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1.  Giant Ventral Midline Schwannoma of Cervical Spine : Agonies and Nuances 
Pure ventral midline giant schwannoma is an extremely rare entity. Spinal intradural extramedullary schwannomas commonly occur posterolateral or anterolateral to the spinal cord. A case of a pure midline ventrally situated giant pan cervical extramedullary schwannoma in an 18-year-old male patient with compressive myelopathy and sphincter involvement is presented. Spinal MR imaging showed a midline ventrally situated extramedullary tumor with severe spinal cord compression extending from clivus to C7 vertebra. It was resected through a posterolateral approach. Histology was consistent with a schwannoma. Post operative MR imaging showed no evidence of the tumor. The radiological features, pathogenesis and surgical strategies in management of these difficult tumors are discussed and the relevant literature is briefly reviewed.
doi:10.3340/jkns.2010.47.6.454
PMCID: PMC2899034  PMID: 20617092
Extramedullary; Intradural; Giant schwannoma; Spine; Ventral location
2.  Profiles of Spinal Cord Tumors Removed through a Unilateral Hemilaminectomy 
Objective
To present the profiles of spinal cord tumors that can be removed through a unilateral hemilaminectomy and to demonstrate its usefulness for benign spinal cord tumors that significantly occupy the spinal canal.
Methods
From June 2004 to October 2010, 25 spinal cord tumors were approached with unilateral hemilaminectomy. We calculated the cross-sectional occupying ratio (CSOR) of tumor to spinal canal before and after the operations.
Results
The locations of the tumors were intradural extramedullary in 20 cases, extradural in 2, and intramedullary in 3. The levels of the tumors were lumbar in 12, thoracic 9, and cervical 4. In all cases, the tumor was removed grossly and totally without damaging spinal cord or roots. The mean height and width of the lesions we195re 17.64 mm (3-47.5) and 12.62 mm (4-32.7), respectively. The mean CSOR was 69.40% (range, 27.8-96.9%). Postoperative neurological status showed improvement in all patients except one whose neurologic deficit remained unchanged. Postoperative spinal stability was preserved during the follow-up period (mean, 21.5 months) in all cases. Tumor recurrence did not develop during the follow-up period.
Conclusion
Unilateral hemilaminectomy combined with microsurgical technique provides sufficient space for the removal of diverse spinal cord tumors. The basic profiles of the spinal cord tumors which can be removed through the unilateral hemilaminectomy demonstrate its role for the surgery of the benign spinal cord tumors in various sizes.
doi:10.3340/jkns.2011.50.3.195
PMCID: PMC3218177  PMID: 22102948
Laminectomy; Microsurgery; Spinal cord neoplasms; Unilateral hemilaminectomy; Spinal ligaments
3.  Removal of Intradural-Extramedullary Spinal Cord Tumors with Unilateral Limited Laminectomy 
Total laminectomy for the removal of intradural-extramedullary spinal cord tumors has been used widely, but postoperative complications often develop, such as kyphosis, spinal instability, and persistent back pain. In this study, we evaluated seven patients with intradural-extramedullary spinal cord tumors with respect to the value of unilateral limited laminectomy. Our cases included six schwannomas, and one meningioma. The cervical region was involved in four cases, the thoracolumbar region in two cases, and the lumbar region in one case. The rationale for choosing a unilateral approach is to preserve musculoligamentous attachments and posterior bony elements as much as possible. The patients were mobilized on the third postoperative day and preoperative neurological symptoms were recovered within a few weeks. We did not observe any complication relating to unilateral limited laminectomy and at follow-up evaluation (at 3 and 12 months postoperatively), none of the patients showed spinal deformity or spinal instability. We think that the unilateral limited laminectomy is a safe and efficient technique for the treatment of intradural-extramedullary spinal cord tumors. We suggest that this technique is one of the best treatments for these tumors.
doi:10.3340/jkns.2008.43.5.232
PMCID: PMC2588222  PMID: 19096602
Laminectomy; Intradural extramedullary spinal cord neoplams
4.  Ventral Schwannoma of the Thoracolumbar Spine 
Asian Spine Journal  2013;7(4):339-344.
