İntramedüller Schwannoma: Nadir Olgu Sunumu

Abstract

Bu olgu sunumu, oldukça nadir görülen intramedüller yerleşimli schwannoma olgusunun literatür eşliğinde incelenmesini amaçlamaktadır. 52 yaşında erkek hasta, yürüme güçlüğü ve bacaklarda kasılma şikayetiyle başvurdu. Radyolojik incelemelerde C7-T3 seviyesinde intradural yerleşimli kitlesel lezyon saptanması üzerine gross total rezeksiyon yapıldı. Postoperatif nörolojik kötüleşme gözlenmedi. Hastanın ameliyat öncesi ASIA ve McCormick skorları sırasıyla C ve 3, ameliyat sonrası ise sırasıyla 6. ay ve 1. yılda D, E ve 2, 1 olarak kaydedildi. Histopatolojik inceleme, schwannoma olarak rapor edildi. Hastamız 4 yıldır poliklinik takibimizdedir. İntramedüller schwannoma, literatürde 198 vaka bildirilen nadir bir omurilik tümörüdür. Bu nadir durumun kesin etyopatogenezi konusunda tartışmalar devam etmektedir. Düşük nüks oranı nedeniyle intramedüller schwannomaların tedavisinde altın standart mikroşirurjikal gross total eksizyondur.

Keywords

• Schwannomas
• Intramedullary
• Spinal cord
• Intradural Tumors

Intramedullary Schwannomas: A Rare Case Report

Abstract

This case report aims to review a very rare case of intramedullary schwannoma with literature review. A 52-year-old male patient presented with complaints of difficulty walking and leg spasms. Radiological examinations revealed an intradural lesion at the C7-T3 level, and gross total resection was performed. No postoperative neurological deterioration was observed. The patient's preoperative ASIA and McCormick scores were recorded as C and 3, respectively; while they were recorded as 6th months and 1st year D, E and 2, 1 postoperatively, respectively. Histopathological examination reported schwannoma. Our patient has been under outpatient clinic follow-up for four years. Intramedullary schwannoma is a rare spinal cord tumor with 198 cases reported in the literature. The exact etiopathogenesis of this rare condition is still under debate. Due to the low recurrence rate, microsurgical gross total excision is the gold standard in the treatment of intramedullary schwannomas.

Keywords

• Schwannomas
• Intramedullary
• Spinal cord
• Intradural Tumors

References

1. 1.Swiatek VM, Stein KP, Cukaz HB, et al. Spinal intramedullary schwannomas-report of a case and extensive review of theliterature. Neurosurg Rev 2021;44(4):1833-1852.
2. 2.Li J, Song Z, Shang A. Clinical Features and SurgicalManagement of Intramedullary Schwannoma of the SpinalCord. World Neurosurg 2024;185:e1280-e1286.
3. 3.McCann MM, Hain JD. Intramedullary melanotic schwannoma: a rare presentation of a rare tumor. Illustrative case. JNeurosurg Case Lessons 2023;5(7):CASE22391.
4. 4.Hara T, Mizuno M, Hida K, et al. Investigators ofIntramedullary Spinal Cord Tumors in the Neurospinal Societyof Japan. Intramedullary Schwannoma of the Spinal Cord: ANationwide Analysis by the Neurospinal Society of Japan.Neurospine 2023;20(3):747-755.
5. 5.Adji NK, Putri KYW, Indreswari L, Gunawan R, Nugraha MY. Multiple thoracic intramedullary schwannoma: A case report.Int J Surg Case Rep 2024;116:109330.
6. 6.Salamah HM, Eltokhy AG, Ezzat M, Alkheder A, Taha MM.Spinal intramedullary schwannoma: Report of two cases withreview of the literature. Int J Surg Case Rep 2024;117:109479.
7. 7.Tahta A, Cetinkal A, Cakir A, Sekerci Z. Intramedullaryschwannoma of cervicomedullary junction: A case report.Neurochirurgie 2022;68(3):331-334.
8. 8.Singh R, Chaturvedi S, Pant I, Singh G, Kumari R.Intramedullary schwannoma of conus medullaris: rare site for acommon tumor with review of literature. Spinal Cord Ser Cases2018; 6;4:99.

9. 9.Cheng X, Liu J, Le J, Huang S, Chen H, You C. Invasiveintramedullary melanotic schwannoma: case report and reviewof the literature. Eur Spine J 2018;27(Suppl 3):303-308.
10. 10.McCormick PC, Stein BM. Intramedullary tumors in adults.Neurosurg Clin N Am 1990; 1(3):609-30.
11. 11.Maynard FM Jr, Bracken MB, Creasey G, et al. InternationalStandards for Neurological and Functional Classification ofSpinal Cord Injury. American Spinal Injury Association. Spinal Cord 1997;35(5):266-274.
12. 12.Kernohan JW WH, Adson AW: Intramedullary tumors of thespinal cord. A review of fifty-one cases, with an attempt athistologic classification. Arch Neurol Psychiatry 1931;25:679–701.
13. 13.Decharin P, Suvithayasiri S, Nivatpumin P, Trathitephun W.Subpial Schwannoma of the Cervical Spinal Cord: A CaseReport and Its Intraoperative Finding Supporting a Theory ofthe Pathogenesis of an Intramedullary Schwannoma. Asian JNeurosurg 2022;17(1):108-111.
14. 14.Ozawa N, Tashiro T, Okamura T, Koyama K, Ohata K, InoueY.Subpial schwannoma of the cervical spinal cord mimicking an intramedullary tumor. Radiat Med 2006;24(10): 690–694.
15. 15.Houkin K, Abe H, Iwasaki Y, Tsuru M, Miyasaka K. Spinal sub-pial schwannoma. Case report [in Japanese]. Neurol MedChir (Tokyo) 1983;23(05):370–374.
16. 16.Kim SD, Nakagawa H, Mizuno J, Inoue T. Thoracic subpialintramedullary schwannoma involving a ventral nerve root: acase report and review of the literature. Surg Neurol2005;63(04): 389–393, discussion 393.
17. 17.Suematsu Y, Tsuji O, Nagoshi N, et al. Concurrent dorsal subpial schwannoma and ventral meningioma arising at thesame upper cervical level: a case report. Spinal Cord Ser Cases2020;6(01):64.