A ganglioglioma versus a schwannoma: Which is in the sacral spine?

Sacral spinal gangliogliomas, rare WHO grade I tumors, present a surgical challenge due to their proximity to critical nerve roots. Symptoms often include lower back pain, sciatica, and bladder dysfunction. Diagnosis is confirmed through MRI and biopsy, with surgical resection being the primary treatment.

A 66-year-old woman presented with left lower limb pain and weakness. MRI showed an intradural lesion at the left S1 root. She underwent surgery, resulting in near-total tumor resection. Postoperatively, she was pain-free and ambulatory. Pathology confirmed a ganglioglioma.

Initially suspected as a disc herniation, MRI indicated a schwannoma-like lesion, but surgery and pathology revealed a ganglioglioma. Total resection was challenging due to the tumor's neural adherence. Radiotherapy and chemotherapy are generally not used for low-grade gangliogliomas.

Treating sacral spinal gangliogliomas requires precise surgery and a multidisciplinary approach. Accurate diagnosis and careful planning are essential for minimizing neurological risks and improving patient outcomes. Continued research is crucial for advancing treatment strategies.