Abstract
Synchronous spinal intramedullary ependymal cysts and intramedullary schwannomas are rare. To the best of our knowledge, the present study is the first report of a case of intramedullary schwannoma coexisting with an ependymal cyst. A 35-year-old male presented with lower back pain and weakness in the left leg. Magnetic resonance imaging identified an intramedullary cystic-solid lesion at the thoracolumbar junction of T11-L2; based on the clinical presentation and radiological features, a pre-operative diagnosis of ependymoma was formed. Subsequently, the patient underwent a T11-12 laminectomy via a posterior approach, with intraoperative monitoring of somatosensory and motor-evoked potentials, achieving a gross total resection of the tumor with a well-demarcated dissection plane. Post-operative histopathological examination demonstrated a schwannoma coexisting with the ependymal cyst, and the neurological status of the patient markedly improved compared with the pre-operatively observed neurological deficit.
Highlights
Case reportSpinal schwannomas are usually intradural extramedullary tumors
The present study reports a case of intramedullary schwannoma coexisting with an ependymal cyst in an adult patient
As Schwann cells are not typically found in the parenchyma of the central nervous system (CNS), these tumors are rarely observed within the spinal cord [1]
Summary
Spinal schwannomas are usually intradural extramedullary tumors. As Schwann cells are not typically found in the parenchyma of the central nervous system (CNS), these tumors are rarely observed within the spinal cord [1]. Sagittal T1‐weighted images demonstrated an intramedullary cystic‐solid lesion in the conus medullaris; following gadolinium injection, the solid mass demonstrated inhomogeneous enhancement. T2‐weighted images revealed that the solid mass was accompanied by a cranial cystic lesion. Following GTR of the solid mass, the cranial syringomyelia was examined. The cyst appeared yellow in color, was filled with clear fluid and did not adhere to the spinal cord, a GTR of the cyst was performed. Pathological examination of the solid mass identified spindle‐shaped cells with features of a schwannoma (Fig. 2A). In the immediate post‐operative period, the weakness in the left leg and the sphincter dysfunction did not improve, the lower back pain disappeared. The patient was discharged two weeks later; the weakness in the left leg had improved to grade 5/5 and sphincter dysfunction gradually improved after three months. The present retrospective study was approved by the Institutional Review Board of Beijing Tiantan Hospital
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