Extradural Lumbar Schwannoma - Case Presentation

45-year old female with an 18 month history of flank pain, abdominal pain, right leg pain, shortness of breath and mild weakness in the left leg. The patient was otherwise in excellent health.

She received a workup for shortness of breath for suspicion of a pulmonary embolism and chest CT showed an incidental large retroperitoneal mass involving a portion of the vertebral body L1. Imaging studies including a MRI and CT myelogram confirmed the diagnosis of retroperitoneal tumor.

* click images to view larger

Patient underwent a biopsy which was suggestive of spindle-cell benign schwannoma. She was referred for final treatment to UWMC and HMC.

The operation was performed with the patient in the prone position on the Jackson table and Wilson frame with intraoperative electrodiagnostic monitoring - EMG and SSEPs. Through midline incision at thoracolumbar junction, a left L1 laminectomy as well as disarticulation of superior articular process and resection of L1 pedicle were performed. The sheath of the tumor was opened and tumor was internally debulked (CUSA) with subsequent complete mobilization and resection of the capsule and left L1 nerve root. A portion of the tumor which was invading into vertebral body of L1 was completely removed.

Defect of vertebral body was reconstructed with Norian SRS and posterior segmental instrumentation and fusion from T12 to L2 was done to provide stability. Final pathology report confirmed diagnosis of Schwannoma.

The patient had an uncomplicated postoperative course and she was discharged home in a stable condition 8 days after her surgery. Follow-up physical examination was consistent with mild weakness in her left hip flexors and otherwise full motor strength in her extremities.

		Follow-up XR of her lumbar spine showed anatomic alignment of thoracolumbar junction without any signs of instability. * click images to view larger
AP XR of thoracolumbar spine	Lateral XR of thoracolumbar spine