Nabhan Ayman, Soleiman Bassem, Ismail Ammar, Salman Iyas, Dahdal Gioia, Salman Issam
Faculty of Medicine, Al Andalus University for Medical Sciences, Tartus, Syria.
Faculty of Medicine, Tartus University, Tartus, Syria.
Ann Med Surg (Lond). 2025 Mar 27;87(4):2434-2439. doi: 10.1097/MS9.0000000000003118. eCollection 2025 Apr.
Ancient schwannoma undergoes a degenerative process leading to hemorrhage, cystic necrosis, and calcification. The head and neck, thorax, and retroperitoneum are the most common locations; the spinal location is extraordinary.
A 50-year-old man presented with muscle weakness in his lower limbs following 2 years of lower back pain, tingling sensation and numbness. He suffers from moderate depression that was refractory to treatment and was put on selective serotonin reuptake inhibitor. MRI showed an intradural extramedullary dumbbell-shaped mass at the T11-T12 level with compression of the spinal cord. Furthermore, it was located on the right side of the spinal canal in close relation to the right T12 spinal root. He underwent a T11-T12 laminectomy with complete en bloc resection and the nerve root was sacrificed. Histopathological exam confirmed the final diagnosis. Follow-up showed a rapid improvement of the neurological and psychiatric symptoms.
Shwannomas are slow growing tumors arising from Schwann cells of the peripheral nerve sheaths. Spinal ancient schwannomas are particularly rare because of the compression of the spinal cord leading to the early presentation of symptoms. The risk of developing depressive disorders is increased by physical diseases; moreover, chronic back pain is strongly associated with depression.
Ancient schwannoma is a slow-growing tumor and best pre-operatively diagnosed by MRI. Diagnostic approach in patient with psychiatric disorders presenting with physical symptoms, especially neurological symptoms should be done carefully depending on objective tools such as imaging or detailed neurological examination.
陈旧性神经鞘瘤会经历一个退行性过程，导致出血、囊性坏死和钙化。头颈部、胸部和腹膜后是最常见的发病部位；脊髓部位则较为罕见。
一名50岁男性，在经历了两年的下背部疼痛、刺痛感和麻木感后，出现下肢肌肉无力。他患有中度抑郁症，治疗效果不佳，正在服用选择性5-羟色胺再摄取抑制剂。磁共振成像（MRI）显示在T11 - T12水平有一个硬膜内髓外哑铃形肿块，压迫脊髓。此外，它位于椎管右侧，与右侧T12神经根关系密切。他接受了T11 - T12椎板切除术及完整的整块切除，牺牲了神经根。组织病理学检查确诊了最终诊断。随访显示神经和精神症状迅速改善。
神经鞘瘤是起源于周围神经鞘雪旺细胞的生长缓慢的肿瘤。脊髓陈旧性神经鞘瘤尤为罕见，因为脊髓受压会导致症状早现。躯体疾病会增加患抑郁症的风险；此外，慢性背痛与抑郁症密切相关。
陈旧性神经鞘瘤是一种生长缓慢的肿瘤，术前最好通过MRI诊断。对于有躯体症状，尤其是神经症状的精神疾病患者，应根据影像学或详细的神经系统检查等客观工具谨慎进行诊断。
