Intradural Schwannoma Associated with Lumbar Spinal Stenosis: A Case Report
- Affiliations
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- 1Department of Orthopaedic Surgery, Soonchunhyang University Hospital, College of Medicine, Soonchunhyang University, Cheonan, Korea. osos@schmc.ac.kr
- KMID: 1444798
- DOI: http://doi.org/10.5292/jkbjts.2011.17.2.106
Abstract
- In the patient who has intradural mass associated with spinal stenosis, if the operation for spinal stenosis is performed alone, the symptom may remain. We report with literature review that we achieved the successful outcome after simultaneous decompression of spinal stenosis and space occupying mass removal in the case of intradural and extradural compression. A 71-year-old female patient suffering from low back pain and radiating pain of both lower extremities admitted. In magnetic resonance imaging, spinal stenosis on L4-5 and spondylolisthesis on L5-S1 compressed dural sac and intradural space occupying mass on L4 level compressed. By posterior approach, decompression and interbody fusion were carried out. Then mass was removed with median durotomy. Pathologic diagnosis was schwannoma and the symptom was improved remarkably.
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Figure
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Figure 1. Preoperative plain radiographs. (A, B) Anteroposterior (A) and lateral (B) radiographs show degenerative spondylosis in L4–5-S1 level. (C, D) Flexion (C) and extension (D) lateral radiographs show spondylolisthesis on L5-S1 level.
Figure 2. T2-weighted sagittal and axial MR images. (A-C) Serial sagittal MR images show foraminal stenosis on L4–5 level and spondylolisthesis on L5-S1 level. (D) Axial MR image shows spinal stenosis on L4–5 level. (E) Axial MR image shows spondylolisthesis on L5-S1 level.
Figure 3. MR images, myelogram and CT myelogram show space occupying mass on L4 level. (A) T1-weighted sagittal and axial MR image shows low-signal intensity lesion. (B) T2-weighted sagittal and axial image shows iso-signal intensity lesion. (C) Gadolinium enhanced sagittal and axial MR image shows high-signal intensity lesion. (D) Myelogram and CT myelogram show space occupying lesion.
Figure 4. Postoperative plain radiographs. (A, B) Anteroposterior (A) and lateral (B) radiographs show posterior decompression and interbody fusion using pedicle screws and cages on L4–5-S1 level.
Figure 5. (A) Intraoperative finding shows oval shaped mass communicating with nerve root (arrow). (B) Gross finding of tumor shows well encapsulated ovoid mass measured 1.5×1.5×1.2 cm.
Figure 6. Microscopic histologic feature (×400) shows palisading pattern which is the specific finding of Schwannoma. (A) H&E stain. (B) Immunohistochemical stain.
Reference
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References
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