Mobility of Intradural Extramedullary Schwannoma at Spine : Report of Three Cases with Literature Review

Abstract

J Korean Neurosurg Soc 47 : [64][65][66][67] 2010 Although very rare, a few cases of intradural extramedullary (IDEM) spinal tumor migration have been reported since Tomimatsu first reported a mobile schwannoma of the cervical cord in 1974. Schwannoma is a neurogenic tumor which originates from nerve sheath that it is relatively wellmarginated tumor with little attachment or adhesion to surrounding tissue. Mobility of tumor in spinal canal sometimes can result in negative exploration at the expected area. We found three interesting cases in which different tumor locations observed in repeated magnetic resonance image (MRI) findings. All tumors were intradural and extramedullary schwannoma. We reviewed the literature about moving tumor in the spine through PUBMED search.

Migrating Extramedullary Intradural Schwannoma of Cervico-Thoracic Junction

“…Migration was most commonly within one vertebral level distance, however migration upto five level vertebral distances have also been reported in thoracic region [2,3]. In our case, the tumor was initially located at the lower cervical region (upper border of C5 vertebral body to lower border of D1) on first MRI and migrated caudally to lie at the level of C7 to D3 as was seen on the second MRI.…”

“…Schwannomas are common mobile spinal tumours among the group, rest being ependymoma and neuroenteric cysts [3]. On imaging, they appear as well defined T2 hyperintense and T1 hypointense lesions showing intense post contrast enhancement.…”

“…Intra operative USG appears to be most convenient method to find out the migrated tumor if the tumor is missing at the expected site. It is an easy and useful method and can be performed even after dural incision [3,5].…”

Mobile Schwannoma of the Cauda Equina Incarcerated Following Caudal Migration After Trauma -Case Report-

“…Tumor migration can be induced by change of the patient's posture and actions resulting in fluctuations in cerebrospinal fluid pressure. 3,4,[6][7][8] In the present case, the caudal migration was probably induced by the episode of trauma, which caused incarceration of the tumor at the L4-5 level with pre-existing canal stenosis. Redundant nerve roots allow tumor mobility.…”

“…4) Most of these tumors were histologically diagnosed as schwannoma, but ependymomas were also included. 6) Migration of the tumors was induced by patient actions or changes in posture.…”