Low-back pain as the presenting sign in a patient with a giant, sacral cellular schwannoma: 10-year follow-up

Case report

Restricted access

Giant sacral tumors present unique challenges to surgeons because there is no established consensus regarding the best treatment options. The authors report on the care of and outcome in a patient presenting with low-back pain only, who underwent preoperative biopsy sampling and subsequent embolization of the feeding vessels of a giant, sacral cellular schwannoma. The main procedure was performed via a combined posterior-anterior approach with complete microsurgical removal of the tumor, without the use of instrumentation, bracing, or adjuvant radio- and chemotherapy. At the 10-year follow-up, no evidence of residual tumor, recurrence, or instability was recognizable. Giant, sacral cellular schwannomas can be aggressively completely removed without any significant morbidity, achieving long-term control of the disease.

Abbreviation used in this paper: DS = digital subtraction.
Article Information

Contributor Notes

Address correspondence to: Alex Alfieri, M.D., Neurosurgery, Martin Luther University Hospital Halle-Wittenberg, Ernst-Grube-Strasse 40, D 06114 Halle (Saale), Germany. email: alex.alfieri@medizin.uni-halle.de.Please include this information when citing this paper: published online January 7, 2011; DOI: 10.3171/2010.10.SPINE1015.

© AANS, except where prohibited by US copyright law.

Headings
References
  • 1

    Abernathey CDOnofrio BMScheithauer BPairolero PCShives TC: Surgical management of giant sacral schwannomas. J Neurosurg 65:2862951986

    • Search Google Scholar
    • Export Citation
  • 2

    Abhinav KShaaban MRaymond TOke TGullan RMontgomery AC: Primary reconstruction of pelvic floor defects following sacrectomy using Permacol graft. Eur J Surg Oncol 35:4394432009

    • Search Google Scholar
    • Export Citation
  • 3

    Acciarri NStaffa GPoppi M: Giant sacral schwannoma: removal by an anterior, transabdominal approach. Br J Neurosurg 10:4894921996

    • Search Google Scholar
    • Export Citation
  • 4

    Anson KMByrne PORobertson IDGullan RWMontgomery AC: Radical excision of sacrococcygeal tumours. Br J Surg 81:4604611994

  • 5

    Chiang ERChang MCChen TH: Giant retroperitoneal schwannoma from the fifth lumbar nerve root with vertebral body osteolysis: a case report and literature review. Arch Orthop Trauma Surg 129:4954992009

    • Search Google Scholar
    • Export Citation
  • 6

    D'Andrea GCaroli ECapponi MGScicchitano FOsti MFBellotti C: Retroperitoneal mesenchymal chondrosarcoma mimicking a large retroperitoneal sacral schwannoma. Neurosurg Rev 31:2252292008

    • Search Google Scholar
    • Export Citation
  • 7

    Deutsch HMummaneni PVHaid RWRodts GEOndra SL: Benign sacral tumors. Neurosurg Focus 15:2E142003

  • 8

    Di Lorenzo NSpallone ANolletti ANardi P: Giant cell tumors of the spine: a clinical study of six cases, with emphasis on the radiological features, treatment, and follow-up. Neurosurgery 6:29341980

    • Search Google Scholar
    • Export Citation
  • 9

    Doita MHarada TIguchi TSumi MSha HYoshiya S: Total sacrectomy and reconstruction for sacral tumors. Spine 28:E296E3012003

    • Search Google Scholar
    • Export Citation
  • 10

    Domínguez JLobato RDRamos ARivas JJGómez PACastro S: Giant intrasacral schwannomas: report of six cases. Acta Neurochir (Wien) 139:9549601997

    • Search Google Scholar
    • Export Citation
  • 11

    Fass GHossey DNyst MSmets DSaligheh ENDuttmann R: Benign retroperitoneal schwannoma presenting as colitis: a case report. World J Gastroenterol 13:552155242007

    • Search Google Scholar
    • Export Citation
  • 12

    Gottfried ONSchmidt MHStevens EA: Embolization of sacral tumors. Neurosurg Focus 15:2E42003

  • 13

    Hosalkar HSJones KJKing JJLackman RD: Serial arterial embolization for large sacral giant-cell tumors: mid- to longterm results. Spine 32:110711152007

