Spinal Schwannomas Research Articles

EPHA2 is a Potential Target for the Treatment of NF2-/-Vestibular Schwannoma

Neurofibromatosis type 2 (NF2) is an autosomal dominant cancer predisposition syndrome characterized by the development of bilateral vestibular (VS) and spinal schwannomas secondary to loss of heterozygosity of NF2 in Schwann cells or their precursors. While these tumors are largely benign, they can cause considerable morbidity due to compromised auditory, vestibular, facial, and vertebral nerve function. This may result in deafness, vertigo, facial muscle weakness, chronic neuropathic pain, and even death.There are currently no pharmacotherapies for VS, and surgical resection remains the standard of care, which is associated with significant morbidity. Thus, there is an urgent need to develop pharmaceutical approaches to halt or reverse the progression of tumor growth in NF2 patients who develop VS. Our lab previously identified the receptor tyrosine kinase inhibitors brigatinib and dasatinib as potentially efficacious agents for the treatment of VS and demonstrated that both agents targeted the Ephrin A2 receptor (EPHA2). EPHA2is a transmembrane receptor tyrosine kinase thatis involved in cell contact-mediated motility, adhesion,and migration. Additionally, EPHA2 modulates axon guidance, and synaptogenesis in developing brain. Here we demonstrate that EPHA2expression is increased in NF2-/-Schwanncells and NF2-/-cancers. We identify ponatinib, a receptor tyrosine kinase inhibitor targeting ABL1 that is FDA-approved for CML, as an additional agent that targets EPHA2. We demonstrate that ponatinib treatment impairs the viability of both human and murine NF2-/-Schwanncells in vitro and decreases EPHA2 protein expression. Accordingly, pharmacologic,and siRNA-mediated inhibition of EPHA2 also impaired the growth of human NF2-/-Schwann cells in vitro. Lastly, we demonstrate that both ponatinib and EPHA2 inhibition induce morphological changes in NF2-/-Schwann cells. Our findings suggest that ponatinib or the direct targeting of EPHA2 may be efficacious for the treatment of NF2-associated vestibular schwannoma. Future in vivo efficacystudies are warranted.

MRI Evaluation of Intradural Extramedullary Spinal Tumors with Histopathological Correlation - A Cross Sectional Study

Introduction: Tumors of nerve sheath, neurofibroma and schwannoma represent 30% of intradural extramedullary tumors. Schwannomas and neurofibromas are histologically composed of Schwann cells. Schwannomas almost always arise from the dorsal sensory roots and form well- encapsulated firm masses that compress adjacent tissue, without invading the involved nerve. Neurofibromas are more complex and are composed of Schwann cells mixed with fibroblast they involve the parent nerve. Meningiomas comprise approximately 25% of primary intraspinal tumors and are second only to nerve sheath tumors in frequency. Spinal cord meningiomas are originate from meningothelial cells near the distal root ganglia. Most menongiomas are intradural extramedullary, only 5% are extradural. Aim of the Study: The aim of this study was to evaluate the role of MRI in diagnosis of intradural extramedullary spinal tumors compared to histopathological findings. Methods: This was a cross sectional study and was conducted in the Department of Radiology and Imaging, Sylhet M.A.G. Osmani Medical College, Sylhet in collaboration with Department of Neurosurgery & Pathology of the same hospital, Sylhet, Bangladesh during the period from September, 2018 to August 2020. Result: In total 35 patients completed the study. In our study we found the Mean ± SD of age was 41.71±13.9 in years. Majority (54%) of our patients presented with spinal tumor were male compared to female (46%).We found schwannoma was diagnosed by (42.9%), meningioma (31.4%), neurofibroma (25.7%) respectively. Neurofibroma & schwannoma showed male predominance with 66.67% & 60% while meningioma showed female predominance with 63.6%. We found majority (55.6%, 60% & 72.7%) of neurofibroma, schwannoma & meningioma was in dorsal region respectively. Conclusion: In our study we found that MRI is a very sensitive and effective imaging procedure of suspected spinal schwannoma tumor of the spinal cord for accurate pre-operative diagnosis and ........

