Surgical management of giant presacral schwannoma: systematic review of published cases and meta-analysis

Presented at the 2019 AANS/CNS Joint Section on Disorders of the Spine and Peripheral Nerves

Restricted access

OBJECTIVE

Giant presacral schwannomas are rare sacral tumors found in less than 1 of every 40,000 hospitalizations. Current management of these tumors is based solely upon case reports and small case series. In this paper the authors report the results of a systematic review of the available English literature on presacral schwannoma, focused on identifying the influence of tumor size, tumor morphology, surgical approach, and extent of resection (EOR) on recurrence-free survival and postoperative complications.

METHODS

The medical literature (PubMed and EMBASE) was queried for reports of surgically managed sacral schwannoma, either involving 2 or more contiguous vertebral levels or with a diameter ≥ 5 cm. Tumor size and morphology, surgical approach, EOR, intraoperative and postoperative complications, and survival data were recorded.

RESULTS

Seventy-six articles were included, covering 123 unique patients (mean age 44.1 ± 1.4 years, 50.4% male). The most common presenting symptoms were leg pain (28.7%), lower back pain (21.3%), and constipation (15.7%). Most surgeries used an open anterior-only (40.0%) or posterior-only (30%) approach. Postoperative complications occurred in 25.6% of patients and local recurrence was noted in 5.4%. En bloc resection significantly improved progression-free survival relative to subtotal resection (p = 0.03). No difference existed between en bloc and gross-total resection (GTR; p = 0.25) or among the surgical approaches (p = 0.66). Postoperative complications were more common following anterior versus posterior approaches (p = 0.04). Surgical blood loss was significantly correlated with operative duration and tumor volume on multiple linear regression (both p < 0.001).

CONCLUSIONS

Presacral schwannoma can reasonably be treated with either en bloc or piecemeal GTR. The approach should be dictated by lesion morphology, and recurrence is infrequent. Anterior approaches may increase the risk of postoperative complications.

ABBREVIATIONS EBL = estimated blood loss; EOR = extent of resection; GTR = gross-total resection; PFS = progression-free survival; STR = subtotal resection.
Article Information

Contributor Notes

Correspondence Daniel M. Sciubba: Johns Hopkins University School of Medicine, Baltimore, MD. dsciubb1@jhmi.edu.INCLUDE WHEN CITING Published online July 5, 2019; DOI: 10.3171/2019.4.SPINE19240.Disclosures Matthew Goodwin reports being a consultant for ROM3 and Augmedics. Daniel M. Sciubba reports being a consultant for Baxter, DePuy-Synthes, Globus, K2M, Medtronic, NuVasive, and Stryker.
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

    Alfieri ACampello MBroger MVitale MSchwarz A: Low-back pain as the presenting sign in a patient with a giant, sacral cellular schwannoma: 10-year follow-up. J Neurosurg Spine 14:1671712011

    • Search Google Scholar
    • Export Citation
  • 3

    Alvarez Z CSanhueza P BRuiz F ICastillo A J: [Retroperitoneal schwannoma. Report of one case.] Rev Med Chil 140:7677702012

  • 4

    Andonian SKarakiewicz PIHerr HW: Presacral cystic schwannoma in a man. Urology 62:5512003

  • 5

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

  • 6

    Balalaa NSaleh AHadad AHassan I: Strategy of surgical treatment of giant presacral tumor—a case report. Rev Med Chir Soc Med Nat Iasi 116:109511002012

    • Search Google Scholar
    • Export Citation
  • 7

    Buchs NTaylor SRoche B: The posterior approach for low retrorectal tumors in adults. Int J Colorectal Dis 22:3813852007

  • 8

    Chandhanayingyong CAsavamongkolkul ALektrakul NMuangsomboon S: The management of sacral schwannoma: report of four cases and review of literature. Sarcoma 2008:8451322008

    • Search Google Scholar
    • Export Citation
  • 9

    Cho DYHur JWShim JHKim JS: Cystic giant sacral schwannoma mimicking aneurysmal bone cyst: a case report and review of literatures. J Korean Neurosurg Soc 54:3503542013

