Sarmiento M Eddy, Espinoza C Fernando, López C Limber, Fuentes-Rocabado Nicole, Chaurasia Bipin
Neurosurgeon and Spine Surgeon.
Traumatologist.
Ann Med Surg (Lond). 2024 Jul 1;86(8):4921-4926. doi: 10.1097/MS9.0000000000002331. eCollection 2024 Aug.
Schwannomas are benign tumors that arise from Schwann cells commonly located in peripheral nerves. Depending on the size and location of sciatic nerve Schwannoma clinical manifestations can either varies from symptoms simulating radiculopathies such as positive Lasegue sign on the affected side, gait weakness and paresthesia or just present with pain and an associated palpable mass.
The authors present a case of a 34-year-old female patient suffering from pain, gait weakness, and a palpable mass since many months. The palpable mass was present in the posterior region of the left lower limb. Imaging studies reveal an extensive lesion measuring 35 cm×8 cm that extends from the gluteal region to the left popliteal fossa.
The finding of a palpable mass during physical examination guided us towards the diagnostic suspicion and thus necessitating the direct imaging studies. When approaching such type of patients, a history of neurofibromatosis must be ruled out due to its frequent association. Surgical resection should focus on the preservation of neurovascular structures, which offers improvement of the symptoms and the quality of life of patients.
Giant sciatic nerve schwannoma if excised completely can lead to relieve of symptoms. Although recurrences are uncommon follow-up for years is necessary.
施万细胞瘤是起源于通常位于周围神经的施万细胞的良性肿瘤。根据坐骨神经施万瘤的大小和位置，临床表现可能有所不同，从模拟神经根病的症状，如患侧拉塞格征阳性、步态无力和感觉异常，到仅表现为疼痛和可触及的肿块。
作者介绍了一例34岁女性患者，数月来一直遭受疼痛、步态无力和可触及肿块的困扰。可触及的肿块位于左下肢后部。影像学检查显示一个广泛的病变，大小为35 cm×8 cm，从臀区延伸至左腘窝。
体格检查中发现可触及的肿块引导我们产生诊断怀疑，因此需要进行直接影像学检查。在诊治这类患者时，由于神经纤维瘤病常与之相关，必须排除其病史。手术切除应注重保留神经血管结构，这有助于改善患者症状和生活质量。
巨大坐骨神经施万瘤如果完全切除可缓解症状。虽然复发不常见，但仍需进行多年随访。
