J Korean Neurosurg Soc.  2012 Feb;51(2):105-108. 10.3340/jkns.2012.51.2.105.

Giant Cauda Equina Schwannoma with Dystrophic Calcifications : Case Report and Review of the Literature

• Hyun SJ
• Rhim SC

• KMID: 1441420
• DOI: http://doi.org/10.3340/jkns.2012.51.2.105

Abstract

Giant spinal schwannoma of the cauda equine involving many nerve roots is rare, and ossification is usually not observed in the schwannoma. A 21-year-old man presented with a 12-month history of urinary dysfunction and numbness below the buttocks. Plain radiography showed scalloping of the posterior surface of the vertebral bodies from L4 to the sacrum, and magnetic resonance imaging and computed tomography revealed a giant cauda equina tumor with dystrophic calcification. The tumor was completely removed, with intraoperative neurophysiologic monitoring. Histopathologic examination showed that the tumor was a schwannoma. The patient's postoperative course was uneventful, with urinary function and numbness gradually improving. Although a giant schwannoma accompanied by dystrophic calcification is extremely rare, such a tumor can be removed safely and completely by meticulous dissection and careful neuromonitoring of the cauda equina spinal nerves involved in the tumor.

Keyword

Giant schwannoma; Cauda equina; Complete excision; Calcification; Neuromonitoring

MeSH Terms

Buttocks
Cauda Equina
Humans
Hypesthesia
Magnetic Resonance Imaging
Neurilemmoma
Pectinidae
Sacrum
Spinal Nerves
Young Adult

Figure

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  Fig. 1 Preoperative sagittal magnetic resonance images of our patient. A : T2-weighted image. B : T1-weighted image. C : Gadolinium-enhanced T1-weighted image. Note the giant cauda equina tumor growing into the vertebral bodies and neural foramina from L3 to S2.

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  Fig. 2 CT scans showing a large calcified mass in the enlarged spinal canal and neural foramen.

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  Fig. 3 Intraoperative photograph showing a large calcification (arrow) in the tumor.

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  Fig. 4 Radiographic images taken 3 years after surgery. A : T2-weighted magnetic resonance (MR) image. B : Gadolinium-enhanced T1-weighted MR image. C : Plain radiograph anteroposterior view. D : Plain radiograph lateral view. There is no evidence of any residual tumor, vertebral fracture, or spinal instability.

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