We report two patients with ventral schwannoma in the thoracolumbar region manifesting as low back pain with or without paraparesis. In both patients magnetic resonance imaging (MRI) revealed a heterogeneously-enhanced intradural extramedullary mass in the thoracolumbar region. The tumors were successfully removed via the posterior approach. Their histology was consistent with schwannoma. Postoperative MRI showed no evidence of a tumor in either patient. Spinal schwannomas are common benign intradural extramedullary spinal neoplasms; most arise from the dorsal- and very few from the anterior roots. A literature review revealed that ventral schwannomas, including giant tumors as in the one from case 2 in our study, affect mainly the cervical region, and most are surgically addressed via the posterior approach. Careful handling of the spinal cord is mandatory for satisfactory surgical results.
doi:10.4184/asj.2013.7.4.339
PMCID: PMC3863661  PMID: 24353852
Spinal schwannoma; Intradural lesion; Ventral schwannoma; Giant
5.  Treatment Results in the Differential Surgery of Intradural Extramedullary Schwannoma of 110 Cases 
PLoS ONE  2013;8(5):e63867.
Study Design
A retrospective study of intradural extramedullary schwannoma.
Objective
The purpose of this study was to compare treatment results in the differential surgery of intradural extramedullary schwannoma.
Background
A reference guide to the surgical procedures available to treat intradural extramedullary schwannoma has not yet been established.
Methods
The study retrospectively reviewed 110 patients: Group A: laminectomy+microscopic excision; Group B: hemilaminectomy+microscopic excision; Group C: laminectomy+microscopic excision+pedicle screw fixation. Researchers selected patients for this retrospective review by applying the following criteria: 1) back pain spread out from the tumor level, sensory and motor loss; 2) treatment by surgery; 3) clinical diagnosis made by physical examination, magnetic resonance imaging (MRI), and pathology; 4) a minimum clinical and radiologic follow-up of 12 months. The clinical outcomes were assessed by comparing the Visual Analogue Pain Scores (VAS) and the Japanese Orthopedic Association Scores (JOA score). The study also performed a cost-effectiveness analysis.
Results
Cervical vertebrae: The estimated blood loss in Group B was significantly less than in Group C (P<0.05) (Table 1). Thoracic vertebrae: The duration of hospital stay and estimated blood loss in Group A was significantly less than in Group C (P<0.05) (Table 2, 3). Lumbar vertebrae: The resection rate in Group C was significantly higher than in Group A and Group B (P<0.05) (Table 4). Treatment in Group B was the least expensive, and therefore, the most cost-effective.
Conclusion
In the case of appropriate surgical indications, the study suggests that hemilaminectomy+microscopic excision is advantageous in the removal of cervical schwannoma, and that laminectomy+microscopic excision is advantageous in the removal of thoracic schwannoma; lumbar intradural extramedullary schwannoma can be managed by laminectomy+microscopic excision+pedicle screw fixation.
doi:10.1371/journal.pone.0063867
PMCID: PMC3664559  PMID: 23724010
6.  Giant thoracic schwannoma presenting with abrupt onset of abdominal pain: a case report 
Introduction
Giant intradural extramedullary schwannomas of the thoracic spine are not common. Schwannomas, that is, tumors derived from neoplastic Schwann cells, and neurofibromas represent the most common intradural extramedullary spinal lesions. We report the case of a patient with a giant thoracic schwannoma presenting unusually with acute abdominal pain and with delayed neurological impairment.
Case presentation
A 26-year-old Hispanic man with no previous medical problems presented with acute periumbilical pain. After extensive work-up including an exploratory laparotomy for appendectomy, magnetic resonance imaging scans of the lumbar and thoracic spine revealed a giant intradural extramedullary thoracic schwannoma within the spinal canal posterior to the T9, T10, and T11 vertebral bodies. Magnetic resonance imaging signal prolongation was noted in the spinal cord both rostral and caudal to the schwannoma. The patient underwent an urgent laminectomy from T8 to L1. After sacrificing the T10 root, the tumor was removed en bloc. Postoperatively, the patient improved significantly gaining antigravity strength in both lower extremities.
