Giant sacral schwannoma: A report of six cases

Abstract

Sacral and presacral schwannomas are often found incidentally, because they present with vague symptoms or symptomless. Schwannoma occurring in this area occasionally presents with enormous dimensions, known as a giant schwannoma. The tumor removal is a surgical challenge due to the difficult approach and abundant vascularity. The aim of this study is to review cases of giant sacral schwannomas focusing the surgical management and outcome. Six patients with sacral and presacral schwannoma were treated surgically. The patients included two males and four females, and the mean age was 47.8 years. All patients experienced pain at the time of presentation. The tumors were classified as intraosseous type in one case, dumb-bell type in four cases, and retroperitoneal type in one case. The tumors were removed with a piecemeal subtotal excision in three patients, a partial excision in two patients, and enucleation in one patient. The surgeries were performed by the combination of an anterior and posterior approach in three patients, a posterior approach in two patients, and an anterior approach in one patient. The mean surgical time was 7.8 hrs, and the mean blood loss was 2572 g. The tumor recurred in one patient after the partial excision and was removed completely in a second surgery. No patient, including the patient who underwent the second surgery, presented with pain and obvious neurological deficit at the final follow-up. The surgical treatment of the giant sacral schwannoma with a piecemeal subtotal excision can achieve a good outcome, avoiding unnecessary neurological deficit.

Giant retroperitoneal ancient schwannoma: An unusual schwannoma type in the rarest localization

“…Partial or subtotal resection is not enough, but subtotal resection can be performed in order to avoid injury to the vessel and adjacent organs. Relapse is inevitable in this type of approach (8). In our case, the mass was totally excised together with the capsule.…”

Clinical features and surgical treatment of sacral schwannomas

“…Pongsthorn et al [7] reported the intraoperative blood loss was 2572 g (range 483-5301g). Intraoperative hemorrhage mainly results from venous plexus of sacral canal, instead of the tumor itself.…”

Schwannoma benigno retroperitoneal gigante: diagnóstico incidental en paciente con masa pélvica sospechosa de cáncer de ovario

“…Se han observado casos de recidiva en aquellos pacientes en los que se realizó exéresis subtotal 3 . Se ha de tener especial cuidado en los pacientes afectados a su vez por la enfermedad de von Recklinghausen, ya que se han descrito casos de transformación maligna, por lo que se recomienda seguimiento 10 .…”