussionmentioning

confidence: 99%

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Clinics in diagnostic imaging (181)

Cheong

Wong

2017

smedj

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A 47-year-old woman underwent elective surgery to resect a known intradural tumour at the T1 level. Histology confirmed the diagnosis of spinal meningioma. On follow-up, the patient was well and magnetic resonance (MR) imaging of the cervical spine was performed. What do the images show? What is the diagnosis? CMEArticle Clinics in diagnostic imaging (181)Wei 2a 2b 2c637 M e d i c a l E d u c a t i o n IMAGE INTERPRETATIONThe thin-walled structure (black arrows in Fig. 1) in the left neural exit canal at the C7-T1 level returns a low signal on the T1-weighted image (Fig. 1a), and a raised signal on the T2-weighted and turbo inversion recovery magnitude images (Figs. 1c & d, respectively). No enhancement is seen following contrast enhancement (Fig. 1b). The overall imaging features are in keeping with those of a cystic structure. On the axial T2-weighted images at the C7-T1 level, the left exiting C8 nerve root is detected on the cyst wall (white arrows in Figs. 2a & b). Findings are compatible with a left C8 transforaminal perineural cyst. Additional small perineural cysts are seen in the bilateral neural exit canals at the C6-7 level (white arrowheads in Fig. 2c). DIAGNOSISCervical spine perineural cysts. CLINICAL COURSEIn keeping with the most common presentation of perineural cysts, those found in the patient were asymptomatic and unlikely to be related to prior spinal surgery. They were incidentally detected and remained stable in size, morphology and signal intensities in subsequent surveillance MR imaging studies. DISCUSSIONMeningeal dilatation of the posterior spinal nerve root sheaths gives rise to perineural cysts, which contain cerebrospinal fluid (CSF) and nerve fibres. When occurring in the lumbosacral spine, they are colloquially known as Tarlov cysts, after Isadore Tarlov, who first described them during a cadaveric study of 30 specimens of filum terminale in 1938.(1) The aetiology of these lesions remains contentious. Some believe that they are congenital in nature, (2,3) while others proposed prior surgery, (2,4) haemorrhage (4) and increased CSF hydrostatic pressure as the possible pathogenesis. (2,5) It was estimated that 4.6%-9.0% of the adult population has perineural cysts.(5) They are most common in the lower lumbar and sacral segments, particularly the S2 and S3 nerve roots (Figs. 3 & 4).(6) Perineural cysts are often multiple and bilateral (Fig. 4).(1) They can be preforaminal, transforaminal or postforaminal in location -the latter being the least common location. On imaging, perineural cysts appear as circumscribed, thin-walled cystic lesions. Owing to their content, the cysts are isointense to CSF on all MR sequences. The demonstration of a traversing spinal nerve root through the cyst or along the cyst wall is a distinctive feature of perineural cysts (Figs. 4 & 5). (7) Diagnosis is more difficult in instances where the spinal nerve roots are at the periphery of the cyst wall (Fig. 6). When perineural cysts become large enough, they widen and remodel the neural exit canals or sacral ...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Clinics in diagnostic imaging (181)

Cheong

Wong

2017

smedj

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“…Prevalensi schwannoma di lumbal tidaklah jarang akan tetapi predominan kistik schwannoma ukuran besar di daerah lumbal sangat jarang terjadi meskipun telah diketahui bahwa schwannoma jinak dapat mengalami degenerasi membentuk formasi kistik, kalsifikasi, perdarahan dan hyalinisasi. 3,4 Menarik diketahui schwannoma di daerah lumbal dapat terjadi tanpa disadari dalam waktu lama karena pertumbuhan tumor yang lambat sehingga timbulnya gejala klinis biasanya jika ukuran tumor sudah besar dan menyebabkan penekanan pada saraf.Gambaran struktur kistik schwannoma yang jarang ditemukan menjadi tantangan dalam penegakkan diagnosis .…”

Section: Pendahuluanunclassified

“…4,5 Lokasi tersering dari spinal schwannoma adalah di daerah lumbar (48%).Schwannoma dapat mengalami perubahan degenerative seperti fibrosis, kalsifikasi, hemoragik, ataupun kistik.Perubahan kistik pada schwannoma sangat jarang ditemukan di daerah vertebra lumbar dan baru 10 kasus yang pernah dilaporkan di literatur. 1,6,7 Berbagai hipotesis teori diajukan untuk menjelaskan perubahan kistik pada Schwannoma, diantaranya nekrosis iskemik sentral, thrombosis pembuluh darah yang mengakibatkan nekrosis dan perdarahan atau neovaskularisasi tumor dapat mengakibatkan pertumbuhan tumor dengan bagian kistik di dalamnya.MRI diaggap sebagai modalitas terbaik untuk menggambarkan tumor spinal kistik.…”

Section: Diskusiunclassified

Spinal Schwannoma Kistik Intradura

Safitri¹,

Hanafi²,

Anwary³

2017

JIK

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ABSTRAKSpinal schwannoma kistik intradura merupakan jenis tumor yang jarang ditemukan. Schwannoma merupakan tumor jinak yang berkembang dari sel Schwann yang terdapat pada lapisan pembungkus saraf dan merupakan tumor spinal intradura yang paling sering ditemukan. Umumnya tumor schwannoma spinal merupakan massa solid atau solid heterogen dan jarang ditemukan dalam bentuk kistik.Suatu kasus, seorang laki-laki umur 43 tahun datang dengan keluhan utama lemah kedua tungkai. Sejak 2,5 bulan sebelumnya pasien merasakan nyeri tulang ekor menjalar ke tungkai kanan dan bertahap diikuti keluhan lemah tungkai kanan. Selanjutnya diikuti dengan nyeri dan kesemutan kaki kiri dan kemudian dirasakan kelemahan kaki kiri dan sulit defekasi dan miksi sejak 1 bulan sebelum masuk rumah sakit. Pemeriksaan Magnetic Resonance Imaging (MRI) lumbosacral dengan kontras menunjukkan gambaran lesi kistik, sebagian bersepta-septa, intradura, mengobliterasi canalis spinalis setinggi corpus vertebra torakal 12 sampai sacral 2 yang memberikan enhancement terhadap kontras pada septa dan tepinya. Pasien menjalani operasi laminektomi dan didapatkan massa tumor intradura, berbatas tegas dengan cord dan radix berbentuk tubular sepanjang 20 cm, dengan bagian yang kistik berisi cairan kental kekuningan dan bagian yang solid berwarna merah kebiruan mudah berdarah, tidak berkapsul, berbatas tegas, spinal cord terdorong ke anterosuperior, cauda equina terdorong ke lateral kanan dan kiri, tumor terangkat 100 %. Secara makroskopis saat operasi, massa tumor di duga sebagai myxopapillary ependymoma.Pemeriksaan patologi anatomi kemudian memastikan bahwa tumor tersebut adalah schwannoma. Setelah operasi keadaan pasien membaik dengan perbaikan motorik pada kedua tungkainya.

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“…However, most studies of spinal intradural extramedullary schwannomas were case reports or were conducted using low-field MRI in a small number of cases, and their evaluation was therefore limited to radiologic-pathologic correlations (4)(5)(6)(7). In addition, we queried whether the imaging findings of peripheral nerve sheath tumors, such as the fascicular sign or the target sign, would be useful in cases of spinal intradural extramedullary schwannomas.…”

Section: Introductionmentioning

confidence: 99%