Schwannoma lumbosacro gigante Translated title: Schwannome lombo-sacré géant Translated title: Giant lumbosacral schwannoma

Schwannomas are benign peripheral nerve sheath neoplasms composed almost entirely of Schwann cells and are diagnosed histopathologically by the presence of singular architectural patterns called Antoni A and Antoni B areas. These were described first in 1920 by the Swedish neurologist Nils Antoni. The Antoni A tissue is highly cellular and made up of palisades of Schwann cell nuclei, a pattern first described in 1910 by the Uruguayan neuro-pathologist Jose Verocay and are known as Verocay bodies. This article describes the structure and appearance of Verocay bodies and Antoni A and B areas with a brief biographical introduction of the men who described these patterns.

Purely extradural giant lumbar schwannomas are rare lesions. Classification of these tumors is performed according to the sizes and spills and is named the modified Sridhar's classification. The management of these tumors has traditionally been performed by combined antero-posterior large or two-stage exposures. This combined exposure has many disadvantages. Recent reports have demonstrated the safety and efficacy of removal of these tumors using mini-open micro surgical resection for the schwannomas, but the safety and efficacy have not been established for extremely large giant tumors. We report a case of a giant L4 dumb-bell schwannoma successfully resected through a mini-open micro surgical resection. These neoplasms can be safely and effectively treated with mini-open techniques. Reduction in blood loss, hospitalization, and tissue disruption may be potential benefits of this approach. We discuss the technical details of this surgical approach along with the limitations and possible complications. In addition, this study is included in the current schwannoma (Kotil) classification.

Introduction Giant invasive spinal schwannoma is defined as a tumor that extends over two or more vertebral levels, erodes vertebral bodies, and extends into the extraspinal space disrupting myofascial planes. Because of its rarity, there have been few published reports describing clinical features and surgical outcomes, especially in the pediatric patient population. Case presentation We analyzed the medical record, pathologic findings, and radiographic studies of a 14-year-old Hispanic boy who presented to Texas Children’s Hospital with a three-month history of progressive spastic paraparesis. Preoperative computed tomography and magnetic resonance imaging reports showed a large mass lesion centered at the left T7-8 neural foramen with intra- and extraspinal extension, resulting in severe spinal cord compression and vertebral body erosion, and protrusion into the retropleural space and descending aorta. Our patient underwent a single-stage posterior approach for complete resection of the tumor with reconstruction and stabilization of the vertebral column. The pathological examination was consistent with schwannoma. At the six-month follow-up, our patient had resolution of preoperative symptoms and remains neurologically intact without any radiographic evidence of recurrent tumor. Conclusion To the best of our knowledge, our case represents the fourth child with giant invasive spinal schwannoma reported in the literature. We describe our case and review the literature to discuss the aggregate clinical features, surgical strategies, and operative outcomes for giant invasive spinal schwannoma in the pediatric age group.