Surgical outcome of spinal schwannoma and neurofibroma.

The aim of this study was to evaluate the outcome and surgical complications in patients with spinal schwannoma or neurofibroma surgically treated at the Hospital das Clínicas of the State University of Campinas. This was a retrospective cohort study, using medical records of patients operated between 2011 and 2021. The sample distribution was verified using the Kolmogorov-Smirnov test. The dynamics between qualitative variables were assessed using Fisher's exact test. We used means analysis to assess patient improvement based on Frankel scores. A total of 16 patients were evaluated, of whom 56.25% (9) were men and 43.75% (7) were women. There were 13 (81.25%) patients with schwannomas and 3 (18.75%) with neurofibromas. Patients with deficits had neurological improvement, such as walking or with at least Frankel D or E after surgery. Laminectomy, performed in 8 patients (50%), and laminoplasty, used in 9 patients (56.25%), were the main techniques. The surgical approach was proved to be an effective and safe alternative to the treatment of these tumors, with neurological improvement and minor surgical complications.

Multiple spinal cord schwannomas in a 58-year-old man

Multiple spinal cord schwannomas in a 58-year-old man

Surgical management of spinal schwannomas arising from the first and second cervical roots: Results of a cumulative case series.

Schwannomas of the first and second nerve roots are rare neurosurgical entities, harboring specific surgical features that make surgical resection particularly challenging and deserve specifics dissertations. This study is a retrospectively analysis of 14 patients operated in two different neurosurgical centers: the San Filippo Neri Hospital of Rome and the Federal Centre of Neurosurgery of Tjumen. In the last 6 years, 14 patients underwent neurosurgical resection of high cervical (C1-C2) schwannomas, in two different neurosurgical centers. Patients data regarding clinical presentation, radiological findings, and surgical results were retrospectively analyzed. The mean age was 50 years (range 13-74), the follow-up mean duration was 30 ± 8.5 (range 24-72 months), and there was no significant differences among different tumor locations (intradural, extradural, and dumbbell). Surgical results were excellent: gross total resection was achieved in all cases and there were no intraoperative complications or postoperative mortality. All patients presented postoperative clinical improvement except one who remained stable. Karnofsky performance status, at the last follow-up, confirmed a global clinical improvement. No vertebral artery (VA) injury neither spinal instability occurred; nerve root sacrifice was reported in one case. Neurosurgical treatment of C1-C2 schwannomas is associated with good outcomes in terms of extent of resection and neurological function. In particular, dumbbell shape and VA involvement do not represent limitations to achieve complete tumor resection and good clinical outcome. In conclusion, microsurgery represents the treatment of choice for C1-C2 schwannomas.

Giant Spinal Schwannomas. Presentation of Two Cases with Interdisciplinary Surgical Resection

Purpose: To report two quite rare cases of giant schwannomas of the cervical and thoracic spine. Surgical resection is usually the treatment of choice for these neoplasms. Methods: The first patient is a 48-year-old male that came to our department, complaining about weakness and paresthesia of both lower extremities and upper left extremity, and a considerably big dorsal palpable lump. MRI and CT scan were used to diagnose giant cervical schwannoma. Because of the intensity of symptoms, he was subjected to surgery. Multidisciplinary resection involving neurosurgical and oncosurgicalteamn was performed for intravertebral and extravertebral approaches. The second patient is a 55-year-old female that came to the hospital complaining about incapacitating pain and dysesthesia involving T6, T7, and T8 dermatomes, with no other deficits. MRI and CT scan were used to diagnose giant thoracic schwannoma. Because of the intensity of the pain, surgery was decided as the treatment of choice. Video assisted thoracoscopic surgery was performed and total resection was achieved, with improvement of the symptoms. Results: Both patients showed complete remission of the symptoms, with no major deficits after surgery. Conclusion: Although infrequent, giant spinal schwannomas may be the cause of visible lumps in the back with radicular symptoms. When asymptomatic, conservative treatment could be viable, but when they present symptoms, surgery offers good results.

