Low back pain with axillary mass in a perimenopausal woman: A case of schwannomatosis mimicking metastasis.

Schwannomatosis is a rare neurocutaneous syndrome characterized by the presence of multiple schwannomas along the peripheral nerves, distinctly excluding the vestibular nerves. It is recognized as the third principal form of neurofibromatosis, alongside neurofibromatosis types 1 and 2. In this report, we discuss the case of a 45-year-old woman who initially sought medical attention for low back pain and swelling in her left axilla. Her magnetic resonance imaging revealed multiple enhancing intradural extramedullary lesions, along with a mass in the right upper thoracic region and another in the left axilla, raising suspicions of metastasis. However, a comprehensive analysis that aligned imaging results with histopathological findings confirmed the diagnosis of schwannomatosis. This case highlights the importance of differentiating between various conditions that can cause multiple intradural extramedullary masses, such as nerve sheath tumors, meningiomas, and metastasis. The presence of multiple schwannomas suggests a diagnosis of either neurofibromatosis type 2 or schwannomatosis, making the distinction between these two conditions critical for appropriate management.

Management of migrating spinal schwannomas: a surgeon's dilemma. Illustrative case.

BACKGROUND: A migrating spinal tumor is a rare phenomenon in the medical literature. Efficient management of these tumors is critical to avoid extended laminectomies. OBSERVATIONS: In this article, the authors present the case of a patient with a migrating lumbar schwannoma. They summarize a literature review of similar cases, highlighting the intraoperative challenges faced, and provide management guidelines for similar cases from their experience. LESSONS: Surgeons dealing with spinal intradural extramedullary lesions should always consider the possibility of tumor migration. Routine preoperative counseling regarding potential tumor migration and its efficient management is essential, as it reduces the risk of unplanned extensive laminectomy or durotomy, minimizing morbidity and medicolegal concerns and enhancing patient care.

Intradural extramedullary tumors. Retrospective cohort study assessing prognostic factors for functional outcome in adult patients / Tumores intradurales-extramedulares. Estudio retrospectivo de cohorte valorando factores predictores de «outcome» en pacientes adultos

Objective The purpose of this study is to analyze a series of patients with intradural extramedullary tumors (IDEM) and assess factors that may modify or determine the final long term outcome and management. Materials and methods Single Center, retrospective study of a series of surgical patients with IDEM lesions from our Institution operated between 2010 and 2021. Patients with less than 6 months of follow up were excluded. Several preoperative demographics, clinical, imaging and surgical features, as well as histopathology, recurrence and adjuvancy were assessed. Patients’ final clinical outcome was categorized using the McCormick scale. Results A total of 203 patients with a mean follow-up of 30.50 months (range 6–130) were included. 57.64% of the analyzed population was female and the mean age was 50.51 years. The most frequent location of the tumors was dorsal (34.98%) followed by the lumbar region (32.02%). Total resection was achieved in 84.24% of cases, and the most frequent histopathology was Schwannoma (36.45%), followed by Meningioma (30.05%). Pain was the most usual initial symptom (63.05%). In our analysis, functional outcome after surgery was associated with statistical significance with preoperative McCormick grade, tumor type, EOR and postoperative complications such as hematoma and sphincter involvement. Conclusion The management of these lesions depends on many factors. It is worthy of mention that clinical presentation, EOR, histopathology and postoperative complications have shown significant prognostic value for the final outcome. Early treatment with the intention of achieving GTR when possible, using carefully tailored approaches, should be considered before the onset of significant symptoms (AU)

Objetivo Analizar una serie de pacientes con tumores intradurales extramedulares y evaluar factores que pueden modificar o determinar el resultado final y el manejo a largo plazo. Materiales y métodos Estudio monocéntrico, retrospectivo de una cohorte de pacientes quirúrgicos con lesiones intradurales extramedulares (IDEM) operados entre 2010 y 2021 y un mínimo de seis meses de seguimiento. Se evaluaron características clínicas, de imagen y quirúrgicas, histopatología, recurrencia y adyuvancia. El resultado clínico final de los pacientes se categorizó utilizando la escala de McCormick. Resultados Se incluyeron un total de 203 pacientes con un seguimiento medio de 30,50 meses (rango 6-130). De la población analizada, 57,64% era del sexo femenino y la edad media fue de 50,51 años. La localización más frecuente de los tumores fue dorsal (34,98%) seguida de la región lumbar (32,02%). La resección total se logró en 84,24% de los casos, y la histopatología más frecuente fue el schwannoma (36,45%), seguido del meningioma (30,05%). El dolor fue el síntoma inicial más habitual (63,05%). En nuestro análisis, el resultado funcional posoperatorio se asoció con significancia estadística con el grado de McCormick preoperatorio, la histopatología, el grado de resección y las complicaciones posoperatorias como el hematoma y la afectación esfinteriana. Conclusión El manejo de estas lesiones depende de muchos factores. Cabe mencionar que la presentación clínica, el grado de resección, la histopatología y las complicaciones posoperatorias han mostrado un importante valor pronóstico para el desenlace. Se debe considerar el tratamiento temprano con la intención de lograr resección total cuando sea posible, mediante abordajes cuidadosamente adaptados, antes de la aparición de síntomas significativos (AU)

