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  • Title: Giant Sacral Schwannoma Treated with a 360 Approach: A Rare Case and Systematic Review of the Literature.
    Author: Khan UA, Ismayl G, Malik I.
    Journal: World Neurosurg; 2018 Jul; 115():65-72. PubMed ID: 29627632.
    Abstract:
    BACKGROUND: Sacral schwannomas are very rare and typically have a benign nature. They occur in a permissive anatomical location leading to nonspecific symptoms that can result in them going unnoticed before reaching a considerable size. CASE DESCRIPTION: We report a rare case of a giant sacral schwannoma (130 × 110 × 90 mm) in a 38-year-old man originating from the S2 nerve root, encompassing the neural canal with sacral erosion and extension in to the pelvis. The patient presented with a history of abdominal pain associated with increased urinary frequency and a sensation of incomplete bladder emptying. Magnetic resonance imaging demonstrated a giant pelvic mass with sacral erosion and involvement of the nerve roots. Subsequently, he went on to have a 2-stage procedure in which complete resection of the schwannoma was achieved by both a posterior hemilaminectomy and laparotomy with the aid of neuromonitoring. The postoperative course was uneventful, with complete resolution of symptoms. CONCLUSIONS: We report one of the largest benign sacral schwannoma originating inside the spinal canal with pelvic extension to be resected without complications. We discuss our successful management and conduct a systematic review of the literature to provide the most up to date guidance on managing this tumor, including the application of neuromonitoring and a 360 approach in 2 stages.
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