Etiology and Factors Related Outcomes of Longitudinally Extensive Transverse Myelitis in Thailand

Objective This study aimed to evaluate the clinical features, etiology, and prognosis of longitudinally extensive transverse myelitis (LETM) patients in Thailand. Background LETM has various etiology and is different in each region. Proper investigations are essential to reduce misdiagnosis and delay in treatments, which affect clinical recovery and prognosis. In Thailand, there is no clinical study on the etiology of LETM. Therefore, our study aimed to evaluate the clinical features, etiology, and prognosis of LETM patients in Thailand. Design/Methods Patients diagnosed with LETM at University Hospital between January 2015 and October 2021 were included. Patient demographics, clinical presentations, Expanded Disability Status Scale (EDSS), imagings, laboratory testing, cerebrospinal fluid profiles, final diagnosis, and treatments were recorded. Factors related to outcomes of LETM were analyzed. Results A total of 40 patients, there were 21 females (52.5%), the mean age of onset was 48.4 years (SD = 15.8). NMOSD was the most common etiology of LETM (n = 15), followed by infection (n = 5), SLE (n = 5), idiopathic causes (n = 4), CIS (n = 3), MS (n = 1), spinal dural AVF (n = 2), ADEM (n = 2), either 1 had spinal cord infarction, schwannoma, and vitamin B12 deficiency. Most patients in this study had severe LETM (n = 31). Complete cord had significantly poorer outcome (p-value = 0.003), while dorsolateral and anterior cord had better outcome (p-value = 0.046, 0.046). Conclusions NMOSD was the most common etiology of LETM, and a history of prior attacks led to the diagnosis of NMOSD. Complete cord lesion on axial spinal cord MRI was sensitive to NMOSD but not specifically. Factors related to the prognosis of LETM included completed cord lesions on MRI axial view trended to have a poor outcome, and dorsolateral and anterior cord lesions had a better prognosis.

Anaesthetic management in the patient with thoracic–lumbar intradural tumor accompanied by heart failure and atrial fibrillation: a case report

Background: Spinal cystic intradural Schwannoma is a type of tumor that is rarely found, with an incidence of 0.3–0.5/100,000 person per year. The operative procedure for this tumor was simple. However, some patients showed other comorbidities, such as heart failure with low ejection fraction (EF) and atrial fibrillation. Such cases are a challenge to the anaesthesiologist as they are most commonly complicated by progressive cardiac failure. Case Presentation: A 68-year-old woman was consulted by the Anaesthesiology Department in dr. Kariadi General Hospital Semarang in April 2019. She had been experiencing right lower extremity and lower back pain since April 2018, and they have been getting worse since two weeks ago. She also complained of shortness of breath two weeks before, accompanied by typical symptoms and signs of heart failure. Her electrocardiogram showed atrial fibrillation, and her echocardiogram showed an LVEF of 33.7%. Magnetic resonance imaging (MRI) showed two lobulated intradural-extramedular cystic lesions at thoracal vertebrae 12 until lumbar vertebrae 1 (VTh12–L1) that were a high suspicious of Schwannoma on the anterior aspect and the lateral aspect accompanied by spinal cord compression at that level. The drugs used for premedication were metoclopramide 10 mg and ranitidine 50 mg, for induction was fentanyl 100 μg, and for maintenance were dobutamine 10 μg/kgBW/minute, rocuronium bromide 30 mg/hour via syringe pump, opioid fentanyl 100 μg and muscle relaxant using rocuronium bromide 40 mg. The patient was hemodynamically stable throughout the surgery, and blood loss was minimal. Conclusion: In patients with heart problems, a moderate reduction in contractility and heart rate often occurs and may induce mild to severe bradyarrhythmia or tachyarrhythmia related to induction agents. It is important to maintain adequate cardiac output that requires inotropic agents to augment contractility and improve circulation. As an inotropic choice, a β-agonist (e.g., dobutamine) causes less vasodilation, increased contractility, and adjuncts to augment contractility in the setting of significant hypotension.

