Zusammenfassung
Schwannome und Ependymome gehören zu den häufigsten Tumoren der Cauda equina. In der Regel verursachen sie aufgrund der Raumforderung im Spinalkanal früh neurologische Ausfälle und werden so klinisch auffällig. Dies gilt insbesondere für ausgedehnte Tumoren. Geschildert wird der Fall einer 75jährigen Patientin mit einem Schwannom der Cauda equina, der von BWK 12 bis LWK 3 reichte, nahezu den gesamten Spinalkanal ausfüllte und lediglich therapierefaktäre Lumbago als einziges Symptom verursachte. Der Tumor wurde mikrochirurgisch über eine Laminotomie von LWK 1 bis LWK 2 ohne bleibendes neurologisches Defizit entfernt. Obwohl chronischen Rückenschmerzen in höherem Alter zumeist degenerative Wirbelsäulenerkrankungen zugrunde liegen, sollte differentialdiagnostisch immer an eine langsam wachsende spinale Raumforderung als mögliche Ursache gedacht werden, da das postoperative Ergebnis entscheidend von einer frühzeitigen Diagnosestellung abhängt.
Summary
Schwannomas and ependymomas are the most frequent tumours of the filum terminale. Giant schwannomas, however, are very rare in this location with less than 30 cases reported in the literature, most of them presenting with preoperative neurological deficits. We present the case of a giant schwannoma in a 75-year-old lady extending from the level of lower D12 to upper L3 vertebra with low-back pain as the only symptom. Microsurgical removal of the tumour was accomplished via an L1–L2 laminotomy without permanent neurological deficits. Giant schwannoma of the cauda equina is a rare tumour with variable symptoms. Early diagnosis is crucial to obtain good postoperative results. Total removal without additional neurological deficits can be achieved by appropriate microsurgical techniques.
References
Engelhard HH, Villano JL, Porter KR, Stewart AK, Barua M, Barker FG, Newton HB. Clinical presentation, histology, and treatment in 430 patients with primary tumors of the spinal cord, spinal meninges, or cauda equina. J Neurosurg Spine 13:67–77
Wager M, Lapierre F, Blanc JL, Listrat A, Bataille B. Cauda equina tumors: a French multicenter retrospective review of 231 adult cases and review of the literature. Neurosurg Rev 2000;23:119–29; discussion 130–111
Jeon JH, Hwang HS, Jeong JH, Park SH, Moon JG, Kim CH. Spinal schwannoma: analysis of 40 cases. J Korean Neurosurg Soc 2008;43:135–8
Turgut M, Erkus M. Giant schwannoma of the cauda equina: case report and review of the literature. Zentralbl Neurochir 2008;69:99–101
Bhatia S, Khosla A, Dhir R, Bhatia R, Banerji AK. Giant lumbosacral nerve sheath tumors. Surg Neurol 1992;37:118–22
Gayral L, Carrie J. Giant neurinoma of the cauda equina. Toulouse Med 1961;62:132–4
Hung CH, Tsai TH, Lieu AS, Lin CL, Lee KS, Hwang SL, Howng SL. Giant invasive schwannoma of cauda equina with minimal neurologic deficit: a case report and literature review. Kaohsiung J Med Sci 2008;24:212–7
Jaiswal A, Shetty AP, Rajasekaran S. Giant cystic intradural schwannoma in the lumbosacral region: a case report. J Orthop Surg (Hong Kong) 2008;16:102–6
Jankowski R, Szmeja J, Nowak S, Sokol B, Blok T. Giant schwannoma of the lumbar spine. A case report. Neurol Neurochir Pol 2010;44:91–5
Kagaya H, Abe E, Sato K, Shimada Y, Kimura A. Giant cauda equina schwannoma. A case report. Spine (Phila Pa 1976) 2000;25:268–72
Natarajan M, Rajagopal T, Srinivasan K. A giant schwannoma of cauda equina. Surg Neurol 1975;4:367–8