    • Search Google Scholar
    • Export Citation
  • 10

    Choi SWKim SUKim YWKim SRKim SDPark IS: Giant intraosseous cellular schwannoma of the sacro-pelvic region in a young woman. Nerve 2:13152016

    • Search Google Scholar
    • Export Citation
  • 11

    Consales APoppi MStumpo M: Sciatic schwannoma spanning the sciatic notch: removal by an anterior, transabdominal approach. Br J Neurosurg 20:46482006

    • Search Google Scholar
    • Export Citation
  • 12

    De Santo DABurgess E: Primary and secondary neurilemmoma of bone. Surg Gynecol Obstet 71:4544611940

  • 13

    Fris TLFriis-Andersen H: Benign sacral schwannomas—A case and short review of the literature. Br J Neurosurg 29:5955962015

  • 14

    Gascón Hove MPueyo Rabanal ACea Soriano MGalindo Jara PGarijo Álvarez JA: Single-port access surgery resection of a presacral schwannoma. Tech Coloproctol 18:4074082014

    • Search Google Scholar
    • Export Citation
  • 15

    Girgin CÖzkan USezer ATuğyan N: Large pelvic schwannoma causing bilateral hydronephrosis. Int J Urol 10:6166182003

  • 16

    Gullo RZoccali MFrim DMSkelly CFichera A: A large pelvic mass in a 39-year-old man. Updates Surg 63:2932962011

  • 17

    Gupta SSikora SSGupta RSingh MKChattopadhyay TK: Presacral neurilemoma (schwannoma)—report of a rare case. Jpn J Surg 19:2292311989

    • Search Google Scholar
    • Export Citation
  • 18

    Guyatt GHOxman ADVist GEKunz RFalck-Ytter YAlonso-Coello P: GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 336:9249262008

    • Search Google Scholar
    • Export Citation
  • 19

    Habib THamdi JTHussain WAlmiamini WHamdi KWani AM: Presacral schwannoma treated as irritable bowel syndrome. BMJ Case Rep 2010:bcr05201029722010

    • Search Google Scholar
    • Export Citation
  • 20

    Hascalik SCelik OErdem GAra CKirimlioglu H: Proton magnetic resonance spectroscopy findings of a sacrococcygeal schwannoma. Int J Gynecol Cancer 16 (Suppl 1):3443482006

    • Search Google Scholar
    • Export Citation
  • 21

    Hassan IWietfeldt ED: Presacral tumors: diagnosis and management. Clin Colon Rectal Surg 22:84932009

  • 22

    Hide IGBaudouin CJMurray SAMalcolm AJ: Giant ancient schwannoma of the pelvis. Skeletal Radiol 29:5385422000

  • 23

    Higgin RPCGlaysher MAZeidan BAMiles AJG: Complexities of abdominoperineal surgery: synchronous resection of an ano-rectal adenocarcinoma and pelvic schwannoma. J Surg Case Rep 2014:rjt1202014

    • Search Google Scholar
    • Export Citation
  • 24

    Hugate RR JrDickey IDPhimolsarnti RYaszemski MJSim FH: Mechanical effects of partial sacrectomy: when is reconstruction necessary? Clin Orthop Relat Res 450:82882006

    • Search Google Scholar
    • Export Citation
  • 25

    Hughes MJThomas JMFisher CMoskovic EC: Imaging features of retroperitoneal and pelvic schwannomas. Clin Radiol 60:8868932005

  • 26

    Hyodo TSugawara YSakayama KKito K: Early-stage malignant peripheral nerve sheath tumour arising from a solitary neurofibroma. Br J Radiol 85:e26e302012

    • Search Google Scholar
    • Export Citation
  • 27

    Ibraheim MIkomi AKhan F: A pelvic retroperitoneal schwannoma mimicking an ovarian dermoid cyst in pregnancy. J Obstet Gynaecol 25:6206212005

    • Search Google Scholar
    • Export Citation
  • 28

    Jatal SPai VDRakhi BSaklani AP: Presacral schwannoma: laparoscopic resection, a viable option. Ann Transl Med 4:1762016