Spinal Nerve Sheath Tumors: Factors Associated with Postoperative Residual and Recurrent Tumors: A Single-Center Experience

Spinal schwannomas (SSs) are usually benign tumors with a good prognosis when treated by surgical excision. However, complete resection can be complicated by factors such as the tumor location and configuration. In the present study, we sought to identify the factors associated with incomplete surgical resection (residual) and the factors associated with tumor recurrence. We performed a retrospective review of 113 cases of SSs treated surgically from 2008 to2021. Of the 113 SSs, 102 were benign and 2 were malignant nerve sheath tumors. Of the 102 benign SSs, gross total resection (GTR) was performed for 87, with 8 displaying residual and 7, recurrent tumor. We found a significantly higher ratio of cervical and sacral tumors (P= 0.008 and P= 0.004, respectively), dumbbell and foraminal configurations (P < 0.0001 and P= 0.0006, respectively), and larger tumor volumes (P= 0.003) in the residual and recurrent cohorts compared with the GTR cohort. A second operation was performed for 2 patients in the residual and 4 patients in the recurrent cohorts. The total complication rate was 6%. We found that most benign SSs will be amenable to GTR (85% of cases), with an excellent prognosis. The patients with residual or recurrent tumor were more likely to have had a cervical or sacral location, a dumbbell or foraminal configuration, and a larger tumor volume. Except for 1 new SS and 1 recurrent tumor that had necessitated a lateral approach, the remainder had been treated using a posterior approach. At surgery, ultrasonography of the canal is advisable to ensure that the intra- and extraspinal components of dumbbell lesions have both been entirely removed.

Commentary: Natural History of Brachial Plexus, Peripheral Nerve, and Spinal Schwannomas.

Commentary: Natural History of Brachial Plexus, Peripheral Nerve, and Spinal Schwannomas.

Natural History of Brachial Plexus, Peripheral Nerve, and Spinal Schwannomas.

Management of sporadic schwannomas is often dictated by a patient's clinical presentation and the tumor's behavior. For patients who are managed nonsurgically, there are little data available about the expected natural history. To evaluate the natural history and growth patterns of extracranial schwannomas including tumors of the distal peripheral nerves, spine, and brachial plexus. A retrospective review was performed to identify patients with nonsyndromic extracranial schwannomas at a single tertiary care institution diagnosed between 2002 and 2019. Patient data and tumor characteristics including volume were recorded. Two hundred twenty-seven patients were identified (mean age 51 years, 42% male, average of 27.8-month follow-up). Tumor location was distal peripheral nerve in 82, brachial plexus in 36, and paraspinal in 109. At the time of diagnosis, peripheral lesions were significantly larger than spinal (59 m 3 vs 13 cm 3 ) and brachial plexus lesions (15 cm 3 ). Distinct growth patterns were seen with both distal peripheral nerve and spinal lesions; 34/82 peripheral nerve lesions had fast growth (β = 0.176%/day), and 48 had slow growth (β = 0.021%/day; P < .01). Spinal schwannomas similarly had 30 fast-growing (β = 0.229%/day), 16 moderate-growing (β = 0.071%/day), and 63 slow-growing (β = 0.022%/day; P = .03) subtypes. The brachial plexus had relatively homogeneous growth patterns (β = 0.065%/day). Females had 2.9 times greater odds of having the fast-growing subtype. Distinct growth patterns were seen in extracranial sporadic schwannomas based on tumor location and patient demographics. Fast (>80% volume change per year) vs slow (5%-10% per year) tumor growth can often be ascertained within 2 follow-up images. Awareness of these patterns might have implications for patient counseling and therapeutic decision-making.

Differentiation of benign and malignant spinal schwannoma using guided attention inference networks on multi-source MRI: comparison with radiomics method and radiologist-based clinical assessment.

