Clinical features of multiple spinal schwannomas without vestibular schwannomas

Rare case of schwannomatosis presenting with cauda equina syndrome: a case report

Background

Schwannomatosis is a rare disorder characterized by multiple schwannomas without vestibular schwannomas or other features of neurofibromatosis type 2 (NF2). It commonly presents with neuropathic pain, neurological deficits, and soft tissue tumors but rarely leads to cauda equina syndrome, a serious condition requiring urgent intervention.

Materials and methods

We report a 28-year-old Pakistani female with progressive back pain, lower limb weakness, sensory deficits, bladder and bowel incontinence, and multiple tender swellings, consistent with cauda equina syndrome. Neurological examination revealed right-sided lower limb weakness. MRI of the brain showed no vestibular schwannomas, while spinal MRI identified a heterogeneously enhancing schwannoma from D11 to L5 with cystic extension into the neural foramina, proximal central canal dilation, and spinal cord compression. Multiple additional schwannomas were detected. Right thigh mass biopsy confirmed schwannoma, showing Antoni A and B regions, Verocay bodies, and S-100 positivity. Genetic testing was not performed due to financial constraints.

Results

The patient underwent partial spinal schwannoma resection, leading to spinal decompression and resolution of cauda equina syndrome symptoms. Symptomatic cutaneous schwannomas were excised. Neuropathic pain was managed with pregabalin and NSAIDs. At 6-month follow-up, she showed improved lower limb strength, resolution of incontinence, and no significant tumor regrowth.

Conclusion

This case highlights schwannomatosis presenting with cauda equina syndrome, emphasizing the importance of early recognition, spinal decompression, and differentiation from NF2 for optimal management.

A rare case of schwannomatosis with meningioma: a case report

Introduction

Schwannomatosis is characterized by multiple schwannomas without vestibular schwannomas or any other stigmata of neurofibromatosis type 2 (NF2). Schwannomatosis is a rare disorder, with a reported incidence ranging from 1 in 40 000 to 1 in 1.7 million. Meningioma is also associated with schwannomatosis in around 5% of cases.

Case presentation

We describe a case of a 20-year-old female presenting with progressive weakness of the right lower limb for 7 months with a tingling sensation and numbness of the same limb for 6 months and was found to have schwannomatosis with multiple spinal and right cerebellopontine angle (CPA) (9th/10th cranial nerve) schwannomas and left anterior cranial fossa meningioma.

Discussion

Schwannomas in schwannomatosis are seen along the cranial, spinal, and peripheral nerves but not along the vestibular nerve, as is characteristically seen in NF2. The occurrence of meningiomas is about 5% in individuals with schwannomatosis, and the patient in our case also had an associated meningioma. The tumor was confirmed to be a schwannoma based on features on an MRI examination and histological examination.

Conclusion

It is of great significance to identify the entire spectrum of the disease in a patient with schwannomatosis, and to differentiate it from related conditions in order to track and surgically manage the patient appropriately based on symptomatology and imaging findings.

Scoring model to predict postoperative neurological deterioration in spinal schwannoma

Background

Spinal schwannomas (SSs) are benign tumors affecting the nerve sheath, accounting for 25% of spinal nerve root tumors. Surgery represents the mainstay of treatment for SS patients. Following surgery, approximately 30% of patients experienced developed new or worsening neurological deterioration, which probably represented an inevitable complication of nerve sheath tumor surgery. The objective of this study was to identify the rates of new or worsening neurological deterioration in our center and accurately predict the neurological outcomes of patients with SS by developing a new scoring model.

Methods

A total of 203 patients were retrospectively enrolled at our center. Risk factors associated with postoperative neurological deterioration were identified by multivariate logistic regression analysis. β–coefficients for independent risk factors were used to define a numerical score to generate a scoring model. The validation cohort at our center was used to verify the accuracy and reliability of the scoring model. Receiver operating characteristic (ROC) curve analysis was used to evaluate the performance of the scoring model.

Results

In this study, five measured variables were selected for the scoring model: duration of preoperative symptoms (1 point), radiating pain (2 points), tumor size (2 points), tumor site (1 point), and dumbbell tumor (1 point). The scoring model divided the spinal schwannoma patients into three categories: low risk (0-2 points), intermediate risk (3-5 points), and high risk (6-7 points), with predicted risks of neurological deterioration of 8.7%, 36%, and 87.5%, respectively. And the validation cohort confirmed the model with the predicted risks of 8.6%, 46.4%, and 66.6%, respectively.

Conclusion

The new scoring model might intuitively and individually predict the risk of neurological deterioration and may aid individualized treatment decision-making for SS patients.