Medial plantar nerve compression by a tibial artery schwannoma

Case report

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✓ The authors describe the case of a patient with a novel cause of medial plantar symptoms due to extrinsic compression by a schwannoma arising within the adventitia of the tibial artery in the ankle region. Additionally they provide the operative, histological, and imaging findings.

Abbreviation used in this paper:MR = magnetic resonance.

Article Information

Address reprint requests to: Robert J. Spinner, M.D., Department of Neurologic Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, Minnesota 55905. email: spinner.robert@mayo.edu.

© AANS, except where prohibited by US copyright law."

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Figures

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    Fast spin echo MR images with fat suppression. A: Coronal T2-weighted image showing the hyperintense mass (thick arrow) adjacent to a small artery (thin arrow). The medial plantar branch of the tibial nerve (arrowhead) is just lateral to the mass. B: Sagittal T1-weighted contrast-enhanced image showing the enhancing mass (thick arrow) with typical features of a benign neurogenic tumor. The small arterial branch (thin arrow) associated with the mass and medial plantar nerve (arrowheads) is seen clearly. C: Sagittal T2-weighted image obtained at the same location as that in panel B showing the hyperintense mass (thick arrow) apposed to the arterial branch (thin arrow) and adjacent to the medial plantar nerve (arrowhead).

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    Intraoperative photographs. A: The mass lesion (arrow) is seen within an arterial branch of the tibial artery (encircled by red vasoloops). The tibial nerve (TN), medial plantar nerve (MPN), lateral plantar nerve (LPN), calcaneal branch (CB), and main tibial vessels (AV) are mobilized. B: Enlarged view of the operative field in the dashed box in panel A.

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    Photomicrographs. A: Histological section showing direct apposition of the schwannoma (left side of panel) to the muscular artery (right side of panel). No intervening vascular adventitia is seen. H & E. B: The tumor stains strongly for S100 protein. C: The arterial nature of the vessel is enhanced by Movat staining, which demonstrates elastic tissue. Original magnification × 120.

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