Differentiating diagnosis between the benign schwannoma and the malignant counterparts merely by neuroimaging is not always clear and remains still confounding in many cases because of atypical imaging presentation encountered in clinic and the lack of specific diagnostic markers. To construct and validate a novel deep learning model based on multi-source magnetic resonance imaging (MRI) in automatically differentiating malignant spinal schwannoma from benign. We retrospectively reviewed MRI imaging data from 119 patients with the initial diagnosis of benign or malignant spinal schwannoma confirmed by postoperative pathology. A novel convolutional neural network (CNN)-based deep learning model named GAIN-CP (Guided Attention Inference Network with Clinical Priors) was constructed. An ablation study for the fivefold cross-validation and cross-source experiments were conducted to validate the novel model. The diagnosis performance among our GAIN-CP model, the conventional radiomics model, and the radiologist-based clinical assessment were compared using the area under the receiver operating characteristic curve (AUC) and balanced accuracy (BAC). The AUC score of the proposed GAIN method is 0.83, which outperforms the radiomics method (0.65) and the evaluations from the radiologists (0.67). By incorporating both the image data and the clinical prior features, our GAIN-CP achieves an AUC score of 0.95. The GAIN-CP also achieves the best performance on fivefold cross-validation and cross-source experiments. The novel GAIN-CP method can successfully classify malignant spinal schwannoma from benign cases using the provided multi-source MR images exhibiting good prospect in clinical diagnosis.

Spinal epidural Cavernous Hemangioma mimicking Schwannoma: Case report and review of literature

Pure epidural spinal cavernous hemangiomas are encountered rarely in clinical practice. These lesions are more commonly found in the thoracic region and present with features of myelopathy. Presentation is usually insidious due to slow growth of these tumors, however, acute neurological deterioration is possible in cases with intra-lesional hemorrhage. Surgery is the treatment of choice with patients having good outcomes after complete resection. Due to high vascularity there may be excessive blood loss intra-operatively which might limit complete resection. It is for these reasons that these lesions should be considered in the differential diagnosis of spinal epidural lesions. Literature on these lesions reveals that these tumors are pre-operatively misdiagnosed as schwannomas. We report a case of an elderly male who presented with features of myelopathy and an epidural lesion in the thoracic region. A diagnosis of spinal epidural schwannoma with paravertebral extension was made pre-operatively on the basis of imaging characteristics. However, the lesion was found to be highly vascular during surgery and post-resection histopathology revealed a cavernous hemangioma.

T2 Hypointense Schwannoma Masquerading As A Vascular Lesion: A Case Report.

Spinal schwannomas are rare nerve root tumors that typically produce subtle symptoms from nerve root compression. These tumors are known to be heterogeneously hyperintense on T2-weighted MRI and avidly enhance with contrast. However, here we describe an L5 spinal schwannoma in a 66-year-old woman that was hypointense on T2-weighted imaging with other radiographic findings more closely aligning with a vascular lesion. The neuroradiologic characteristics on MRI, time resolved MR angiography, and catheter digital subtraction angiography are presented. The patient underwent a full workup for possible dural arteriovenous fistula and thrombosed venous varix before the nerve sheath tumor was discovered intraoperatively and confirmed as a schwannoma on histopathology.

Surgical management of sacral schwannomas: a 21-year mayo clinic experience and comparative literature analysis.

Sacral and presacral schwannomas are rare, accounting for a minority of spinal schwannomas. We present our institution's experience surgically treating spinal schwannomas and compare it to the literature. Data were collected for 27 patients treated surgically for sacral or presacral schwannoma between 1997 and 2018 at all Mayo Clinic locations and 93 patients in the literature. Kaplan-Meier disease-free survival analysis was conducted. Unpaired two-sample t tests and Fisher's exact tests assessed statistical significance between groups. Our patients and those in the literature experienced a similar age at diagnosis (49.9 y/o. vs 43.4 y/o., respectively). Most of our patients (59.3%) reported full recovery from symptoms, while a minority reported partial recovery (33.3%) and no recovery (11.1%). A smaller percentage in the literature experienced full recovery (31.9%) and partial recovery (29.8%) but also no recovery (1.1%). Our patients experienced fewer complications (14.8% versus 25.5%). Disease-free survival curves for all patients showed no significant variation in progression by extent of resection of schwannoma (log-rank P = 0.26). No lesion progression was associated with full or partial symptom improvement (p = 0.044), and female patients were more likely to undergo resection via a posterior approach (p = 0.042). Outcomes of patients with sacral or presacral schwannomas vary based on patient demographics, tumor characteristics, symptoms, and surgical treatment. Among the range of symptoms experienced by these patients, the most common is pain. Prognosis improves and overall survival is high when the surgical approach towards sacral schwannomas is prepared and executed appropriately.