Conclusion
The T10 dermatome is represented by the umbilical region. This referred pain may represent a mechanism by which a giant thoracic schwannoma may present as acute abdominal pain. Acute, intense abdominal pain with delayed neurologic deficit is a rare presentation of a thoracic schwannoma but should be considered as a possible cause of abdominal pain presenting without clear etiology. Although these lesions may be delayed in their diagnosis, early diagnosis and treatment may lead to an improved clinical outcome.
doi:10.1186/1752-1947-3-88
PMCID: PMC2783087  PMID: 19946504
7.  Spinal Schwannoma; Analysis of 40 Cases 
Objective
This study is to report our experience of 40 cases of spinal schwannoma.
Methods
From 1995 to 2006, medical records were retrospectively reviewed in 40 cases of spinal schwannoma.
Results
We treated 40 spinal schwannomas in 38 (22 male and 16 female) patients. The mean age was 50.2. Four cases were sited in the cervical spine, 11 cases in the thoracic spine, and 25 cases in the lumbar spine. Two patients showed recurrences. Thirty-eight cases were intradural-extramedullary type and 2 cases were extradural. Two cases (5%) including 1 recurred case had no postoperative motor improvement. Ninety-five percents of patients improved on postoperative motor grade.
Conclusion
Spinal schwannoma is mostly benign and extramedullary tumor. There were 2 recurred cases (5%) that had history of previous subtotal removal at first operation and had shown worse prognosis compared with the cases without recurrence. To reduce the recurrence of spinal schannoma, total excision of tumor mass should be done.
doi:10.3340/jkns.2008.43.3.135
PMCID: PMC2588243  PMID: 19096620
Spinal schwannoma; Recurrence; Laminoplasty
8.  Laryngeal schwannoma excised under a microlaryngoscope without tracheotomy: A case report 
Schwannomas are benign encapsulated tumors arising from Schwann cells in the peripheral nervous system. Between 25 and 45% of schwannomas occur in the head and neck region. Schwannomas of the larynx are extremely rare with an incidence of 0.1–1.5% in all benign laryngeal tumors. Laryngeal schwannomas usually occur in females aged between their 4th and 5th decades. The most successful curative method is surgical resection. When selecting the surgical method, the size and location of the tumor, as well as the requests of the patient, should be considered. The present case report describes a 29-year-old female patient with symptoms of hoarseness and dyspnea on exertion. Through endoscopic biopsy, histopathology revealed a schwannoma. Considering the symptoms, age and preferences of the patient, the method of trans-oral microlaryngoscopic excision without tracheotomy was used to excise the tumor located in the aryepiglottic fold. Results from a short-term follow-up showed the postoperative result to be satisfactory.
doi:10.3892/etm.2014.1528
PMCID: PMC3964928  PMID: 24669270
laryngeal schwannoma; magnetic resonance imaging; surgical treatment
9.  Ancient schwannoma of lumbar spine and review of the literature on paraspinal tumors, the role of preoperative biopsy: a case report 
Cases Journal  2009;2:9325.
Introduction
Schwannomas are rare encapsulated tumors that derive from the nerve sheath and should be removed due to their infrequent, but existent possibility of malignancy.
Case presentation
We report a case of a mass located in the L5 lumbar spine in a 42 year old man, presented with intermittent lumbar pain. Ultrasound, CT and MRI were used to examine the characteristics of the lesion. Fine needle aspiration showed cytologic characteristics of benign schwannoma and final histological diagnosis was ancient schwannoma. An extraperitoneal approach, through a left paramedian incision was used to approach the site of the mass. The lesion originated from the nerve root of the L4-L5 lumbar spinal space and a complete excision was achieved.
