A rare cause of chronic sciatic pain: Schwannoma of the sciatic nerve

Abstract

Schwannomas are common, benign tumors of the shelth of peripheral nerves. Sciatic schwannomas are rare. Their symptomatology usually mimics sciatic pain due to a herniated disc, which can delay the diagnosis. If there is no lumbar pain and lumbar MRI is normal, the sciatic nerve must be clinically and radiologically examined all along its course. We report a case of sciatic nerve schwannoma presenting with chronic sciatica which was diagnosed and monitored radiologically for several years before successful surgical resection.

Case Report: Sciatic nerve schwannoma - a rare cause of sciatica

“…Sciatic nerve schwannoma is a rare cause of sciatica, occurring only in 1 of every 100 cases 1 . It should be suspected in a patient who presents with a typical history of sciatica but with MRI scans that fail to reveal any inter-vertebral disc prolapse in the lumbar spine 1 .…”

“…It should be suspected in a patient who presents with a typical history of sciatica but with MRI scans that fail to reveal any inter-vertebral disc prolapse in the lumbar spine 1 . Other differential diagnoses included sciatic nerve tumors, a far lateral disc or Pyriformis syndrome.…”

“…Neurofibromas are intrinsic lesions that cause fusiform dilatation of the nerve, since the lesions are intermixed with the nerve 1 . On the other hand, schwannomas are placed in such a way that nerve fascicles are being pushed to the periphery, allowing their safe preservation following excision of the schwannoma 2, 4– 6 .…”

“…Sciatic nerve schwannoma is a rare cause of sciatica 1– 3 . However, it remains a probable diagnosis in patients that present with symptoms of sciatica with no prolapsed disc in the lumbar spine and a negative crossed straight leg raise test, suggesting the presence of a far lateral disc.…”

“…However, it remains a probable diagnosis in patients that present with symptoms of sciatica with no prolapsed disc in the lumbar spine and a negative crossed straight leg raise test, suggesting the presence of a far lateral disc. Magnetic resonance imaging (MRI) along the course of the sciatic nerve is the cornerstone for coming to a correct diagnosis and thereafter implementing a right therapeutic decision 1 . This case report highlights the need to consider sciatic nerve schwannoma as a possible cause of a sciatica in patients that have a negative lumbar spine MRI, so that the correct therapeutic decision can be made.…”