Spinal Cord Schwannoma

4/03/02 (Doughty(

Question: What are diagnostic and therapeutic aspects of spinal schwannoma?

<2>

Unique Identifier:10735772

Authors: Binatli O. Ersahin Y. Korkmaz O. Bayol U.

Institution: Department of Neurosurgery, Social Security Hospital, Izmir, Turkey.

Title: Intramedullary schwannoma of the spinal cord. A case report and review of the literature.

Source: Journal of Neurosurgical Sciences. 43(2):163-7; discussion 167-8, 1999 Jun.

Abstract: A 9-year-old boy presented with the numbness in both arms and hands, and neck stiffness. On examination, he had a slight quadriparesis and restricted neck movements. There were no signs of von Recklinghausen's disease. Magnetic resonance imaging (MRI) scan disclosed a gadolinium enhanced intramedullary tumor located at C6-T1 associated with syringomyelia. C6-T1 laminectomies were performed and the intramedullary tumor was totally removed by a microsurgical technique. Postoperative course was uneventful. The pathological examination revealed an intramedullary schwannoma. The occurrence of intramedullary schwannoma in a patient without signs of von Recklinghausen's disease is extremely rare. We have been able to find 57 cases of intramedullary schwannoma reported in the literature. Intramedullary schwannomas are usually seen in males. The ages of the patients ranged from 9 to 75 years (mean 40.44 years). Only 4 cases in the pediatric age group have been reported. The duration of symptoms ranged from 3 months to 20 years (mean 31.03 months). Symptoms and signs varied with the location of tumor. The vertebral levels of intramedullary schwannomas were usually cervical (61%). MRI has been the choice of diagnostic tool in the cases reported since 1986. The majority of the cases showed either a partial or complete recovery in the postoperative period.

Fulltext Available in EBSCO using ACADEMIC SEARCH PREMIER and the search term: (AN 2096734)

<3>

Unique Identifier:10562847

Authors: Acciarri N. Padovani R. Riccioni L.

Institution: Department of Neurosurgery, Bellaria Hospital, Bologna, Italy.

Title: Intramedullary melanotic schwannoma. Report of a case and review of the literature. [Review] [29 refs]

Source: British Journal of Neurosurgery. 13(3):322-5, 1999 Jun.

Abstract: A case of an intramedullary melanotic schwannoma located in the spinal cord at the T2-T3 level is described. The lesion occurred in a 44-year-old woman with a 10-year history of weakness and sensory numbness in both legs and feet. At operation the lesion appeared as a well-demarcated grey-brown intramedullary mass. Histologically, it was composed of interlacing bundles of spindle cells showing their cytoplasm filled with melanin. Among spinal cord neoplasms, melanotic schwannomas are rare tumours, which have apparently been reported only in three previous instances. The clinical, diagnostic and pathological features, as well as the possible aetiology of these rare tumours are discussed. [References: 29]

<12>

Unique Identifier:7674010

Authors: Seppala MT. Haltia MJ. Sankila RJ. Jaaskelainen JE. Heiskanen O.

Institution: Department of Neurosurgery, Helsinki University, Finland.

Title: Long-term outcome after removal of spinal schwannoma: a clinicopathological study of 187 cases.

Source: Journal of Neurosurgery. 83(4):621-6, 1995 Oct.

Abstract: Are spinal schwannomas as benign as we think? To what extent do patients recover? Are patients prone to develop late complications such as cystic myelopathy or symptomatic spinal deformity? Is their life expectancy compromised? In an effort to answer these questions, the authors analyzed the long-term outcome for 187 patients from one neurosurgical department with surgically treated spinal schwannoma. Median follow-up period was 12.9 years (2454 patient years). One-fifth of the patients considered themselves free of symptoms at follow-up examination. The most common late complaint was local pain (46%), followed by radiating pain (43%), paraparesis (31%), radicular deficit (28%), sensory deficit due to a spinal cord lesion (27%), and difficulty voiding (19%). Late complications occurred in 21% of the patient population, including cystic myelopathy (2%), spinal arachnoiditis (6%), spinal deformity (6%), and troublesome pain (7%). Life expectancy of the patients corresponded to that of the general population.

<18>

Unique Identifier:1590138

Authors: Friedman DP. Tartaglino LM. Flanders AE.

Institution: Department of Radiology, Jefferson Medical College, Philadelphia, PA.

Title: Intradural schwannomas of the spine: MR findings with emphasis on contrast-enhancement characteristics.

Source: AJR. American Journal of Roentgenology. 158(6):1347-50, 1992 Jun.

Abstract: Intradural extramedullary schwannomas are nerve sheath neoplasms that consist of focal proliferations of Schwann cells involving a spinal nerve. We reviewed the MR findings in seven patients with pathologically proved intradural schwannomas. The contrast-enhancement characteristics on MR images were determined and compared with the histologic features of the tumor. Six lesions were variably hyperintense on T2-weighted images and one was uniformly hypointense compared with the signal intensity of the spinal cord. Signal on T1-weighted images ranged from hypointense to isointense. All seven tumors showed heterogeneous enhancement; in five, the enhancement involved only the periphery of the lesion. The pattern of enhancement did not correlate with the signal characteristics noted on unenhanced T1- and T2-weighted images. Pathologically, hyaline thickening of vessel walls and cyst formation were prevalent in the peripherally enhancing lesions. However, enhancement did not correlate with the relative proportion of Antoni type A and type B tissue. Recognition of the MR characteristics of intradural extramedullary schwannomas may be helpful in the differential diagnosis of spinal tumors. In particular, peripheral contrast enhancement of an intradural extramedullary tumor on MR images should suggest the diagnosis of schwannoma.