Abstract
Spinal schwannoma is the most common benign intradural spinal tumor. However, studies regarding the neurological outcome of tumor resection in complete paraplegia patients are still lacking. The authors report a case of complete paraplegia due to primary intradural extramedullary low-grade schwannoma of the spinal cord. Surgery was performed 5 weeks after the paraplegia complaint first occurred. The patient did not regain motor nor sensory function in the 1-month follow-up but resolution of pain was achieved. The patient was able to perform daily activity more comfortably. In the event of complete paraplegia, surgery should still be offered promptly as it can still benefit the patient. Possible factors that could have influenced the prognosis in our study are discussed.
Highlights
Accounting for almost 25% of all intradural spinal tumors, spinal schwannoma is the most common benign intradural tumor
We aim to discuss the neurological outcome of surgical intervention in complete paraplegia patient due to spinal schwannoma based on the current study and review of the literature
Because total laminectomy was done at 3 spinal levels (T8-9, T9-10, and T1011) and more than 50% of facetectomy was performed, we decided to install pedicle screws to maintain spinal stability
Summary
Accounting for almost 25% of all intradural spinal tumors, spinal schwannoma is the most common benign intradural tumor. The typical clinical manifestation is localized pain, radicular pain, and myelopathy, while symptoms of motor weakness usually occur at a later stage.[1,2] The mainstay of treatment for spinal schwannoma is surgical resection, whether it is done through minimally invasive procedure or conventional one. While radiosurgery is reserved for selected cases (i.e., tumor recurrence, incomplete resection, or surgery not feasible due to tumor location and other comorbidities).[3,4] The goal of surgical intervention is to do maximum possible resection to decompress the spinal cord, without worsening the pre-operative neurological status and maintaining the spinal stability.[5] Complete resection can be achieved in 85%-97% of primary operated cases with more than 60 percent of patients experiencing improvement in neurological outcome.[4,6]
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