  • 29

    Jia ZLyu XXu YLeonardi RZhang X: Robot-assisted laparoscopic resection of a huge pelvic tumor: a case report. Arch Ital Urol Androl 88:1441462016

    • Search Google Scholar
    • Export Citation
  • 30

    Kanamori MYasuda THori TSuzuki K: Giant invasive sacral schwannoma showing chromosomal numerical aberrations [-14,+18,+22]. Asian Spine J 7:2272312013

    • Search Google Scholar
    • Export Citation
  • 31

    Kemmann EConrad PChen CKNicastri AD: Pelvic neurilemmoma. Report of a case, electron microscopic studies and review of the literature. Gynecol Oncol 5:3873951977

    • Search Google Scholar
    • Export Citation
  • 32

    Khan UAIsmayl GMalik I: Giant sacral schwannoma treated with a 360 approach: a rare case and systematic review of the literature. World Neurosurg 115:65722018

    • Search Google Scholar
    • Export Citation
  • 33

    Khatib RAKhalil AMSaba MIAswad NKMroueh AM: A pelvic retroperitoneal Schwannoma presenting as an adnexal mass. Gynecol Oncol 53:2422441994

    • Search Google Scholar
    • Export Citation
  • 34

    Klimo P JrRao GSchmidt RHSchmidt MH: Nerve sheath tumors involving the sacrum. Case report and classification scheme. Neurosurg Focus 15(2):E122003

    • Search Google Scholar
    • Export Citation
  • 35

    Konstantinidis KTheodoropoulos GESambalis GGeorgiou MVorias MAnastassakou K: Laparoscopic resection of presacral schwannomas. Surg Laparosc Endosc Percutan Tech 15:3023042005

    • Search Google Scholar
    • Export Citation
  • 36

    Korkontzelos ITsimoyiannis EZagaliki ADemou AKarabina EAntoniou N: Pelvic retroperitoneal schwannoma presenting as a gynecologic mass: case report. Eur J Gynaecol Oncol 26:1171192005

    • Search Google Scholar
    • Export Citation
  • 37

    Kotoura YShikata JYamamuro TKasahara KIwasaki RNakashima Y: Radiation therapy for giant intrasacral schwannoma. Spine (Phila Pa 1976) 16:2392421991

    • Search Google Scholar
    • Export Citation
  • 38

    Kovalcik PJSimstein NLCross GH: Benign neurilemmoma manifesting as a presacral (retrorectal) mass: report of a case. Dis Colon Rectum 21:1992021978

    • Search Google Scholar
    • Export Citation
  • 39

    Labędź WKubaszewski LAdamek J: Operative treatment of schwannoma, the primary sacral tumor—case presentation. Pol Orthop Traumatol 77:10162012

    • Search Google Scholar
    • Export Citation
  • 40

    Lacarriere ELe Long ECaremel RGrise P: Removal of pelvic schwannoma using a retroperitoneoscopic and open double approach: description of an effective novel technique. J Laparoendosc Adv Surg Tech A 22:2692722012

    • Search Google Scholar
    • Export Citation
  • 41

    Lee BHHyun SJPark JHKim KJ: Single stage posterior approach for total resection of presacral giant schwannoma: a technical case report. Korean J Spine 14:89922017

    • Search Google Scholar
    • Export Citation
  • 42

    Lin CLFang JJLin RM: Resection of giant invasive sacral schwannoma using image-based customized osteotomy tools. Eur Spine J 25:410341072016

    • Search Google Scholar
    • Export Citation
  • 43

    Lin CMKao CCLin TCCha TLWu ST: Giant presacral schwannoma mimicking malignancy in a man. Acta Chir Belg 110:3873892010

  • 44

    Lin PPHorenstein MGHealey JH: Sacral mass in a 56-year-old woman. Clin Orthop Relat Res (344):333–3373413431997

  • 45

    Manabe TKoba RNagayoshi KSadakari YFujita HNagai S: Laparoscopic excision of neurogenic retrorectal tumors. Asian J Endosc Surg 10:2232262017