Intradural extramedullary tumors. Retrospective cohort study assessing prognostic factors for functional outcome in adult patients.

OBJECTIVE: The purpose of this study is to analyze a series of patients with intradural extramedullary tumors (IDEM) and assess factors that may modify or determine the final long term outcome and management. MATERIALS AND METHODS: Single Center, retrospective study of a series of surgical patients with IDEM lesions from our Institution operated between 2010 and 2021. Patients with less than 6 months of follow up were excluded. Several preoperative demographics, clinical, imaging and surgical features, as well as histopathology, recurrence and adjuvancy were assessed. Patients' final clinical outcome was categorized using the McCormick scale. RESULTS: A total of 203 patients with a mean follow-up of 30.50 months (range 6-130) were included. 57.64% of the analyzed population was female and the mean age was 50.51 years. The most frequent location of the tumors was dorsal (34.98%) followed by the lumbar region (32.02%). Total resection was achieved in 84.24% of cases, and the most frequent histopathology was Schwannoma (36.45%), followed by Meningioma (30.05%). Pain was the most usual initial symptom (63.05%). In our analysis, functional outcome after surgery was associated with statistical significance with preoperative McCormick grade, tumor type, EOR and postoperative complications such as hematoma and sphincter involvement. CONCLUSION: The management of these lesions depends on many factors. It is worthy of mention that clinical presentation, EOR, histopathology and postoperative complications have shown significant prognostic value for the final outcome. Early treatment with the intention of achieving GTR when possible, using carefully tailored approaches, should be considered before the onset of significant symptoms.

Imaging of intraspinal cystic lesions: A review.

Several distinct conditions present as cystic or pseudocystic lesions within the spinal canal. Some of the most common spinal cystic lesions include spinal meningeal cysts, juxtafacet cysts, dermoid/epidermoid cysts, nerve sheath tumors, and syringohydromyelia. Clinical presentation is usually nonspecific and imaging characteristics are frequently overlapping, which may pose a challenging presurgical diagnosis. We provide a pictorial review of cystic intraspinal lesions and discuss the main imaging features that can aid the neuroradiologist in the differential diagnosis. First, we propose a categorization of the lesions according to their location as extradural, intradural extramedullary, and intramedullary. This is a crucial initial step in the diagnostic workup and surgical planning. Second, for each of these locations, we organize the lesions according to their etiology: congenital and developmental disorders, degenerative disorders, traumatic or postsurgical collections, infectious conditions, neoplastic lesions, and other miscellaneous disorders. Finally, we summarize the clinical highlights and MR features that provide important insights for the differential diagnosis. MR is the technique of choice in presurgical evaluation and postsurgery follow-up. It provides accurate lesion localization and characterization and, most of the times, it will allow a confident differential diagnosis. High-resolution three-dimensional T2-weighted sequences and diffusion-weighted imaging can provide important hints in specific cases. Signal correlation with T1-weighted and fat-saturated sequences allows to differentiate true cystic lesions from hemorrhage or fat tissue.

Neurosurgical Management of a Thoracic Dorsal Arachnoid Web: Case Illustration.

Dorsal thoracic arachnoid webs are rare clinical entities caused by a thickened intradural extramedullary band of arachnoid tissue that compresses the spinal cord, and often present with progressive back pain, paresthesias, and lower extremity weakness. In this report, we review the radiographic features of the "Scalpel Sign" and describe the case of a 47-year-old male that failed conservative therapy and was found to have dorsal thoracic arachnoid web. The patient underwent laminectomy and microsurgical release of the compressing arachnoid band. Postoperatively, the patient had complete resolution of his pain. Intraoperatively, the somatosensory evoked potentials were improved once the band was released. The prompt diagnosis of dorsal arachnoid webs remains critical because surgical treatment arrests and potentially reverses the pathology.