Machine Learning for the Detection and Segmentation of Benign Tumors of the Central Nervous System: A Systematic Review.

Simple SummaryMachine learning in radiology of the central nervous system has seen many interesting publications in the past few years. Since the focus has largely been on malignant tumors such as brain metastases and high-grade gliomas, we conducted a systematic review on benign tumors to summarize what has been published and where there might be gaps in the research. We found several studies that report good results, but the descriptions of methodologies could be improved to enable better comparisons and assessment of biases.Objectives: To summarize the available literature on using machine learning (ML) for the detection and segmentation of benign tumors of the central nervous system (CNS) and to assess the adherence of published ML/diagnostic accuracy studies to best practice. Methods: The MEDLINE database was searched for the use of ML in patients with any benign tumor of the CNS, and the records were screened according to PRISMA guidelines. Results: Eleven retrospective studies focusing on meningioma (n = 4), vestibular schwannoma (n = 4), pituitary adenoma (n = 2) and spinal schwannoma (n = 1) were included. The majority of studies attempted segmentation. Links to repositories containing code were provided in two manuscripts, and no manuscripts shared imaging data. Only one study used an external test set, which raises the question as to whether some of the good performances that have been reported were caused by overfitting and may not generalize to data from other institutions. Conclusions: Using ML for detecting and segmenting benign brain tumors is still in its infancy. Stronger adherence to ML best practices could facilitate easier comparisons between studies and contribute to the development of models that are more likely to one day be used in clinical practice.

Risk factors for recurrence and regrowth of spinal schwannoma

BackgroundSpinal schwannoma recurs after initial surgery at a rate of 4%–6%, with known risk factors including subtotal resection, multilevel involvement, large tumor size, and malignant histopathology. This study examined risk factors for schwannoma recurrence and residual tumor regrowth. MethodsSixty-five patients who underwent resection of spinal schwannoma in our department between July 2010 and December 2018 and were followed up for more than 1 year were retrospectively analyzed for age, sex, follow-up duration, imaging and surgical data, recurrence, reoperation, and Japanese Orthopaedic Association scores before and 1 year after surgery. Patients with postoperative recurrence or residual tumor regrowth of >10% at the final visit (R+ group) were compared with patients without recurrence or regrowth (R– group). Multivariate logistic regression analysis was performed to analyze concurrent effects of risk factors on recurrence and regrowth. ResultsThe 65 patients (mean age 52.4 years at surgery) had schwannomas involving cervical (n = 14), thoracic (n = 25), and lumbar (n = 26) spinal levels. Mean follow-up duration was 58 months. Location was intradural in 65%, extradural in 17%, and both intradural and extradural in 18%. There were 4 recurrences (6.2%), and the mean interval between surgery and recurrence was 18.8 months. Seven patients (10.8%) experienced regrowth. Comparing group R+ (n = 11) and group R– (n = 54), univariate analysis showed significant differences in Sridhar tumor classification, giant tumor (Sridhar classification II, IVb, and V), left–right and cranial–caudal tumor size, largest diameter, operative time, blood loss, subtotal resection, reoperation, fusion surgery, and follow-up duration. Multivariate logistic regression analysis revealed giant tumor (Sridhar classification types II, IVb, and V) as an independent risk factor for recurrence and regrowth. ConclusionsThis retrospective review of 65 consecutive patients with spinal schwannoma in a single institution demonstrated that 16.9% had recurrence or regrowth, demonstrating that this potential risk should be kept in mind.