    • Search Google Scholar
    • Export Citation
  • 46

    Marinello FGTargarona EMLuppi CRBoguña IMolet JTrias M: Laparoscopic approach to retrorectal tumors: review of the literature and report of 4 cases. Surg Laparosc Endosc Percutan Tech 21:10132011

    • Search Google Scholar
    • Export Citation
  • 47

    Nakashima TTsurumaru DNishimuta YMiyasaka MNishie AHonda H: A case of pelvic schwannoma presenting prominent eggshell-like calcification. Case Rep Radiol 2013:8250782013

    • Search Google Scholar
    • Export Citation
  • 48

    Nedelcu MAndreica ASkalli MPirlet IGuillon FNocca D: Laparoscopic approach for retrorectal tumors. Surg Endosc 27:417741832013

    • Search Google Scholar
    • Export Citation
  • 49

    Ng JMunoz DG: Pitfalls and uncertain prognosis in pathological diagnosis of psammomatous melanotic schwannoma. J Clin Neurosci 33:2362392016

    • Search Google Scholar
    • Export Citation
  • 50

    Nyapathy VMurthy UKChintamani JSridhar DY: A case report of a giant presacral cystic schwannoma with sigmoid megacolon. J Radiol Case Rep 3:31372009

    • Search Google Scholar
    • Export Citation
  • 51

    Ogose AHotta TSato STakano RHiguchi T: Presacral schwannoma with purely cystic form. Spine (Phila Pa 1976) 26:181718192001

  • 52

    Ohsawa MMiguchi MYoshimitsu MOishi KKohashi THihara J: Laparoscopic excision of a retroperitoneal schwannoma: A case report. Asian J Endosc Surg 12:1921962019

    • Search Google Scholar
    • Export Citation
  • 53

    Okuyama TTagaya NSaito KTakahashi SShibusawa HOya M: Laparoscopic resection of a retroperitoneal pelvic schwannoma. J Surg Case Rep 2014:rjt1222014

    • Search Google Scholar
    • Export Citation
  • 54

    Ortolan EGSola CAGruenberg MFCarballo Vazquez F: Giant sacral schwannoma. A case report. Spine (Phila Pa 1976) 21:5225261996

  • 55

    Oshima YMiyoshi KMikami YKawamura N: Pelvic ring reconstruction with a vascularized pedicle iliac bone graft for a large sacral schwannoma. J Spinal Disord Tech 18:2002022005

    • Search Google Scholar
    • Export Citation
  • 56

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

  • 57

    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
  • 58

    Pan WWang ZLin NHuang XLiu MYan X: Clinical features and surgical treatment of sacral schwannomas. Oncotarget 8:38061380682017

    • Search Google Scholar
    • Export Citation
  • 59

    Parreira J de SFerreira APontes FTGAntonucci ATSantiago NMOliveira B de A: Tactics for the surgical handling of neurogenic sacral tumors. Arq Neuropsiquiatr 70:4702012

    • Search Google Scholar
    • Export Citation
  • 60

    Patocskai EJTabatabaian MThomas MJ: Cellular schwannoma: a rare presacral tumour. Can J Surg 45:1411442002

  • 61

    Petrovic JBarisic GKrivokapic Z: Sacral schwannoma found incidentally—report of a case. Chirurgia (Bucur) 107:4124142012

  • 62

    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
  • 63

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

  • 64

    Pruthi RSHubbard JSKouba EFunkhouser WWallen E: Large presacral schwannoma after radical prostatectomy. Eur Urol 49:9149172006

    • Search Google Scholar
    • Export Citation
  • 65

    Rao MSagar PDuff SHulme-Moir MBrayshaw I: Laparoscopic excision of a retrorectal schwannoma. Tech Coloproctol 14:3533552010

    • Search Google Scholar
    • Export Citation
  • 66

    Regan JFJuler GLSchmutzer KJ: Retroperitoneal neurilemoma. Am J Surg 134:1401451977

  • 67

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

  • 68

    Salvant JB JrYoung HF: Giant intrasacral schwannoma: an unusual cause of lumbrosacral radiculopathy. Surg Neurol 41:4114131994

