Chiari type I malformation with an associated intramedullary schwannoma

Spinal intramedullary schwannomas-report of a case and extensive review of the literature

Intramedullary schwannomas (IMS) represent exceptional rare pathologies. They commonly present as solitary lesions; only five cases of multiple IMS have been described so far. Here, we report the sixth case of a woman with multiple IMS. Additionally, we performed the first complete systematic review of the literature for all cases reporting IMS. We performed a systematic review of the literature in PubMed, EMBASE and Cochrane Central Register of Controlled (CENTRAL) to retrieve all relevant studies and case reports on IMS. In a second step, we analysed all reported studies with respect to additional cases, which were not identified through the database search. Studies published in other languages than English were included. One hundred nineteen studies including 165 reported cases were included. In only five cases, the patients harboured more than one IMS. Gender ratio showed a ratio of nearly 3:2 (male:female); mean age of disease presentation was 40.2 years; 11 patients suffered from neurofibromatosis (NF) type 1 or 2 (6.6%). IMS are rare. Our first systematic review on this pathology revealed 166 cases, including the here reported case of multiple IMS. Our review offers a basis for further investigation on this disease.

Thoracic dumbbell intra- and extramedullary schwannoma

We present a rare case of a solitary dumbbell intra- and extramedullary schwannoma of the thoracic spine in a 54-year-old man without signs of von Recklinghausen's disease. The patient presented with motor weakness in the left lower extremity, bilateral sensory impairment below the T9 dermatome and rectovesical dysfunction. Preoperative magnetic resonance imaging was suspicious for an intradural extramedullary tumor. At operation, the tumor was located posteriorly, at the midline, with no relationship to the posterior nerve roots and was firm and adherent to the adjacent spinal cord, which surrounded the intramedullary portion of the tumor. The intramedullary mass was completely removed with sharp dissection after removal of the extramedullary mass. Surgery resulted in minimal postoperative neurological deficits. These tumors may arise from the Schwann cells of the nerve plexus surrounding vessels in the posterior median sulcus and thus may grow in both an intra- and extramedullary fashion. The optimal treatment of these schwannomas is total removal.

Thoracic subpial intramedullary schwannoma involving a ventral nerve root: a case report and review of the literature

BACKGROUND

Subpial intramedullary schwannoma of the spine is a rare tumor. A few case reports have revealed that the tumor originates from around the ventral nerve exit zone, with only one case confirming involvement of the ventral root.

CASE DESCRIPTION

A 72-year-old female with a 10-month history of Brown-Sequard-type monoparesis is described. On neurological examination, the left leg motor function was grade 3 or 4/5, and dysthesia with low pinprick sensation at the right side below the T8 and T9 dermatome was identified. There were no signs of multiple neurofibromatosis. Magnetic resonance imaging demonstrated a well-demarcated round mass with high enhancement and moderate peritumoral edema, but no combined syrinx. The mass (1.5 x 1 x 1.5 cm) was located at the anterior part of the spinal canal on the left of the midline of the T8 and T9 space. A left-sided unilateral approach was performed with osteoplastic laminotomy of T8 and T9 vertebrae, and radical removal of a subpial tumor was achieved. Pathological examination revealed subpial intramedullary schwannoma. The patient improved postoperatively and at discharge was able to walk without any support.

CONCLUSION

The authors emphasize that the differential diagnosis of intramedullary schwannoma should be included when peritumoral edema is moderately present to provide appropriate preoperative preparations, even if a tumor is seemingly located in the intradural extramedullary space.

Spinal neurinomas: retrospective analysis and long-term outcome of 179 consecutively operated cases and review of the literature

BACKGROUND

We present a series of 179 spinal neurinomas consecutively observed at the Department of Neurosurgery at the University of Florence for a period of 30 years (between 1967 and 1997). We decided to limit the retrospective study to obtain at least 5 years of follow-up. Therefore, 20 additional neurinomas treated between 1997 and 2002 were excluded.