Conclusion
A great variety of tumors should be differentiated when a paraspinal mass is discovered, including neurogenic, neuroendocrine and vascular tumors, as well as malignancies, cystic and inflammatory masses. Fine needle aspiration is a useful and reliable tool in the preoperative evaluation of paraspinal masses. A review of the literature is also presented.
doi:10.1186/1757-1626-2-9325
PMCID: PMC2806391  PMID: 20072675
10.  Thoracic Intramedullary Schwannoma Accompanying by Extramedullary Beads-Like Daughter Schwanommas 
Thoracic intramedullary schwannomas are rare spinal cord tumors. Most of these tumors have been reported as a single lesion in the spinal cord. The authors report the first case of intramedullary schwannoma accompanying by extramedullary beads-like daughter masses of the thoracic spine. A 68-year-old male presented with walking disturbance and decreased sensation below T10 dermatome. Imaging workup revealed an intramedullary mass at T6 and T7. T6 and T7 laminectomy and mass removal were performed. Intraoperatively, extramedullary beads-like daughter masses along the nerve roots adjacent to intramedullary mass were identified. Total removal of intramedullary lesion and partial resection of extramedullary masses were done. Histological analysis confirmed the diagnosis of schwannoma. The patient could ambulate independently at postoperative 1 month without any neurological sequelae. The authors experienced a surgical case of intramedullary schwannoma accompanying by extramedullary beads-like same pathologies in the thoracic spine.
doi:10.3340/jkns.2011.49.5.302
PMCID: PMC3115155  PMID: 21716630
Neurilemmoma; Intramedullary lesion; Spinal cord neoplasm
11.  Minimally invasive surgery for benign intradural extramedullary spinal meningiomas: experience of a single institution in a cohort of elderly patients and review of the literature 
Meningiomas of the spine are the most common benign intradural extramedullary lesions and account for 25%–46% of all spinal cord tumors in adults. The goal of treatment is complete surgical resection while preserving spinal stability. Usually, these lesions occur in the thoracic region and in middle-aged women. Clinical presentation is usually nonspecific and the symptoms could precede the diagnosis by several months to years, especially in older people, in whom associated age-related diseases can mask the tumor for a long time. We report a series of 30 patients, aged 70 years or more, harboring intradural extramedullary spinal meningiomas. No subjects had major contraindications to surgery. A minimally invasive approach ( hemilaminectomy and preservation of the outer dural layer) was used to remove the tumor, while preserving spinal stability and improving the watertight dural closure. We retrospectively compared the outcomes in these patients with those in a control group subjected to laminectomy or laminotomy with different dural management. In our experience, the minimally invasive approach allows the same chances of complete tumor removal, while providing a better postoperative course than in a control group.
doi:10.2147/CIA.S38923
PMCID: PMC3526880  PMID: 23271902
spinal meningioma; elderly; hemilaminectomy; outer dural layer; inner dural layer; minimally invasive surgery
12.  Clinical Analysis of 21 Cases of Spinal Cord Ependymoma : Positive Clinical Results of Gross Total Resection 
Objective
To evaluate the clinical results of gross total resection in the surgical approach to spinal ependymoma.
Methods
Between June 1995 and May 2009, 13 males and 8 females (mean age 34) diagnosed with intramedullary or extramedullary spinal ependymoma were surgically treated at our centre. The neurological and functional state of each patient were evaluated according to the modified McCormick scale.
Results
The average follow-up duration was 54 months (ranging from 12 to 168 months). The locations of the lesions were: thoracic region (4, 19%), lumbar region (7, 34%), cervical region (4, 19%), cervicothoracic region (3, 14%) and conus medullaris (3, 14%). Four patients (19%) had deterioration of neurological function in the early postoperative period. The neurological function of three patients was completely recovered at the 6th postoperative month, while that of another patient was recovered at the 14th month. In the last assessment of neurological function, 20 patients (95%) were assessed as McCormick grade 1. No perioperative complications developed in any of our patients. In one patient's 24-month assessment, tumour recurrence was observed. Re-operation was not performed and the patient was taken under observation.
Conclusion
Two determinants of good clinical results after spinal ependymoma surgery are a gross total resection of the tumour and a good neurological condition before the operation. Although neurological deficits in the early postoperative period can develop as a result of gross total tumour resection, significant improvement is observed six months after the operation.
doi:10.3340/jkns.2010.47.2.102
PMCID: PMC2836443  PMID: 20224707
Ependymoma; Intramedullary ependymoma; Intramedullary tumour; Functional outcome
13.  Single-Stage Removal of Thoracic Dumbbell Tumors from a Posterior Approach Only with Costotransversectomy 
Yonsei Medical Journal  2012;53(3):611-617.
