Department of Neurosurgery, King's College Hospital, London, United Kingdom.
Department of Neurosurgery, King's College Hospital, London, United Kingdom; College of Medicine, University of Sharjah, Sharjah, United Arab Emirates.
World Neurosurg. 2018 Jul;115:65-72. doi: 10.1016/j.wneu.2018.03.203. Epub 2018 Apr 5.
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.
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.
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.
骶神经鞘瘤非常罕见，通常为良性。它们发生在一个允许的解剖位置，导致非特异性症状，在达到相当大的尺寸之前，这些症状可能会被忽视。
我们报告了一例罕见的巨大骶神经鞘瘤（130×110×90 毫米）的病例，该肿瘤起源于 S2 神经根，包绕神经管，伴有骶骨侵蚀，并向骨盆延伸。该患者有腹部疼痛的病史，伴有尿频增加和膀胱排空不完全的感觉。磁共振成像显示骨盆内有巨大肿块，伴有骶骨侵蚀和神经根受累。随后，他接受了 2 期手术，在后半椎板切除术和腹腔镜检查的帮助下，借助神经监测，成功地完全切除了神经鞘瘤。术后过程顺利，症状完全缓解。
我们报告了一例起源于椎管内并向骨盆延伸的最大良性骶神经鞘瘤之一，在无并发症的情况下成功切除。我们讨论了我们的成功治疗方法，并对文献进行了系统回顾，为管理这种肿瘤提供了最新的指导，包括在 2 期手术中应用神经监测和 360 度方法。
