Intraspinales Neurinom im thorako-lumbalen Übergang mit ungewöhnlicher Symptomatik: Ein Beitrag zur Differentialdiagnose von Kreuzschmerzen

Abstract

After more than a year of persistent lumbosacral pain a 53-year-old woman suddenly developed unilateral monoradicular pain over the S1 dermatome. Neurological, general medical and biochemical examinations were unremarkable, but myelography and magnetic resonance imaging revealed a cystic intraspinal space-occupying lesion at the level of L1, which was completely excised surgically. It proved to be a neurinoma, 5 x 3 x 3 cm, completely filling the spinal canal at the junction between the conus medullaris and the cauda equinus. The patient was without symptoms and neurological deficit after the operation. The tumour having been completely removed, the prognosis is good.

The sequelae of a neglected thoracolumbar cystic spinal lesion

“…Rare acute complications such as intracranial subarachnoid haemorrhage, hydrocephalus without tumour rupture, or even traumatic intra-tumoural haemorrhages have been reported. 2,8,9,22 The serial MRI spine images over the 5 years period (Figure 1) showed a large intradural thoracolumbar cystic lesion. There was clear progression of kyphotic deformity as well as clinical neurological deficits.…”

“…Till date, only less than 12 of spinal schwannoma with total cystic component have been reported. 1,2,[4][5][6][7][8][9][11][12][13] The combination of a giant spinal schwannoma with a dominant cystic component is exceedingly rare, there are only 3 reported cases prior to our case report. 21 Delayed presentation is common because of the slow growing nature of schwannomas.…”

“…There are only 12 cases of lumbar spinal cystic schwannomas that have been reported in literature. [1][2][3][4][5][6][7][8][9][10][11][12][13] Other differential diagnoses of radiological cystic lesion would be arachnoid cysts or dural ectasia. 14,15 Most of these are asymptomatic and are discovered incidentally.…”

Spinal Cord Tumors of the Thoracolumbar Junction Requiring Surgery: A Retrospective Review of Clinical Features and Surgical Outcome

“…Though there were differences in both groups, the distinction was of little clinical value 10. In addition, it is important to note that differentiation of SCTs of the TLJ from other conditions (such as IVDs) is difficult when based only on clinical features 4,5,7,13. Symptomatic similarities may cause diagnostic delays of four months to three years in conus and cauda equina tumors.…”