Totally intra-axial giant spinal schwannoma with late clinical onset

A 44-year-old woman was hospitalized for a 2-month history of progressive spastic paraparesis and low back pain. A magnetic resonance imaging study showed a T7–L1 giant intradural extramedullary mass with total intra-axial development, causing vertebral bone scalloping with left dislocation of the spinal cord (FigureA–B). At surgery, after exposure of the T6–L3 segments, laminar bone erosion was evident. A T7–L2 laminectomy and dura mater opening were then performed, identifying the upper and lower poles of the tumor. The mass was gently dissected from spinal cord and cauda equina roots and then removed en bloc (Figure C). Histopathological examination documented a schwannoma. The postoperative course was uneventful. By 6-months postsurgery, the patient was able to walk without support and returned to her previous occupation. A postoperative magnetic resonance imaging scan documented complete removal of the lesion (Figure D). Only one other case of a giant spinal schwannoma (defined as a schwannoma extending greater than two vertebral levels [1]) with minimal neurological deficit has been reported [2].