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Torsion of a lumbar nerve root schwannoma
Sami Khoshyomn1, Konrad N M Barth, Robert A Christman
1Division of Neurosurgery, Department of Surgery, University of Vermont College of Medicine, Burlington, Vt., USA.
Abstract:
We report a very rare case of a lumbar nerve root schwannoma presenting with torsion and infarction. The patient was a 16-year-old male presenting with severe low back pain and urinary retention following an aggressive game of hockey. Subsequent MRI of the lumbar spine revealed a nonenhancing lumbar intradural lesion at the level of L3. The patient was taken to the operating room where he underwent a bilateral L2 and L3 laminectomy and gross total resection of an intradural nerve root tumor, which appeared to have undergone torsion and infarction. Subsequent histopathological examination of the surgical specimen verified the diagnosis of infarcted schwannoma. This is a unique case of lumbar nerve root schwannoma, with atypical MRI findings, presenting with infarction due to torsion of the involved nerve root.
Insights
A rare lumbar nerve root schwannoma case presented with torsion and infarction in a teen. Surgical resection confirmed the infarcted schwannoma, highlighting unusual MRI findings for this spinal tumor.
Area of Science:
- Neurosurgery
- Spinal Oncology
- Neuropathology
Background:
- Schwannomas are typically benign nerve sheath tumors.
- Lumbar nerve root schwannomas are rare, especially presenting with acute complications.
- Intradural spinal tumors can cause significant neurological deficits.
Observation:
- A 16-year-old male presented with acute severe low back pain and urinary retention after physical activity.
- Lumbar spine MRI revealed a nonenhancing intradural lesion at L3.
- The lesion appeared to have undergone torsion and infarction during surgery.
Findings:
- Histopathological examination confirmed an infarcted schwannoma.
- The tumor was successfully resected via bilateral L2-L3 laminectomy.
- Atypical MRI findings were noted in this rare presentation.
Implications:
- This case highlights the importance of considering torsion and infarction in the differential diagnosis of spinal tumors.
- Prompt surgical intervention is crucial for managing symptomatic nerve root schwannomas.
- Understanding rare presentations aids in accurate diagnosis and treatment planning for spinal tumors.