Giant Sacral Schwannoma Treated with a 360 Approach: a Rare Case and Systematic Review of the Literature.

Giant Sacral Schwannoma Treated with a 360 Approach: a Rare Case and Systematic Review of the Literature.

World Neurosurg. 2018 Apr 05;:

Authors: Khan UA, Ismayl G, Malik I

Abstract
Sacral schwannomas are very rare and typically have a benign nature. They occur in a permissive anatomical location leading to non-specific symptoms which can result in them going unnoticed before reaching a considerable size. We report a rare case of a giant sacral schwannoma (130x110x90mm) in a 38-year-old man originating from the S2 nerve root, encompassing the neural canal with sacral erosion and extension in to the pelvis. The patient presented with a history of abdominal pain associated with increased urinary frequency and a sensation of incomplete bladder emptying. An MRI demonstrated a giant pelvic mass with sacral erosion and involvement of the nerve roots. Subsequently he went on to have a two-stage procedure where complete resection of the schwannoma was achieved by both a posterior hemilaminectomy and laparotomy with the aid of neuro-monitoring. The post-operative course was uneventful with complete resolution of symptoms. We report one of the largest benign sacral schwannoma originating inside the spinal canal with pelvic extension to be resected without complications. We discuss our successful management and conduct a systematic review of the literature to provide the most up to date guidance on managing this tumour including the application of neuro-monitoring and a 360 approach in two stages.

PMID: 29627632 [PubMed - as supplied by publisher]

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