    • Search Google Scholar
    • Export Citation
  • 14

    Jaiswal AShetty APRajasekaran S: Giant cystic intradural schwannoma in the lumbosacral region: a case report. J Orthop Surg (Hong Kong) 16:1021062008

    • Search Google Scholar
    • Export Citation
  • 15

    Kagaya HAbe ESato KShimada YKimura A: Giant cauda equina schwannoma. A case report. Spine 25:2682722000

  • 16

    Kishi YKajiwara SSeta SKawauchi NSuzuki TSasaki K: Retroperitoneal schwannoma misdiagnosed as a psoas abscess: report of a case. Surg Today 32:8498522002

    • Search Google Scholar
    • Export Citation
  • 17

    Kuznetsov DPeabody TPosner MCMcKinsey JFMontag AGSteinberg GD: The giant of the giant schwannomas. J Urol 162:7917921999

  • 18

    Lackman RDKhoury LDEsmail ADonthineni-Rao R: The treatment of sacral giant-cell tumours by serial arterial embolisation. J Bone Joint Surg Br 84:8738772002

    • Search Google Scholar
    • Export Citation
  • 19

    Laforga JB: Cellular schwannoma: report of a case diagnosed intraoperatively with the aid of cytologic imprints. Diagn Cytopathol 29:951002003

    • Search Google Scholar
    • Export Citation
  • 20

    Leggon REZlotecki RReith JScarborough MT: Giant cell tumor of the pelvis and sacrum: 17 cases and analysis of the literature. Clin Orthop Relat Res 4231962072004

    • Search Google Scholar
    • Export Citation
  • 21

    Lesoin FKrivosic ICama AJomin M: A giant intrasacral schwannoma revealed by lumbosacral pain. Neurochirurgia (Stuttg) 27:23241984

    • Search Google Scholar
    • Export Citation
  • 22

    Levine EDe Smet AANeff JR: Role of radiologic imaging in management planning of giant cell tumor of bone. Skeletal Radiol 12:79891984

    • Search Google Scholar
    • Export Citation
  • 23

    Li QGao CJuzi JTHao X: Analysis of 82 cases of retroperitoneal schwannoma. ANZ J Surg 77:2372402007

  • 24

    Lin PPGuzel VBMoura MFWallace SBenjamin RSWeber KL: Long-term follow-up of patients with giant cell tumor of the sacrum treated with selective arterial embolization. Cancer 95:131713252002

    • Search Google Scholar
    • Export Citation
  • 25

    Luther NBilsky MHHärtl R: Giant cell tumor of the spine. Neurosurg Clin N Am 19:49552008

  • 26

    McLoughlin GSSciubba DMSuk IWitham TBydon AGokaslan ZL: En bloc total sacrectomy performed in a single stage through a posterior approach. Neurosurgery 63:1 Suppl 1ONS115ONS1202008

    • Search Google Scholar
    • Export Citation
  • 27

    Nakashima JUeno MNakamura KTachibana MBaba SDeguchi N: Differential diagnosis of primary benign and malignant retroperitoneal tumors. Int J Urol 4:4414461997

    • Search Google Scholar
    • Export Citation
  • 28

    Newman CBKeshavarzi SAryan HE: En bloc sacrectomy and reconstruction: technique modification for pelvic fixation. Surg Neurol 72:7527562009

    • Search Google Scholar
    • Export Citation
  • 29

    Ortolan EGSola CAGruenberg MFCarballo Vazquez F: Giant sacral schwannoma. A case report. Spine 21:5225261996

  • 30

    Ozdemir NBezircioǧlu HAkar O: Giant erosive spinal schwannomas: surgical management. Br J Neurosurg 24:5265312010

  • 31

    Ozturk CMirzanli CKaratoprak OTezer MAydogan MHamzaoglu A: Giant sacral schwannoma: a case report and review of the literature. Acta Orthop Belg 75:7057102009

    • Search Google Scholar
    • Export Citation
  • 32

    Pongsthorn COzawa HAizawa TKusakabe TNakamura TItoi E: Giant sacral schwannoma: a report of six cases. Ups J Med Sci 115:1461522010

