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Migratory schwannoma of the cauda equina with a change in radicular pattern: illustrative case – Lumbar Spinal Stenosis

The article discusses a case of a 38-year-old male with a migratory schwannoma, a rare type of intradural spinal tumor. The patient initially presented with bilateral upper lumbar radicular symptoms and an enhancing tumor at L1-2, which later migrated to T12-L1 and then to L2-3. Despite initially declining surgery, the patient eventually underwent laminectomy and tumor resection, leading to resolution of his radicular symptoms and improvement in strength. The case highlights the importance of considering migratory schwannoma when radicular symptoms change, the need for repeat imaging to avoid wrong-level surgery, and the use of intraoperative imaging for tumor localization. Overall, the article emphasizes the rare nature of migratory schwannoma and the importance of appropriate management strategies in such cases

Summarised by Mr Mo Akmal – Lead Spinal Surgeon
The London Spine Unit : most established spinal clinic in UK

Published article

BACKGROUND: Intradural spinal tumors are an uncommon entity with a variety of pathologies and symptom patterns. Few cases reports in the literature have described tumor migration within the spinal canal.

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J Neurosurg Case Lessons. 2024 Apr 8;7(15):CASE23706. doi: 10.3171/CASE23706. Print 2024 Apr 8. ABSTRACT BACKGROUND: Intradural spinal tumors are an uncommon entity with a variety of pathologies and symptom patterns. Few cases reports in the literature have described tumor migration within the spinal canal. OBSERVATIONS: A 38-year-old male presented with bilateral upper lumbar radicular symptoms,

J Neurosurg Case Lessons. 2024 Apr 8;7(15):CASE23706. doi: 10.3171/CASE23706. Print 2024 Apr 8.

ABSTRACT

BACKGROUND: Intradural spinal tumors are an uncommon entity with a variety of pathologies and symptom patterns. Few cases reports in the literature have described tumor migration within the spinal canal.

OBSERVATIONS: A 38-year-old male presented with bilateral upper lumbar radicular symptoms of anterior thigh pain, with an enhancing tumor of the cauda equina initially located at L1-2. He declined surgery initially, and at a follow-up 3 years later, his symptoms were unchanged but the tumor was now located at T12-L1. He again declined surgery, but 3 months later, he had a significant change in his pain distribution, which was now along his posterolateral right leg to his foot with associated dorsiflexion and extensor hallicus longus weakness. At this time, the tumor had migrated to L2-3. He underwent laminectomy and tumor resection with resolution of his radicular symptoms and improvement in his strength back to baseline by the 1-month follow-up. Pathology was consistent with a World Health Organization grade I schwannoma.

LESSONS: Migratory schwannoma is a rare entity but should be considered when radicular symptoms acutely change in the setting of a known intradural tumor. Repeat imaging should be performed to avoid wrong-level surgery. Intraoperative imaging can also be used for tumor localization.

PMID:38588598 | DOI:10.3171/CASE23706

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Migratory schwannoma of the cauda equina with a change in radicular pattern: illustrative case

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J Neurosurg Case Lessons. 2024 Apr 8;7(15):CASE23706. doi: 10.3171/CASE23706. Print 2024 Apr 8. ABSTRACT BACKGROUND: Intradural spinal tumors are an uncommon entity with a variety of pathologies and symptom patterns. Few cases reports in the literature have described tumor migration within the spinal canal. OBSERVATIONS: A 38-year-old male presented with bilateral upper lumbar radicular symptoms

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