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KMID : 0948320040040020204
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Konyang Medical Journal
2004 Volume.4 No. 2 p.204 ~ p.207
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Concurrent Presentaton of Spinal Schwannoma and Meningioma: - Case Report -
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Kim Hyun-Woo
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Abstract
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Schwannomas coexisting with meningiomas in the spine is a very rare finding that has been scantly reported in world literature. We are presenting a case of concurrent intradural extramedullary spinal tumors that occurred in a 68-year-old female. The patient presented with gradually developing lower extremity weakness and decreased proprioception, resulting in gait disturbance with frequent tendency to slip and fall. These symptoms had been existent for 6 months previous to the visit and recently aggravated. She had a history of NIDDM requiring medication for 1 year and except for an operation for gallstone, there was no other specific history. Her familial history was also non-productive. On neurological exam, there was abnormal sensation from T8 sensory dermatome and motor weakness of grade2 on both lower extremities with decrease in deep tendon reflexes on both sides. There was also radiculopathy to the left anterior tibial aspect. Urinary incontinence had developed recently. MRI with gadolinium enhancement revealed a well demarcated and enhancing mass dorsal to the cord at T7-8 level without obvious dural tail sign as well as a smaller ovoid mass at the cauda level of L4. Both mass lesions were intradural extramedullary lesions. After imaging studies, complete removal of tumors was achieved via unilateral partial hemilaminectomies. As there was posterior dural attachment in the cranial lesion, bipolar coagulation of the dura was done intraoperatively. The caudal lesion originated from the cauda Pathologic diagnosis was meningioma, transitional type for the T7 lesion and schwannoma for the L4 lesion. Gait disturbance and motor weakness on both extremities showed dramatic improvement after surgery but some sensory deficit persisted. The authors are presenting a case where there were two intradural extramedullary tumors on different levels of the spinal cord with differing pathologies. These cases have been rarely reported and because of their different origin and behavior, they require alternate management plans. The importance of distinguishing these tumors prior to surgery to determine an optimal surgical plan cannot be overemphasised.
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KEYWORD
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Meningioma, Schwannoma, Neurofibromatosis Type 2, Spinal tumor
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