Cervical spine schwannomas in a young female from a low resource setting: a case report

Schwannomas are benign, slow-growing tumors, primarily affecting the cervical and lumbar spine. When large, they may extend over multiple vertebral levels, posing surgical challenges. Spinal schwannomas are commonly encapsulated and extramedullary intradural tumors that rarely exhibit invasive characteristics.

A 13-year-old Ugandan Munyankore female patient, presented with a 6-year history of nontraumatic progressive quadriparesis, particularly in the lower limbs. Clinical examination showed power of 1/5 in the lower limbs, 4/5 in the upper limbs, hypertonia and hyperreflexia, with intact sensation, and no stigmata of neurofibromatosis. Magnetic resonance imaging revealed two "kissing" schwannomas extending from C2 to T2 in the cervical spine. Decompressive surgery was performed through laminoplasty and partial lesion resection, and histology confirmed schwannoma. Follow up of the patient showed stabilizing neurological status with noted improvement in lower limb strength.

"Kissing" schwannomas are most frequently documented in the cerebellopontine angle, rarely in the spine, and even more rarely in children. While multiple schwannomas are often associated with Neurofibromatosis type 2, this case had no family history or clinical signs of the disorder and no genetic testing were done. Giant invasive spinal schwannomas (GISS) that span multiple vertebrae demand intricate surgical approaches owing to their proximity to neurovascular structures, though such procedure may require advanced technology, which is not available in low income countries.

This is one of the rarest reported cases of kissing cervical schwannomas in a young patient from a low-to-middle-income country. Surgical decompression, though challenging, is critical for neurological recovery in such advanced cases.