Purpose
Thoracic dumbbell tumors are relatively rare, usually arising from neurogenic elements. Methods for surgical removal thereof remain controversial. The purpose of this study was to evaluate the surgical results of a single-stage posterior approach with laminectomy and costotransversectomy only for the management of thoracic dumbbell tumors.
Materials and Methods
Eight cases of thoracic large dumbbell tumor were analyzed retrospectively: seven men and one woman (mean age, 49 years). Pathologic findings included schwannoma in five patients, neurofibroma in two patients (Recklinghausen in one patient), and ganglioneuroma in one patient. All patients underwent single-stage removal of dumbbell tumors by a posterior approach followed by laminectomy and costotransversectomy combined with instrumentation. Clinical and radiologic outcomes were reviewed, thereafter.
Results
Operative time ranged from 185 to 420 minutes (mean, 313 minutes), with estimated blood loss ranging from 71 to 1830 mL (mean, 658 mL). Postoperative complications included atelectasis in one case. All patients had tumors successfully removed with no neurological deterioration. Spinal deformities were not observed in any patients at the last follow-up (mean, 52 months), with instrumentation.
Conclusion
Single-stage surgery with laminectomy and costotransversectomy may be useful for removing thoracic dumbbell tumors without a combined anterior approach.
doi:10.3349/ymj.2012.53.3.611
PMCID: PMC3343420  PMID: 22477007
Thoracic dumbbell tumor; single-stage surgery; posterior approach; posterior fusion; laminectomy; costotransversectomy
14.  Unilateral hemilaminectomy for patients with intradural extramedullary tumors 
A modified hemilaminectomy was introduced in an attempt to explore the operative techniques and the values of the limited approach to spinal cord tumors. Forty-five consecutive patients with intradural extramedullary lesions, who underwent modified hemilaminectomy, were studied retrospectively. The intraspinal tumors were removed via the limited bone window with a 3.3-cm mean length (range: 2.0–6.5 cm) and a 1.2-cm mean width (range: 0.6–1.5 cm), in which the inner parts of the medial and lateral laminae were mostly undercut for wider view. Spinal lesions were cervical in 21 cases, thoracic in 12 cases, lumbar in 10 cases, and multiple in 2 cases. Forty-three cases were completely excised via hemilaminectomy alone. Two subjects with dumbbell neurinoma underwent two-stage tumor removal via anterolateral cervical approach following hemilaminectomy. With respect to neurological status, the percentage of good Frankel scale (D+E grade) was markedly improved from 22.2% on admission to 93.3% at follow-up. At the median 26-month follow-up evaluation by magnetic resonance imaging (MRI), none of the subjects showed spinal deformity or instability. By preserving musculoligamentous attachments and posterior bony elements as much as possible, the modified approach is minimally invasive and may be routinely used to remove intradural and extramedullary tumors, especially in patients with meningiomas and neurinomas.
doi:10.1631/jzus.B1000402
PMCID: PMC3134846  PMID: 21726065
Hemilaminectomy; Spinal cord tumors; Microsurgery
15.  Giant Plexiform Schwannoma of the Tongue 
Case Reports in Otolaryngology  2011;2011:762524.
We present the case of a 38-year-old woman that presented with a very slowly enlarging mass of the tongue. MRI revealed a large mass originating in the tongue base and extending to the supraglottic space. Biopsy of this tumor confirmed the diagnosis of schwannoma. An endaural approach allowed complete resection of the tumor. Definitive histopathological examination showed a plexiform schwannoma. Schwannoma or neurilemoma represents a benign tumor potentially affecting any nerve. The head and neck region is a relatively common location for schwannomas, but tongue schwannomas are considered to be rare and pose the problem of both clinical and histological differential diagnosis of tongue masses.
doi:10.1155/2011/762524
PMCID: PMC3420782  PMID: 22937374
16.  Glossopharyngeal Nerve Schwannoma 
Skull base surgery  1999;9(1):57-63.
