Cystic spinal neurilemmoma on magnetic resonance imaging

Shen, Wu‐Chung; Lee, S. K.; Chang, Chuan Chia; Ho, William L.

doi:10.1007/bf00596514

Cited by 13 publications

(9 citation statements)

References 5 publications

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“…Predominantly cystic schwannomas have been reported throughout the nervous system 19 and at other sites 8 . In a review of the literature, we identified ten cases of cystic schwannoma of the spine 3,6,[9][10][11][12] . Cystic changes are hypothesized to occur due to mucinous degeneration, ischemic necrosis, hemorrhage, and the formation and subsequent coalescence of microcysts.…”

Section: Discussionmentioning

confidence: 99%

Giant Cystic Intradural Lumbosacral Schwannoma: Is Stabilization Necessary?

Wilkinson

Mann

Robinson

et al. 2010

Can. j. neurol. sci.

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Schwannomas are relatively common in neurosurgical practice, accounting for approximately 25% of all primary spinal tumors 1. The vast majority of spinal schwannomas are small, well-circumscribed, intradural, extradural or combined intradural-extradural lesions. Lumbosacral schwannomas may attain significant size before the development of painful symptoms or neurologic deficit, owing to slow growth of the tumor, mobility of the nerve roots, and wide capacity of the spinal canal. There are more than 20 reported cases of giant schwannomas involving the cauda equina-most of them intrasacral 2. Degenerative changes such as hemorrhage, calcification, or fibrosis are frequently seen in schwannomas, but cystic changes are rare. Cystic schwannomas have been reported in the orbit 3 , olfactory groove 4 , cavernous sinus 3,5 , ventricular system 6 , cervical plexus 7 and pancreas 8. Within the spine, there are at least ten previously reported cases of schwannomas with a large cyst 3,6,9-12. The combination of a giant intradural lumbosacral schwannoma with a significant cystic component is exceedingly rare. To the best of our knowledge, there are only two previously reported cases 2,3. The case reported by Jaiswal et al 3 had minimal vertebral erosion; however, the case reported by Kagaya et al 2 has extensive vertebral body scalloping, L3-S1. Therefore, an extensive stabilization was performed, which included L2-ilium fixation and vertebral body reconstruction at L3-S1 with a ceramic implant. We report an additional case and discuss (1) the differential diagnosis of cystic lumbosacral masses and (2) the difficulty of obtaining spinal stabilization in the presence of significant bony erosion by tumor. CASE REPORT Presentation: A 38-year-old woman with a longstanding (>10 years) history of lower back pain presented with an increase in back pain and right-sided sciatica over one month. She was referred to our clinic after x-ray films showed scalloping of the vertebral bodies at L4 and S1 (Figure 1). There was no history of bladder or bowel dysfunction. On examination, she had numbness to pin prick in an L4-S1 distribution on the right. There was weakness and mild wasting of her right hamstring, tibialis anterior, and gastrocnemius muscles (grade 3-4/5). The right ankle reflex was absent. Imaging: Computed tomogram images best demonstrated the erosive scalloping of the L3-S1 vertebral bodies (Figure 2). Magnetic resonance imaging (MRI) (Figure 3) showed an L3-5 intradural mass, hyperintense on T2 and hypointense on T1, demonstrating avid contrast enhancement. At L4, almost 2/3rds THE CANADIAN JOURNAL OF NEUROLOGICAL SCIENCES

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Section: Discussionmentioning

confidence: 99%

Giant Cystic Intradural Lumbosacral Schwannoma: Is Stabilization Necessary?

Wilkinson

Mann

Robinson

et al. 2010

Can. j. neurol. sci.

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“…Although complete cystic change of neurilemmoma is rare [19], central necrosis or cystic degeneration is sometimes observed [7,10].…”

Section: Discussionmentioning

confidence: 99%

Cystic spinal cord tumors: Magnetic resonance imaging correlated to histopathological findings

et al. 1998

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We report the characteristics of magnetic resonance imaging (MRI) of cystic intradural extramedullary spinal cord tumors (cystic neurilemmoma, epidermoid cyst, and enterogenous cyst). T1-weighted MRI enhanced with gadolinium-DTPA clearly demonstrated the rim morphology of these tumors. The comparison between the rim enhancement pattern and histopathological findings offered possible qualitative diagnosis of these cystic spinal cord tumors by MRI.

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“…Nerve sheath tumours are the most common intradural tumours in the lumbar spinal region 1 . However, intraspinal cystic nerve sheath tumours are uncommon and only approximately eight cases have been reported in the literature to date 2–8 . Neurofibromas and schwannomas are generally not considered in the differential diagnosis of cystic lumbar mass lesions, as these are mostly solid or heterogenous solid tumours.…”

Section: Introductionmentioning

confidence: 99%

“…1 However, intraspinal cystic nerve sheath tumours are uncommon and only approximately eight cases have been reported in the literature to date. [2][3][4][5][6][7][8] Neurofibromas and schwannomas are generally not considered in the differential diagnosis of cystic lumbar mass lesions, as these are mostly solid or heterogenous solid tumours. In such cases, diagnosis of cystic nerve sheath tumours can be difficult.…”

Section: Introductionmentioning

confidence: 99%

“…Cystic intraspinal nerve sheath tumours are rare and have seldom been described in the literature previously. [2][3][4][5][6][7][8] Cystic neurogenic tumours are also described as arising from the cerebrum, 16 cerebellum, 17 brainstem, 18 trigeminal nerve, 12,19 facial nerve, 15 etc., which are easy to identify on MRI and can be differentiated from cystic nerve sheath tumours. They are usually encountered in the younger age group.…”

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