  • 69

    Samarakoon LWeerasekera ASanjeewa RKollure S: Giant presacral schwannoma presenting with constipation: a case report. J Med Case Reports 6:2852012

    • Search Google Scholar
    • Export Citation
  • 70

    Samter TGVellios FShafer WG: Neurilemmona of bone. Report of 3 cases with a review of the literature. Radiology 75:2152221960

  • 71

    Santi MDMitsunaga MMLockett JL: Total sacrectomy for a giant sacral schwannoma. A case report. Clin Orthop Relat Res (294):2852891993

    • Search Google Scholar
    • Export Citation
  • 72

    Santiago CLucha PA: Atypical presentation of a retrorectal ancient schwannoma: a case report and review of the literature. Mil Med 173:8148162008

    • Search Google Scholar
    • Export Citation
  • 73

    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
  • 74

    Schindler OSDixon JHCase P: Retroperitoneal giant schwannomas: report on two cases and review of the literature. J Orthop Surg (Hong Kong) 10:77842002

    • Search Google Scholar
    • Export Citation
  • 75

    Sohn SKim JChung CKLee NRSohn MJKim SH: A nation-wide epidemiological study of newly diagnosed primary spine tumor in the adult Korean population, 2009-2011. J Korean Neurosurg Soc 60:1952042017

    • Search Google Scholar
    • Export Citation
  • 76

    Sridhar KRamamurthi RVasudevan MCRamamurthi B: Giant invasive spinal schwannomas: definition and surgical management. J Neurosurg 94 (2 Suppl):2102152001

    • Search Google Scholar
    • Export Citation
  • 77

    Takeyama MKoshino TNakazawa ANitto HNakamura JSaito T: Giant intrasacral cellular schwannoma treated with high sacral amputation. Spine (Phila Pa 1976) 26:E216E2192001

    • Search Google Scholar
    • Export Citation
  • 78

    Theodosopoulos TStafyla VKTsiantoula PYiallourou AMarinis AKondi-Pafitis A: Special problems encountering surgical management of large retroperitoneal schwannomas. World J Surg Oncol 6:1072008

    • Search Google Scholar
    • Export Citation
  • 79

    Togral GArikan MHasturk AEGungor S: Incidentally diagnosed giant invasive sacral schwannoma. Its clinical features and surgical management without stability. Neurosciences (Riyadh) 19:2242282014

    • Search Google Scholar
    • Export Citation
  • 80

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

  • 81

    Yang CCChen HCChen CM: Endoscopic resection of a presacral schwannoma. Case report. J Neurosurg Spine 7:86892007

  • 82

    Yin JWu HTu JZou CHuang GXie X: Robot-assisted sacral tumor resection: a preliminary study. BMC Musculoskelet Disord 19:1862018

    • Search Google Scholar
    • Export Citation
  • 83

    Zhou JLWu BXiao YLin GLWang WZZhang GN: A laparoscopic approach to benign retrorectal tumors. Tech Coloproctol 18:8258332014

    • Search Google Scholar
    • Export Citation
  • 84

    Zhou MChen KWu CYang H: Giant sacral schwannoma with pelvic and lumbar spine extension. Spine J 13:115411552013

  • 85

    Zileli MHoscoskun CBrastianos PSabah D: Surgical treatment of primary sacral tumors: complications associated with sacrectomy. Neurosurg Focus 15(5):E92003

    • Search Google Scholar
    • Export Citation
  • 86

    Zoccali CSkoch JPatel ASWalter CMMaykowski PBaaj AA: Residual neurological function after sacral root resection during en-bloc sacrectomy: a systematic review. Eur Spine J 25:392539312016

    • Search Google Scholar
    • Export Citation
  • 87

    Zou FDai MZhang BNie T: Misdiagnosis of a giant intrapelvic schwannoma: a case report. Oncol Lett 6:164616482013

TrendMD
Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 43 43 21
Full Text Views 14 14 3
PDF Downloads 43 43 17
EPUB Downloads 0 0 0
PubMed
Google Scholar