Complete resection with conservation of cranial nerves is the primary goal of contemporary surgery for lower cranial nerve tumors. We describe the case of a patient with a schwannoma of the left glossopharyngeal nerve, operated on in our Neurosurgical Unit. The far lateral approach combined with laminectomy of the posterior arch of C1 was done in two steps. The procedure allowed total tumor resection and was found to be better than classic unilateral suboccipital or combined supra- and infratentorial approaches. The advantages and disadvantages of the far lateral transcondylar approach, compared to the other more common approaches, are discussed.
Images
PMCID: PMC1656714  PMID: 17171083
17.  The Anatomical Location and Course of the Facial Nerve in Vestibular Schwannomas : A Study of 163 Surgically Treated Cases 
Objective
The aim of this study was to identify the anatomical location and course of the facial nerve (FN) and their relationship to the tumor size in surgically treated vestibular schwannomas.
Methods
A retrospective study was conducted on 163 patients who had been treated by the microsurgical resection for a newly diagnosed vestibular schwannoma between 1995 and 2005 (mean age of 46.1 years; 108 females and 55 males). Surgery was carried out via retrosigmoid approach in all patients with the electromyographic monitoring for the FN function. The anatomical location and course of the FN along the tumor surface were verified in each patient during the microsurgery, and were classified into 4 groups : 1) the FN displaced along the ventral and superior surface of the tumor (VS); 2) the ventral and central (VC); 3) the ventral and inferior (VI); and 4) the dorsal (Do).
Results
The FN displacement was identified as the followings : VS in 91 patients (55.8%); VC in 57 (35.0%); VI in 14 (8.6%); and Do in 1 (0.6%). In the subgroup with tumors less than 2 cm in diameter (n=23), the FN was displaced along the ventral and central surface of the tumor in the majority (65.2%), whereas, in the patients with tumors larger than 2cm (n=140), it was displaced along the ventral and superior surface most frequently (59.3%).
Conclusion
The FN can be displaced variably in vestibular schwannomas, and most frequently along the ventral and superior surface of the tumor, especially in large ones.
doi:10.3340/jkns.2007.42.6.450
PMCID: PMC2588177  PMID: 19096588
Vestibular schwannoma; Facial nerve; Microsurgery
18.  Benign pericardial schwannoma in a Chinese woman: a case report 
Background
Intrathoracic schwannomas are most frequently located in the posterior mediastinum. A Chinese woman presented with a benign pericardial schwannoma in the pretracheal space and aortopulmonary window, a location which has not been described previously in the literature.
Case presentation
A 50-year-old Chinese woman initially reported a cough associated with a small amount of sputum. Contrast-enhanced computed tomography (CT) subsequently revealed a 9 × 11 cm2 lobulated mass with sharp margins that presented as a capsule with heterogeneous enhancement and punctate calcification. Complete surgical resection was performed using a thoracotomy approach. The resected intrapericardial tumor was a firm, large mass with lobulation. Capsulation prevented infiltration of the mass into adjacent organs. Pathological examination verified that the tumor was a benign pericardial schwannoma.
Conclusion
This is the first reported case of a benign pericardial schwannoma located in the pretracheal space and aortopulmonary window. While a contrast-enhanced CT scan was able to differentiate this pericardial schwannoma from other middle mediastinal tumors, the exact diagnosis and plan for treatment depended on a pathological examination. For similar cases involving pericardial schwannomas, complete surgical resection is recommended, particularly for the prevention of life-threatening cardiopulmonary complications.
doi:10.1186/1471-2261-13-45
PMCID: PMC3699360  PMID: 23800005
Pericardium; Benign schwannoma; Computed tomography
19.  Microexcision of intramedullary schwannoma at the thoracic vertebra 
Intramedullary schwannoma is often misdiagnosed as other types of malignant tumour prior to surgery due to its atypical imaging appearance and low incidence. In the present study, a case of small intramedullary schwannoma was analysed using clinical and imaging data. Data concerning the surgery and follow-up process of this case were collected. Instead of performing the traditional surgical procedure of cutting the central and posterior rhizotomies of the patient, minimally invasive hemilaminectomy was performed to maintain spinal stability. This procedure was selected since the small mass would be removed completely via minimally invasive hemilaminectomy. Intramedullary schwannoma was confirmed following surgery. The patient recovered well and no recurrence of the tumour was detected during the two-year follow-up period. In conclusion, the treatment strategy for intramedullary schwannoma was determined based on its atypical symptoms and imaging characteristics.
