Giant sacral schwannomas

Abstract

Sacral schwannomas are very rare tumors. There are merely around 50 cases reported in the literature most of which are case presentations. In this study we present a 13-case series, which is one of the most extensive series in the literature. Thirteen giant sacral schwannoma cases operated at Ege University, Faculty of Medicine, Neurosurgery Department between 1995 and 2010 are investigated retrospectively. All patients were assessed with direct radiography, computerized tomography (CT) and magnetic resonance imaging (MRI). The patients were operated, after the diagnosis through biopsy patients with Sridhar Type V classification are included in the study. Five patients were male, eight were female and the average age was 37.1 (ranging between 14 and 55). All the patients were suffering from back and leg pain at the time of consultation. Four patients had sphincter problems and three had weakness in the leg. After the biopsy and histological analysis, intralesionary resections were performed. Five patients went through both anterior and posterior interventions, six patients had only posterior and two had just anterior intervention. One patient had iliac vein injury during the anterior surgery. This patient was reoperated for embolectomy and vein graft because of thrombosis. Average follow-up period was 8.1 years (1-15 years). All patients were assessed with MR annually. A small residual tumor was detected in two patients, however they were not reoperated. Although sacral schwannomas are rare tumors, the diagnosis is not so difficult with CT and MRI. In this study, we suggest biopsy for predetermination of the nature of the tumor as it affects the treatment choice and the method of operation. Surgically, a simple intralesionary excision is an appropriate choice.

Alternatives to surgical approach for giant spinal schwannomas

“…In our clinic, the rate of GSSs was relatively high compared with the overall rate of SSs, which is because these types of cases are referred to our clinic. Although most of the reported case presentations and case series were comprised of sacral GSS, a review of the related literature revealed that many GSS cases are located in the lumbar spine; indeed, 60-70% of GSSs have been reported to be lumbar by other studies 10,13-18. High rates of cervical GSSs have only been reported by Kim et al19 and Özdemir et al,14 who found rates of 50-55% in their series.…”

“…There is no clear data in the literature regarding the frequency of GSSs 2,6. A large portion of the published studies is composed of case reports, and the numbers of cases in case series are well below 20 ( Table 3 ) 4,10-15…”

Management and retrospective analysis of primary and metastatic sacral tumors and infections: evaluation with 73 cases

“…One of our cases treated with partial sacrectomy developed local recurrence four months after the surgery. According to Cagli et al, [16] only 50 giant sacral schwannomas have been reported in the literature.…”

Giant cystic sacral schwannoma mimicking tarlov cyst: a case report

“…Sacral schwannomas are very rare entities, with only about 50 cases reported in the literature worldwide [3]. Because of their slow-growing nature, and the mobility of the nerve roots in the sacral canal, symptoms do not manifest until the tumor grows to be quite large [9].…”

“…Spinal schwannomas are the most common intradural extramedullary tumors, accounting for 25 % of all primary spinal tumors [1,2]. However, sacral schwannomas are very rare, accounting for only 1-5 % [3]. Because of their indolent growth, the mobility of the sacral nerve roots and the generous width of the sacral canal, these tumors can reach large sizes before becoming symptomatic.…”