Owens Tyler C, de Lomba Weston C, Schroeder Christian B, Mingrino Jennifer, Fridley Jared, Oyelese Adetokunbo A, Miner Thomas J, Liu Paul Y, Woo Albert S, Gokaslan Ziya L, Zadnik Sullivan Patricia
Departments of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island.
Departments of Surgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island.
J Neurosurg Case Lessons. 2024 Nov 4;8(19). doi: 10.3171/CASE24224.
The authors report on a patient who presented with an extremely large presacral schwannoma and subsequent mass effect-induced hydronephrosis and kidney failure. To the authors' knowledge, this case represents the largest radiographically verified spinal schwannoma in the medical literature. The tumor presented here was more than three times as large as a typical giant schwannoma. While smaller presacral schwannomas are usually uncomplicated surgical cases, the supergiant schwannomas described here create significant surgical challenges.
The extremely large size of this nerve sheath tumor introduced a level of surgical complexity not seen in most spinal schwannoma cases. The authors hope that this case informs surgeons regarding the approach to excision of giant spinal schwannomas.
The resection of giant spinal schwannomas is likely to involve one or more lengthy surgeries, and the resection volume can be limited by excessive bleeding. Physicians approaching these large, benign spinal tumors should be aware of the challenges of surgery duration and hemostasis before approaching a tumor of this kind. https://thejns.org/doi/10.3171/CASE24224.
作者报告了一例患有巨大骶前神经鞘瘤并继发肿块效应导致肾积水和肾衰竭的患者。据作者所知，该病例是医学文献中经影像学证实的最大的脊柱神经鞘瘤。此处呈现的肿瘤比典型的巨大神经鞘瘤大三倍多。虽然较小的骶前神经鞘瘤通常是简单的手术病例，但此处描述的超大神经鞘瘤带来了重大的手术挑战。
这种神经鞘瘤的巨大尺寸带来了大多数脊柱神经鞘瘤病例中未见的手术复杂性。作者希望该病例能为外科医生提供有关切除巨大脊柱神经鞘瘤的方法的信息。
切除巨大脊柱神经鞘瘤可能需要进行一次或多次长时间手术，且切除量可能会因出血过多而受限。在处理这类大型良性脊柱肿瘤时，医生在面对此类肿瘤之前应意识到手术时间和止血方面的挑战。https://thejns.org/doi/10.3171/CASE24224 。
