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  • Title: Giant Invasive Sacral Schwannoma with Aortic Bifurcation Compression and Hydronephrosis.
    Author: Ragurajaprakash K, Hanakita J, Takahashi T, Ueno M, Minami M, Tomita Y, Tsujimoto Y, Kanematsu R.
    Journal: World Neurosurg; 2020 Mar; 135():267-272. PubMed ID: 31883482.
    Abstract:
    BACKGROUND: Sacral schwannomas are rare tumors arising from nerve sheath Schwann cells. They are classified into 3 types: first type schwannoma arising from the sacrum, second type schwannoma eroding the sacrum, and third type schwannoma extending extensively, involving anterior, posterior, and retroperitoneal space. Among these type 2 sacral tumors, according to Klimo's classification, an eroding sacrum extending all over posteriorly, anteriorly, and laterally is still rarer. Only 38 cases have been reported in literature reviews. Only 6 cases of giant tumors of >10 cm in any 1 dimension have been reported. CASE DESCRIPTION: We present such a giant sacral schwannoma, with invasiveness eroding the sacrum; compressing the ureters, aortic bifurcation, bladder, and bowel; and presenting as lower abdominal pain, hydronephrosis, dysuria, and constipation. This is the first case reported in the literature that has described a large retroperitoneal tumor compressing retroperitoneal structures-aortic bifurcation vascular compression and ureter compression causing hydronephrosis. CONCLUSIONS: Though complete resection, which caused various severe postoperative complications in the reported cases, is the best option, a less morbid procedure would be appropriate; hence we underwent subtotal excision of the tumor, with complete recovery of our patient's symptoms without neurologic deficit.
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