Cauda equina schwannoma with concomitant intervertebral disc herniation: A case report and review of literature. (April 2019)

• Record Type: Journal Article
• Authors: Fujii, Kengo; Abe, Tetsuya; Koda, Masao; Funayama, Toru; Noguchi, Hiroshi; Miura, Kousei; Kumagai, Hiroshi; Nagashima, Katsuya; Mataki, Kentaro; Shibao, Yosuke; Yamazaki, Masashi
• Is Part Of: Journal of clinical neuroscience. Volume 62(2019)
• Page Start: 229
• Page End: 231
• Publication Date: 2019-04
• Subjects: Schwannoma -- Cauda equina -- Intervertebral disc herniation -- Nerve sheath neoplasm -- Low back pain -- Partial laminectomy; Brain -- Surgery -- Periodicals; Neurosciences -- Periodicals; Nervous system -- Surgery -- Periodicals; Brain -- surgery -- Periodicals; Neurosurgical Procedures -- Periodicals; Neurosciences -- Periodicals; Electronic journals; 616.8
• DOI: 10.1016/j.jocn.2018.12.033
• Languages: English
• ISSNs: 0967-5868

Abstract

Highlights: Cauda equina schwannoma along with lumbar intravertebral disc herniation is rare. Concomitant small schwannoma and lumbar IVD herniation can cause symptom. Enhanced MRI may be helpful in the detection of these tumors. Associated symptoms can acutely worsen with concomitant lumbar IVD herniation. Abstract: The coexistence of lumbar intervertebral disc (IVD) herniation and cauda equina schwannoma in symptomatic patients is uncommon. We experienced a case with a surgically treated cauda equina schwannoma with concomitant lumbar IVD herniation (L2/L3); both were relatively small but presented with painful symptoms in combination. A 45-year old man complained of low back pain and right anterior thigh pain six months prior to surgery. He underwent conservative treatment; however, his pain suddenly worsened three months before surgery, with abnormal sensations and pain in his right buttock and posterior thigh. A magnetic resonance imaging (MRI) scan revealed an L2/L3 disc herniation extruding to the center of the lumbar spinal canal and compressing the thecal sac. Incidentally, an intrathecal tumor was suspected, and enhanced MRI revealed a round tumor measuring 10-mm in diameter at the L2/L3 intervertebral level, which was uniformly enhanced by gadolinium chelate, radiologically diagnosed as a schwannoma. Microscopic discectomy and tumor resection were performed and the patient's symptoms disappeared immediately. Schwannoma is generally slow-growing, and usually asymptomatic when the tumor size is small. Therefore, we suspected that the tumor occasionally impinged on the left L3 root with L2/3 IVD herniation, leading to acute worsening of the patient's symptoms. Altogether, in case of tumor in patients undergoing conservative treatment for cauda equina schwannoma, we should consider that symptoms can acutely worsen with the occurrence of lumbar IVD herniation.