doi:10.3892/etm.2013.890
PMCID: PMC3570231  PMID: 23407875
spinal cord; intramedullary schwannoma; treatment; follow-up
20.  Cystic Giant Sacral Schwannoma Mimicking Aneurysmal Bone Cyst : A Case Report and Review of Literatures 
To present a rare case of a cystic giant schwannoma of the sacrum mimicking aneurysmal bone cyst (ABC). A 54-year-old man visited our institute complaining left leg weakness and sensory change for several years. Magnetic resonance imaging revealed a large multilocular cystic mass with canal invasion and bone erosion confined to left S1 body. The lesion showed multiple septal enhancement without definite solid component. Initially the tumor was considered as ABC. The patient underwent grossly-total tumor resection with lumbosacral reconstruction via posterior approach. The tumor was proved to be a cystic schwannoma. The postoperative course was uneventful and the patient was relieved from preoperative symptoms. We present a rare case of pure cystic giant schwannoma confined to sacrum mimicking ABC. The surgical treatment is challenging due to the complex anatomy of the sacrum. Schwannoma should be considered in the differential diagnosis of osteolytic sacral cysts.
doi:10.3340/jkns.2013.54.4.350
PMCID: PMC3841281  PMID: 24294462
Giant schwannoma; Sacrum; Cystic degeneration; Aneurysmal bone cyst
21.  Solitary olfactory schwannoma without olfactory dysfunction: a new case report and literature review 
Neurological Sciences  2011;33(1):137-142.
Schwannomas are rare and seldom extend into the anterior cranial fossa. Herein, we report a case of schwannoma arising from the olfactory groove in a 16-year-old girl who presented with generalized seizures without olfactory dysfunction or other neurologic deficits. Computerized tomography (CT) scan showed a large mass with abundant calcification located in the olfactory groove, which was confirmed as a schwannoma by histology and totally resected via basal subfrontal approach. The presentation, imaging findings and histogenesis of the tumor are discussed along with a review of the pertinent literature.
doi:10.1007/s10072-011-0573-9
PMCID: PMC3275737  PMID: 21484358
Olfactory groove; Subfrontal; Schwannoma; Olfactory dysfunction
22.  Large Cystic Hypoglossal Schwannoma with Fluid-Fluid Level: A Case Report 
Skull Base  2010;20(3):193-197.
ABSTRACT
Hypoglossal schwannomas are rare skull base tumors. Furthermore, cystic hypoglossal schwannomas are extremely uncommon. We report the first case of a large cystic hypoglossal schwannoma with a fluid-fluid level. A 36-year-old woman presented with increased intracranial pressure and cerebellar signs without hypoglossal nerve palsy. Magnetic resonance imaging showed a predominantly cystic mass with a fluid-fluid level in the foramen magnum region extending into the hypoglossal canal. The intracranial tumor was largely removed via a midline suboccipital subtonsillar approach, leaving only a tiny residue in the hypoglossal canal. Histology confirmed a schwannoma with relative hypervascularity. Twenty months later, the tumor recurred and presented as a multicystic dumbbell-shaped lesion, extending intra- and extracranially through the enlarged hypoglossal canal. A complete resection of the intracranial and intracanalicular parts of the tumor was achieved with a small extracranial remnant treated by radiosurgery. Histology revealed a focal increased Ki67 proliferative index. In this report, we discuss the possible reasons for the absence of hypoglossal nerve palsy and the potential mechanism of the formation of the fluid-fluid level, and we consider the treatment of this lesion.