TRATAMIENTO COMBINADO “MICROCIRUGÍA-ARTRODESIS”: EXÉRESIS TOTAL DE SCHAWNNOMA DORSAL MÁS ARTRODESIS DORSAL

Introduction: Schwannomas are benign, unusual, and slow-growing tumors originating in Schwann cells, they constitute 30% of spinal tumors and are more common in women between the fifth and sixth decade. The symptoms depend on the location, degree of spinal cord compression, vertebral erosion, and tumor size. The diagnosis is clinical and imaging. The gold standard of treatment is total excision, to avoid recurrence. Surgical planning must be holistic, and the surgical field must be wide to allow complete excision. Clinical case: A 65-year-old woman with symptoms of axial pain, with an imaging diagnosis of a spinal tumor, is presented. Total resection of the tumor was performed by means of a hemilaminectomy plus dorsal arthrodesis. The pathology result was spinal schwannoma. The patient evolved favorably without presenting a neurological deficit. Conclusion: Hemilaminectomy plus posterior arthrodesis with facetectomy constitutes an effective way for total resection of extramedullary intradural tumors at the dorsal level, as was the case we performed in our patient. This allows for a larger operating field and optimizes the surgical approach. Keywords: Spinal Cord Neoplasms, Neurilemmoma, Laminectomy, Arthrodesis. (Source: MeSH NLM)

SCHWANNOMA ANCIENT TORÁCICO: UNA ETIOLOGÍA INFRECUENTE DE COMPRESIÓN MEDULAR. REPORTE DE CASO

Introduction: Ancient schwannoma is a rare subtype of spinal schwannomas. It is named for the degenerative changes that it can present. Contrast-enhanced magnetic resonance helps us diagnose, as it can show heterogeneous lesions that capture ring contrast. The treatment is surgical. Clinical Case: A 67-year-old male patient is presented, with 2 years of the disease characterized by thoracic radicular pain and severe paraparesis in the last 6 months. Contrast-enhanced MRI showed a tumor with heterogeneous uptake, widening the right T2/T3 foramina with right anterior paravertebral extension and severe canal stenosis at the T2 level. A laminectomy plus total resection of the lesion was performed; the pathology study was reported as ancient schwannoma. The evolution was favorable, with complete recovery of muscle strength in subsequent months. Conclusion: Ancient schwannoma is a rare pathology that has peculiar imaging characteristics and whose treatment is surgical. Keywords: Schwannoma, spinal neoplasms, paraparesis, laminectomy (Source: MeSH NLM)

Primary Spinal Schwannoma: A Single Center Study Of 37 consecutively Operated Cases

Primary spinal Schwannoma (PSS) remains uncommon nerve sheath tumor of the spine with male preponderance and presenting in fourth to fifth decades. They arise from the Schwann cells in sensory root as PSS or part of Neurofibromatosis 2.&#x0D; This is a retrospective study of histopathologically confirmed cases of PSS treated between 2010 to 2021. They were operated and age, sex, clinic-radiological findings, surgical technique used and outcome studied. Laminectomy or laminoplasty or combined anterior-posterior approach was used with either an intracapsular or extracapsular tumor removal. Follow-up was at 15 days, 2 months, 6 months and yearly intervals.&#x0D; There were 37 cases operated with age ranging from 16 to 81 years and majority in the 21–40-year group (40%) followed by 41 to 60 years (32%). There were 22 males and 15 females. Localized pain in the back or cervical region was the commonest finding (75%) followed by myelopathy in 38%, radiculopathy in 35% and bladder disturbances in 13%. They were most common in the lumbar region (35%) followed by thoracic (30%). With relation to the level and sex, the cervical level showed equal sex distribution while the rest had male preponderance&#x0D; PSS although can frequently present to the spine surgeon and the diagnosis is clinched with help of an MRI. Surgery remains the main modality of treatment either by laminectomy, laminoplasty or minimal invasive spine surgery. The nerve root of origin must be preserved in all that can be aided with help of intraoperative neurophysiological monitoring.