Ortolan EG, Sola CA, Gruenberg MF, Carballo Vazquez F. Giant sacral schwannoma. A case report. Spine (Phila Pa 1976) 1996;21:522–6
Osborn RE, DeWitt JD. Giant cauda equina schwannoma: CT appearance. Am J Neuroradiol 1985;6:835–6
Ozturk C, Mirzanli C, Karatoprak O, Tezer M, Aydogan M, Hamzaoglu A. Giant sacral schwannoma: a case report and review of the literature. Acta Orthop Belg 2009;75:705–10
Piera JB, Durand J, Pannier S, Guiot G, Grossiord A. 10 cases of giant lumbo-sacral neurinoma. Ann Med Interne (Paris) 1975;126:316–30
Rusu M, Lacatusu R, Aldescu C, Cozma V, Pop A. Giant tumors of the cauda equina. Considerations on 2 cases of lumbar intraspinal neurinoma. Rev Med Interna Neurol Psihiatr Neurochir Dermatovenerol Neurol Psihiatr Neurochir 1981;26:187–94
Saito T, Shimode M, Azuma S, Seichi A. Giant schwannoma of the cauda equina with dural ectasia: a case report. J Orthop Sci 2004;9:635–7
Sampaio P. Giant tumors of the cauda equina with minimal symptoms. Rev Bras Cir 1958;36:425–30
Wu WQ. Management of two giant neurilemomas of the cauda equina. South Med J 1980;73:386–8
Sze G. Neoplastic disease of the spine and spinal cord. In: Atlas SW, editor. Magnetic resonance imaging of the brain and spine, Vol. 1. Philadelphia: Lippincott-Raven; 1996. pp 1339–85
Shimada Y, Miyakoshi N, Kasukawa Y, Hongo M, Ando S, Itoi E. Clinical features of cauda equina tumors requiring surgical treatment. Tohoku J Exp Med 2006;209:1–6
Ombregt L. Tumors of the cauda equina: the importance of early diagnosis. Ned Tijdschr Geneeskd 1986;130:371–2
HogenEsch RI, Staal MJ. Tumors of the cauda equina: the importance of early diagnosis. Ned Tijdschr Geneeskd 1985;129:2170–3
Conti P, Pansini G, Mouchaty H, Capuano C, Conti R. Spinal neurinomas: retrospective analysis and long-term outcome of 179 consecutively operated cases and review of the literature. Surg Neurol 2004;61:34–43; discussion 44
Asahara H, Kawai A, Harada Y, Senda M, Inoue H. Spinal schwannomas: a review of 42 cases. Acta Med Okayama 1996;50:25–8
HogenEsch RI, Staal MJ. Tumors of the cauda equina: the importance of an early diagnosis. Clin Neurol Neurosurg 1988;90:343–8
Akhaddar A, Ajja A, Albouzidi A, Elmostarchid B, Boucetta M. Cystic schwannoma of the cauda equina mimicking hemangioblastoma. Neurochirurgie 2008;54:101–3
De Verdelhan O, Haegelen C, Carsin-Nicol B, Riffaud L, Amlashi SF, Brassier G, Carsin M, Morandi X. MR imaging features of spinal schwannomas and meningiomas. J Neuroradiol 2005;32:42–9
Schultheiss R, Gullotta G. Resection of relevant nerve roots in surgery of spinal neurinomas without persisting neurological deficit. Acta Neurochir (Wien) 1993;122:91–6
Schick U, Marquardt G, Lorenz R. Recurrence of benign spinal neoplasms. Neurosurg Rev 2001;24:20–5
Iwasaki M, Nakamura K, Takeshita K, Kawaguchi H, Akune T, Hoshino Y. Surgical management of giant schwannoma in the lumbosacral region. J Spinal Disord 1998;11:444–7
Celli P. Treatment of relevant nerve roots involved in nerve sheath tumors: removal or preservation? Neurosurgery 2002;51:684–92; discussion 692
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Piek, J. Giant schwannoma of the cauda equina without neurological deficits – case report and review of the literature. Wien Klin Wochenschr 122, 645–648 (2010). https://doi.org/10.1007/s00508-010-1473-3
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DOI: https://doi.org/10.1007/s00508-010-1473-3