doi:10.1055/s-0029-1246219
PMCID: PMC3037104  PMID: 21318038
Hypoglossal schwannoma; cystic; fluid-fluid level; schwannoma
23.  Ancient schwannoma involving the median nerve: a case report and review of the literature 
Ancient schwannomas are benign long standing schwannomas of the neural sheaths. Histological findings are these seen as in conventional schwannomas, but ancient schwannomas additionally demonstrate cystic hemorrhagic changes and degenerative nuclei with pleomorphism and hyperchromasia. Due to the nuclear atypia, and cystic degeneration, ancient schwannomas might be confused with malignant tumors on histology and imaging, leading to a radical surgical approach. The median nerve is rarely affected. We present a rare case of an ancient schwannoma involving the median nerve at the mid humerus. The tumor slowly grew up within ten years and become symptomatic with local pain, mild numbness in the distribution of the median nerve in the palm and Tinel’s test. The tumor was successfully removed by separating it from the nerve fascicles to negative margins. Post-operatively local symptoms relieved but minor sensory loss in the median nerve distribution in the palm was noticed which improved in the following six months. Ancient schwannomas can be misdiagnosed as sarcomas due to specific imaging and histologic findings. Patients’ physical examination, history and fine radiologic and pathology features should be cautiously interpreted in order to achieve correct diagnosis and avoid unnecessary wide tumor excisions.
doi:10.1007/s11751-013-0158-7
PMCID: PMC3623924  PMID: 23546803
Benign neural sheath tumors; Ancient schwannoma; Neurilimoma; Median nerve
24.  One-Stage Resection of Giant Invasive Thoracic Schwannoma: Case Report and Review of Literature 
The Ochsner Journal  2014;14(1):135-140.
Background
Schwannomas comprise approximately 25% of all spinal tumors, being the third most frequent soft-tissue tumor after hemangiomas and lipomas. Grade 5 invasive giant schwannomas erode the vertebral bodies, involve 2 or more levels, and invade the myofascial planes. Because 3 compartments are involved, these tumors represent a surgical challenge and frequently require staged surgeries with a multidisciplinary surgical team.
Case Report
We report the case of a 62-year-old female who presented with intermittent upper back pain for 3 years. A magnetic resonance imaging scan of the thoracic spine showed a mass invading the vertebral body, pedicle, and lamina of T4 and part of T3 and T5. Needle biopsy confirmed the diagnosis of schwannoma. The patient underwent surgery using a parascapular extracavitary costotransversectomy approach.
Conclusion
Giant invasive spinal schwannomas are rare in the thoracic spine, and surgical approaches usually have entailed multiple-stage surgeries with the assistance of other surgical specialties. Our 1-stage complete surgical resection of a giant invasive spinal schwannoma used a parascapular costotransversectomy approach that maintained spinal stability and thus avoided the need for instrumentation.
PMCID: PMC3963045
Instrumentation; laminectomy; neuroma; spinal fusion
25.  Surgical Results of Intradural Extramedullary Tumors 
Clinics in Orthopedic Surgery  2009;1(2):74-80.
Background
To report the treatment results of 12 patients who underwent a total excision of intradural extramedullary tumors.
Methods
Twelve cases of histopathologically confirmed intradural extramedullary tumors were treated surgically between February 2002 and March 2005. There were 8 males and 4 females with an average age of 42.6 years. The mean postoperative follow-up period was 24.2 months. The histopathological findings, locations of the tumors, and clinical results were analyzed. The neurological findings obtained during the preoperative stage and the postoperative follow-up were evaluated according to the Frankel classification.
Results
The histopathological results are as follows: 4 cases of a meningioma, 4 cases of a schwannoma, 2 cases of an epidermoid cyst, 1 case of an arachnoid cyst, and 1 case of an ependymoma. The locations of the tumors were as follows: 7 cases in the thoracic region, 4 cases in the lumbar region, and 1 case in the cervical region. At the final follow-up, a 2-grade and 1-grade improvement was observed in 1 and 7 cases, respectively. There were no changes in the Frankel grade in 4 cases. The preoperative neurological deficit improved within 8 postoperative weeks in most cases and within 1 postoperative year in all cases. Postoperatively, there were 2 cases of cerebrospinal fluid leakage and 2 cases of paresthesia.
Conclusions
Intradural extramedullary tumors detected by MRI are mostly benign and good clinical results can be obtained when treated surgically. Therefore, more active surgical approaches by orthopedic surgeons are recommended to decrease morbidity.
doi:10.4055/cios.2009.1.2.74
PMCID: PMC2766757  PMID: 19885058
Intradural; Extramedullary; Tumor

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