Tumor Occupation in the Spinal Canal and Clinical Symptoms of Cauda Equina Schwannoma: An Analysis of 22 Cases

Small L4 ventral root schwannoma with acute onset of radicular pain: A case report

Background:

Patients with cauda equina schwannomas usually present with slowly progressive radiculopathy. Herein, we describe a 34-year-old male who presented with acute radiculopathy attributed to a small L4 ventral root schwannoma.

Case Description:

A 34-year-old male suddenly developed left leg pain. Magnetic resonance imaging (with/without contrast) revealed a small intradural mass lesion involving the L4 nerve root that was enhanced with contrast (size: 9 × 12 × 12 mm). The computed tomography myelogram revealed that the tumor had originated from the L4 ventral root and compressed the dorsal root in the lateral recess. Following a decompressive laminectomy for tumor removal, the patient’s radicular pain improved. The histological diagnosis was consistent with a schwannoma.

Conclusion:

Small cauda equina schwannomas involving ventral nerve roots can cause acute radiculopathy readily relieved with decompressive laminectomies for tumor excision.

Cauda equina schwannoma with concomitant intervertebral disc herniation: A case report and review of literature

The coexistence of lumbar intervertebral disc (IVD) herniation and cauda equina schwannoma in symptomatic patients is uncommon. We experienced a case with a surgically treated cauda equina schwannoma with concomitant lumbar IVD herniation (L2/L3); both were relatively small but presented with painful symptoms in combination. A 45-year old man complained of low back pain and right anterior thigh pain six months prior to surgery. He underwent conservative treatment; however, his pain suddenly worsened three months before surgery, with abnormal sensations and pain in his right buttock and posterior thigh. A magnetic resonance imaging (MRI) scan revealed an L2/L3 disc herniation extruding to the center of the lumbar spinal canal and compressing the thecal sac. Incidentally, an intrathecal tumor was suspected, and enhanced MRI revealed a round tumor measuring 10-mm in diameter at the L2/L3 intervertebral level, which was uniformly enhanced by gadolinium chelate, radiologically diagnosed as a schwannoma. Microscopic discectomy and tumor resection were performed and the patient's symptoms disappeared immediately. Schwannoma is generally slow-growing, and usually asymptomatic when the tumor size is small. Therefore, we suspected that the tumor occasionally impinged on the left L3 root with L2/3 IVD herniation, leading to acute worsening of the patient's symptoms. Altogether, in case of tumor in patients undergoing conservative treatment for cauda equina schwannoma, we should consider that symptoms can acutely worsen with the occurrence of lumbar IVD herniation.