spinal schwannomatosis

Q: 42 year old female is admitted to ICU with progressive weakness of both upper extremities with motor function deficits. Weakness is associated with pain. MRI was performed in the emergency department (ED) showing schwannoma at cervical level causing spinal cord compression. Neurosurgery service decides to pursue surgery. The patient inquired regarding her chances of recovery? (select one)

A) Full recovery
B) no recovery of lost function


Answer: B

When schwannoma is associated with clinical symptoms it is called schwannomatosis. In normal cases, surgery is usually avoided due to its benign nature. Pharmacologic and non-pharmacologic interventions are treatments. In life-threatening situations like our patient in the above question, surgery is indicated. This is unfortunate that in schwannomas lost neurological functions do not get recovered despite its benign pathology and removal of the mass. Surgery helps in preventing the progression of the disease i.e., loss of neuro function. Another grim part of this scenario is that may help in the resolution of pain but may also paradoxically exacerbate the pain.

#neuro-surgery
#surgical-critical-care


Reference:

1. Jacopo Lenzi, et al. Spinal Nerves Schwannomas: Experience on 367 Cases—Historic Overview on How Clinical, Radiological, and Surgical Practices Have Changed over a Course of 60 Years Neurology Research International. Volume 2017 |Article ID 3568359 | 12 pages | https://doi.org/10.1155/2017/3568359

2. T. Jinnai, M. Hoshimaru, and T. Koyama, “Clinical characteristics of spinal nerve sheath tumors: analysis of 149 cases,” Neurosurgery, vol. 56, no. 3, pp. 510–515, 2005. 

3. M. T. Seppala, M. J. J. Haltia, R. J. Sankila, J. E. Jaaskelainen, and O. Heiskanen, “Long-term outcome after removal of spinal schwannoma: a clinicopathological study of 187 cases,” Journal of Neurosurgery, vol. 83, no. 4, pp. 621–626, 1995. 

4. P. Li, F. Zhao, J. Zhang et al., “Clinical features of spinal schwannomas in 65 patients with schwannomatosis compared with 831 with solitary schwannomas and 102 with neurofibromatosis type 2: a retrospective study at a single institution,” Journal of Neurosurgery Spine, vol. 24, no. 1, pp. 145–154, 2016.