METHODS

All the cases are evaluated under statistical, clinical, neuroradiological, and surgically technical profiles based on data from clinical records and from periodic check-ups after surgery. In particular, the results are analyzed on the basis of an accurate pre- and postsurgical evaluation using Karnofsky's scale and Kleklamp-Samii's scoring system.

RESULTS

We treated 179 spinal neurinomas in 152 (93 male and 59 female) patients. The mean age was 44.3. In 33 cases the neurinoma was sited in the cervical tract, in 59 cases in the dorsal tract, and in 87 cases in the lumbo-sacral tract. Eleven patients harbored Recklinghausen's neurofibromatosis (7 NF1 and 4 NF2 of which 1 was intramedullary). In 123 cases the neurinoma was intradural, in 11 cases it was extradural, in 2 intra/extradural, in 9 it had a dumbbell form, and in 2 cases it was intramedullary; the remaining cases had neurofibromatosis. The most common presurgical symptom was segmental pain. Total removal of the lesion was possible in the first operation for 174 neurinomas. We encountered 3 cases of malignant neurinoma of which 1 was in NF2. The result of surgery was recovery in 108 cases; 2 patients with NF2 died, and local recurrence occurred even after total exeresis (excision) and radiotherapy in the cases of malignant neurinoma.

CONCLUSIONS

Schwannomas represent the most frequent tumor lesions of the spine with prevalence for the cervical-inferior tract and the dorso-lumbar passage. Intramedullary neurinomas are rarely observed. The total surgical removal of neurinomas is often an attainable goal, and clinical improvement is the common outcome with exception to malignant forms and NF2 neurofibromatosis. We describe a series of 179 treated schwannomas.

Intraparenchymal schwannomas of the central nervous system: an additional case report and review

Intraparenchymal location of schwannomas in the central nervous system (CNS) is rare. Occasional cases involving the cerebrum, cerebellum, brain stem, and spinal cord have been reported. We report here an additional case of thoracic intramedullary schwannoma in a 42 year old woman. The literature concerning intraparenchymal schwannomas in the CNS is reviewed and discussed.

Intramedullary neuroma of the cervical spinal cord: case report

OBJECTIVE AND IMPORTANCE

Intramedullary neuromas are rare tumors; only 37 cases have been described in the literature since 1931.

CLINICAL PRESENTATION

The case of a 36-year-old woman presenting with an 8-month history of a progressive cervical myelopathy is reported. A diagnosis of a cervical intramedullary tumor was made by magnetic resonance imaging.

INTERVENTION

A C3-C7 laminectomy and a near total resection were performed. Pathological examination revealed a neuroma; the various operative and pathological findings are presented.

CONCLUSION

The existence of intraparenchymal neuromas is difficult to explain. Various pathogenic hypotheses are discussed. Microsurgical resection is considered the therapeutic option of choice for these entities.

Intramedullary and extramedullary schwannoma of the cervical spinal cord--case report

Intramedullary schwannomas and neurofibromas are rare tumors. Only two cases have been reported as having both an intramedullary and extramedullary component. We have managed the case of a 15-year-old girl with a schwannoma that appeared to track along the sensory nerve root into the spinal cord. The clinical presentation in this case was that of motor weakness and atrophy, sensory abnormalities, and, late in the course, pain. Magnetic resonance imaging with gadolinium enhancement was better than myelography and computed tomography at delineating the intramedullary extent of the tumor. The tumor was removed microsurgically at two operative sittings. Reports of this unusual pathology are reviewed.

Schwannoma of the medulla oblongata. Case report

A case of intraparenchymal schwannoma of the medulla oblongata is presented. The radiographic and pathological characteristics of this rare tumor are discussed, and the world literature regarding intracerebral intraparenchymal schwannomas is reviewed. The current etiological theories of these intra-axial nerve-sheath tumors are reviewed. The importance of early identification and differentiation of these potentially curable tumors from malignant glial tumors is emphasized.