Minim Invasive Neurosurg 2007; 50(2): 120-123
DOI: 10.1055/s-2007-982506
Case Report

© Georg Thieme Verlag KG Stuttgart · New York

A Schwannoma of the S1 Dural Sleeve was Resected while the Intact Nerve Fibers were Preserved Using a Microscope. Report of a Case with Early MRI Findings

S. Kobayashi 1 , K. Uchida 1 , Y. Kokubo 1 , T. Yayama 1 , H. Nakajima 1 , T. Inukai 1 , E. Nomura 2 , H. Baba 1
  • 1Department of Orthopedic Surgery, Fukui University School of Medicine, Matsuoka, Fukui, Japan
  • 2Department of Orthopedic Surgery, Kawasaki Municipal Hospital, Kawasaki, Kanagawa, Japan
Further Information

Publication History

Publication Date:
03 August 2007 (online)

Abstract

In this report, we describe a small schwannoma of the dural sleeve and mention that it is often difficult to differentiate this tumor from lumbar disc herniation, especially a sequestered hernia, or a discal cyst. Gadolinium-enhanced MR images were a useful preoperative examination modality for differentiating this lesion from other diseases. Microscopically, the intradural tumor was successfully removed. The dura mater of the S1 nerve root was opened microsurgically, allowing the nerve fibers involved in the tumor to be identified. The involved fibers were cut around the tumor, and the lesion was resected while the intact nerve fibers were preserved. Based on histological examination of the resected specimen, the tumor was diagnosed as a schwannoma with multilocular cystic degeneration. Microsurgery allowed the tumor to be removed with minimal impairment from cutting of nerve fibers in the nerve root.

References

  • 1 Sartor K, Weber K, Fliedner E. Lumbale Myelographie: Koinzidenz von Bandscheibenvorfall und intraduralem Tumor.  Fortschr Röntgenstr. 1978;  128 183-184
  • 2 Sanguinetti C, Esposito L, Laudati A. Associazione di ernia discale e neurinoma vertebrale.  Chir Org Mov. 1985;  70 369-374
  • 3 Albert FK, Oldenkott P, Bicker Danz B. Lumbar intervertebral disk herniation with a concomitant nerve root neurinoma at the same site.  Neurochirurgia. 1988;  31 222-225
  • 4 Lahat E. Schwannoma presenting as lumbar disc disease an adolescent boy.  Ann Neurol. 1996;  20 643-644
  • 5 Nittner K. Spinal meningiomas, neurinomas and neurofibromas and hourglass tumors. In: Vinken PJ, Bruyn GW (eds.) Handbook of clinical neurology. 20 North-Holland Pub, Amsterdam 1976: 177-322
  • 6 Simeone FA, Lawner PM. Intraspinal neoplasms. In: Rothman RH, Simeone FS (eds.) The Spine. Saunders, Philadelphia 1982: 1041-1054
  • 7 Nayernouri T. Neurilemomas of the cauda equina presenting as prolapsed lumbar intervertebral disks.  Surg Neurol. 1985;  23 187-188
  • 8 Eden K. The dumb-bell tumors of the spine.  Brit J Surg. 1940;  28 549-570
  • 9 Koga H, Yone K, Yamamoto T, Komiya S. Percutaneous CT-guided puncture and steroid injection for the treatment of lumbar discal cyst: A case report.  Spine. 2003;  28 E212-E216
  • 10 Schramm JW, Umbach W. Simultaneous occurrence of spinal tumor and lumbar disk herniation. Report of cases.  Neurochirugia. 1977;  20 22-28
  • 11 Baba H, Furusawa N, Maezawa Y, Uchida K, Kokubo Y, Imura 5, Noriki S. Ganglion cyst of the posterior longitudinal ligament causing lumbar radiculopathy: Case report.  Spinal Cord. 1977;  35 632-635
  • 12 Maezawa Y, Baba H, Uchida K, Furusawa N, Kubota C, Yoshizawa K. Spontaneous remission of a solitary intraspinal synovial cyst of the lumbar spine.  Eur Spine J. 2000;  9 85-87
  • 13 Oro JJ, Geise AW. Dumbbell ganglioneuroma of the lumbar spine associated with a herniated intervertebral disc.  Case report. Neurosurgery. 1983;  13 711-714
  • 14 Gandolfi A, Bertolino G. Simultaneous cervical cord compression from herniated disk and extra-dural meningioma: Report of a case.  Acta Neurol (Napoli). 1978;  33 273-278
  • 15 Love JG, Rivers MB. Intractable pain due to associated protruded intervertebral disk and neoplasm.  Neurology. 1962;  12 60-64
  • 16 Kobayashi S, Yoshizawa H, Hachiya Y, Ukai T, Monta T. The Volvo Award on Low Back Pain Research, International Society for the Study of the Lumbar Spine. Vasogenic edema induced by compression injury to the spinal nerve root. Distribution of intravenously injected protein tracers and gadolinium enhanced magnetic resonance imaging.  Spine. 1993;  18 1410-1424
  • 17 Kobayashi S, Yoshizawa H, Yamada S. Pathology of lumbar nerve root compression. Part 1: Intraradicular inflammatory changes induced by mechanical compression.  J Orthop Res. 2004;  22 170-179
  • 18 Kobayashi S, Uchida K, Takeno K, Baba H, Suzuki Y, Hayakawa K, Yoshizawa H. Imaging of the cauda equina edema in lumbar canal stenosis using gadolinium-enhanced MR imaging: Experimental constriction injury.  AJNR Am J Neuroradiol. 2006;  7 346-353
  • 19 Roser F, Ritz R, Morgalla M, Tatagiba M, Bornemann A. Spinal nerve root ganglionitis as cause of disc herniation.  J Neurosurg Spine. 2005;  2 472-475
  • 20 Hueftle M, Modic MT, Ross JS, Masaryk TJ, Carter JR, Wilber R, Bohlman HH, Steinberg PM, Delamarter RB. Lumbar spine: Postoperative MR imaging with Gd-DTPA.  Radiology. 1988;  167 817-824
  • 21 Uchida K, Baba H, Maezawa Y, Chen Q, Imura S. Lumbosacral dumb-bell neurilemmoma approached by microsurgical interlaminar foraminotomy.  Int Orthop. 1996;  20 119-122
  • 22 MacCulloch JA. Indications for microsurgery for lumbar disc disease. In: Watkins R (ed.) Microsurgery of the lumbar spine. Aspen Pub, Maryland 1990: 2l-29
  • 23 Harrison MJ, Al-Mefty O. Microsurgery for spinal canal tumors. In: MacCulloch JA, Yong PH (eds.) Microsurgery of the lumbar spine. Lippincott Raven, Philadelphia, New York 1998: 555-567

Correspondence

S. KobayashiMD, PhD 

Department of Orthopedics and Rehabilitation Medicine

Fukui University School of Medicine

Shimoaizuki 23

Matsuoka

910-1193 Fukui

Japan

Phone: +81/776/61 83 83

Fax: +81/776/61 81 25

Email: kshigeru@fmsrsa.fukui-med.ac.jp

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