Incidentally diagnosed giant invasive sacral schwannoma

ناوش ايلاخ للاخ نم ةفلغلما ةديملحا مارولأا نم وه ينافش مرو مرو .ينلايلمأ ةيطيلمحا ةيبصعلا فايللأا لوط ىلع ءطبب ومنت يتلا ةبسنب ثدحي دق و ،ًادج ةردان ةلاح وه يزجعلا يكوشلا ينافش طقف ةلاح 50و ،يكوشلا ينافش مرو تلااح عيمج نم 1-5% .يزجعلا ينافش مرو نم ةددحم عاونأ 3 كانه .اهنع غلابلإا متي ينافش مروو يمظعلا لخاد ،زجهلا مامأ وأ قافصلا فلخ يهو ينافش ببسب لمنتو مللأا نم ةداع نوكشي ىضرلماف .يكوشلا ةعشلأا مدختست .ةيفاضلإا ةيكوشلا ةجسنلأا ىلإ دتيمو يكوشلا صيخشتلل يئاضمولا ريوصتلاو ،CT ،MRI ،ةرشابلما ةينيسلا ثيبخ مرو ىلإ لوحتلاو ةسكنلا .جلاعلا طيطختلو ةحارلجا لبق وأ ةلتكلا ةلازإ وه لثملأا جلاعلاف ،ببسلا اذهلو .ًادج ردانو جلاعلاو ةيريرسلا رهاظلما انشقان ،ةلاقلما هذه يف .لاصئتسلاا ينافش مرو ةلاح نم ققحتلل ةجالحا نود هانيرجأ يذلا يحارلجا .مخضلا يورغلا Schwannomas are benign encapsulated tumors of Schwan cells that grow slowly along the peripheral myelin nerve fibers. Sacral spinal schwannomas are very rare, and the incidence of sacral schwannoma ranges from 1-5% of all spinal schwannomas, and only around 50 cases are reported in the literature. There are 3 defined types of sacral schwannomas. These are retroperitoneal or presacral, intra osseous, and spinal schwannomas. Patients commonly present with complaints of pain and paresthesia due to the spinal schwannoma extending to extra spinal tissues. Direct x-ray, CT, MRI, and scintigraphy are used for preoperative diagnosis and treatment planning. Local recurrence and transformation to malignancy is very rare. For this reason, the frequently preferred treatments are subtotal removal of the mass or simple enucleation. In our article, we discuss the clinical features and the surgical treatment we performed without the need for stabilization in an incidentally determined giant invasive schwannoma case. Neurosciences 2014; Vol. 19 (3): 224-228 Disclosure. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript. P sacral and presacral tumors are very rare. Spinal schwannomas constitute approximately 25% of vertebral tumors. They most commonly tend to settle in the thoracic region. They are very rarely seen in the sacral region and constitute 1-5% of all spinal schwannomas, and only around 50 cases are reported in the literature.1-3 Schwannomas are mostly benign lesions. Malignant ones are either malignant from the beginning or become malignant due to degeneration of benign schwannomas, such as is the case in neurofibromatosis type II patients. There are 3 defined types of sacral schwannomas; retroperitoneal or presacral, intra osseous, or spinal schwannomas. According to the definition by Sridhar et al,2 giant invasive spinal schwannomas are masses that invade more than 2 vertebral levels, invade vertebral bodies, and by extending posteriorly, reach the myofascial regions. For this reason, the clinical and surgical results of giant invasive type spinal schwannomas (GISS) differ slightly from typical schwannomas. The clinical diagnoses of these tumors are made by direct x-ray, CT, and MRI. The ideal treatment of GISS would be to totally remove the tumor by decompression and surgery From the Departments of Orthopedics and Traumatology (Togral, Arikan, Gungor), and Neurosurgery (Hasturk), Oncology Training and Research Hospital, Ankara, Turkey. Received 16th January 2014. Accepted 29th April 2014. Address correspondence and reprint request to: Dr. Askin E. Hasturk, Department of Neurosurgery, Oncology Training and Research Hospital, Vatan Caddesi, No: 33, 06200, Demetevler, Ankara, Turkey. Tel. +90 5337282904. Fax. +90 (312) 3454979. E-mail: [email protected] 224 Neurosciences 2014; Vol. 19 (3) www.neurosciencesjournal.org Case Reports