Schwannoma of Tibial Nerve; Diagnosis and Management: A Rare Case Report With Brief Review of Literature

Abstract

Introduction: Schwannomas are benign, encapsulated, silent, and usually solitary tumors originating from Schwann cells of the peripheral nerve sheath. Tibial nerve Schwannomas are very rare hence we are reporting this case for the better understanding of this unusual clinical entity. Case Presentation: A 53-year-old male patient, truck- driver by occupation, arrived to our Plastic Surgery Department complaining of swelling, pain and paresthesia in the upper part of his right leg. These symptoms were present for about 8 months and were more apparent at the end of the day. There was no evidence of any other medical comorbidity like peripheral vascular disease. There was no history of prior traumatic events related to right lower limb. Thorough clinical examination and MRI supported the diagnosis of a benign peripheral nerve tumor and patient was treated by microsurgical excision of the lesion which completely relieved the patient’s symptoms. Discussion: Mechanical compression caused by the space occupying lesion resulted in aggravation of symptoms. Classical burning/shooting pain and paresthesia often manifested by nerve sheath tumors. An increase in intracompartmental pressure resulted in pressure over nerve which consequently led to episodic pattern of neurological symptoms (diurnal variation in pain and paresthesia). Microsurgical excision of the tumor cured the symptoms completely and again patient was able to resume his regular day- to- day activities without any discomfort. Conclusion: We describe a rare case of a patient with an unusual tibial nerve Schwannoma clinical presentation. Microsurgical excision of the space occupying lesion preserving the nerve fascicles play an important role in achieving the good post- surgical outcome. Medical literature on this topic is scarce hence this case report intends to add further data about such pathological conditions.