    • Search Google Scholar
    • Export Citation
  • 33

    Popuri RDavies AM: MR imaging features of giant presacral schwannomas: a report of four cases. Eur Radiol 12:236523692002

  • 34

    Ramamurthy RBose JCMuthusamy VNatarajan MKunjithapatham D: Staged sacrectomy—an adaptive approach. Clinical article. J Neurosurg Spine 11:2852942009

    • Search Google Scholar
    • Export Citation
  • 35

    Randall RL: Giant cell tumor of the sacrum. Neurosurg Focus 15:2E132003

  • 36

    Rengachary SSO'Boynick PBatnitzky SKepes JJ: Giant intrasacral schwannoma: case report. Neurosurgery 9:5735771981

  • 37

    Rousseau MAPascal-Mousselard HLazennec JYSaillant G: The mini-invasive anterior extra peritoneal approach to the pelvis. Eur J Surg Oncol 31:9249262005

    • Search Google Scholar
    • Export Citation
  • 38

    Sahakitrungruang CChantra KDusitanond NAtittharnsakul PRojanasakul A: Sacrectomy for primary sacral tumors. Dis Colon Rectum 52:9139182009

    • Search Google Scholar
    • Export Citation
  • 39

    Satake KMatsuyama YYoshihara HYanase MMiura Y: Three-dimensional images for surgical plan of giant sacral schwannoma. Spinal Cord 42:3683702004

    • Search Google Scholar
    • Export Citation
  • 40

    Sementa ARGambini CBorgiani LComes P: Cellular schwannoma: report of a case with immunohistochemical and electron microscopical study. Pathologica 80:5055121988

    • Search Google Scholar
    • Export Citation
  • 41

    Shikata JYamamuro TShimizu KShimizu KKotoura Y: Surgical treatment of giant-cell tumors of the spine. Clin Orthop Relat Res 27829361992

    • Search Google Scholar
    • Export Citation
  • 42

    Takeyama MKoshino TNakazawa ANitto HNakamura JSaito T: Giant intrasacral cellular schwannoma treated with high sacral amputation. Spine 26:E216E2192001

    • Search Google Scholar
    • Export Citation
  • 43

    Tomita KTsuchiya H: Total sacrectomy and reconstruction for huge sacral tumors. Spine 15:122312271990

  • 44

    Tong RSCollier NKaye AH: Chronic sciatica secondary to retroperitoneal pelvic schwannoma. J Clin Neurosci 10:1081112003

  • 45

    Turk PSPeters NLibbey NPWanebo HJ: Diagnosis and management of giant intrasacral schwannoma. Cancer 70:265026571992

  • 46

    Wajanavisit WLaohacharoensombat WLektrakul SSirikulchayanonta V: Treatment of giant-cell tumor of the spine: report of four cases. J Med Assoc Thai 78:5655721995

    • Search Google Scholar
    • Export Citation
  • 47

    White WShiu MHRosenblum MKErlandson RAWoodruff JM: Cellular schwannoma. A clinicopathologic study of 57 patients and 58 tumors. Cancer 66:126612751990

    • Search Google Scholar
    • Export Citation
  • 48

    Woodruff JMGodwin TAErlandson RASusin MMartini N: Cellular schwannoma: a variety of schwannoma sometimes mistaken for a malignant tumor. Am J Surg Pathol 5:7337441981

    • Search Google Scholar
    • Export Citation
  • 49

    Wuisman PHärle AMatthiass HHRoessner AErlemann RReiser M: Two-stage therapy in the treatment of sacral tumors. Arch Orthop Trauma Surg 108:2552601989

    • Search Google Scholar
    • Export Citation
  • 50

    Xia RYLuo YXWang TP: Operational techniques and combination treatment for the recurrent sacro-coccygeal tumor. J Tongji Med Univ 14:2452481994

    • Search Google Scholar
    • Export Citation
  • 51

    Zhang HYThongtrangan IBalabhadra RSMurovic JAKim DH: Surgical techniques for total sacrectomy and spinopelvic reconstruction. Neurosurg Focus 15:2E52003

    • Search Google Scholar
    • Export Citation
TrendMD
Cited By
Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 175 175 20
Full Text Views 52 40 0
PDF Downloads 193 148 0
EPUB Downloads 0 0 0
PubMed
Google Scholar