Thoracic dumbbell intra- and extramedullary schwannoma

We present a rare case of a solitary dumbbell intra- and extramedullary schwannoma of the thoracic spine in a 54-year-old man without signs of von Recklinghausen's disease. The patient presented with motor weakness in the left lower extremity, bilateral sensory impairment below the T9 dermatome and rectovesical dysfunction. Preoperative magnetic resonance imaging was suspicious for an intradural extramedullary tumor. At operation, the tumor was located posteriorly, at the midline, with no relationship to the posterior nerve roots and was firm and adherent to the adjacent spinal cord, which surrounded the intramedullary portion of the tumor. The intramedullary mass was completely removed with sharp dissection after removal of the extramedullary mass. Surgery resulted in minimal postoperative neurological deficits. These tumors may arise from the Schwann cells of the nerve plexus surrounding vessels in the posterior median sulcus and thus may grow in both an intra- and extramedullary fashion. The optimal treatment of these schwannomas is total removal.