Multilevel Spinal Schwannomas with Sacrococcygeal Dural Ectasia in a Young Female:  A Case Report and Literature Review

Wassan Nori; Muna Abid Al Ghani Zghair; Nour Fawzi Shaheed; Shaymaa Khalid Abdulqader

doi:10.54133/ajms.v11i2.3226

Authors

Wassan Nori Department of Obstetrics and Gynecology, College of Medicine, Mustansiriyah University, Baghdad 10052, Iraq https://orcid.org/0000-0002-8749-2444
Muna Abid Al Ghani Zghair Department of Radiology, College of Medicine, Mustansiriyah University, Baghdad, Iraq; Department of Radiology, Al Yarmouk Teaching Hospital, Baghdad, Iraq https://orcid.org/0000-0002-6219-1215
Nour Fawzi Shaheed Department of Obstetrics and Gynecology, College of Medicine, Mustansiriyah University, Baghdad 10052, Iraq https://orcid.org/0009-0003-4157-1926
Shaymaa Khalid Abdulqader Department of Radiology, Al-Kindy College of Medicine, University of Baghdad, Baghdad, Iraq https://orcid.org/0000-0001-7029-0451

DOI:

https://doi.org/10.54133/ajms.v11i2.3226

Keywords:

Multi-level spinal schwannomas, MRI, Sacral dural ectasia, Spinal cord tumors

Abstract

Renal cell carcinoma (RCC) is a rare urological malignancy that may present during multilevel spinal schwannoma, a rare type of spinal cord tumor that is commonly observed in the cervical and thoracic spine as a solitary lesion. In this report, we present a case of a 24-year-old woman who experienced a gradual onset of neck and back pain accompanied by upper limb numbness. No focal motor deficits or urinary dysfunctions were reported. The results of the magnetic resonance imaging of the neuroaxis revealed a multilevel thoracic, lumbar, and sacrococcygeal involvement, characterized by a massive extramedullary tumor burden, a highly suspected intramedullary extension, and prominent sacrococcygeal dural ectasia. Only a handful of cases in the literature have described lumbar region involvement by multilevel spinal Schwannoma. No earlier case has documented concurrent lower sacral dural ectasia. Furthermore, we present a comprehensive review regarding the current knowledge, diagnostic challenges, and therapeutic options for multilevel spinal schwannomas of the spinal cord.

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References

Swiatek VM, Stein KP, Cukaz HB, Rashidi A, Skalej M, Mawrin C, et al. Spinal intramedullary schwannomas—report of a case and extensive review of the literature. Neurosurg Rev. 2021;44(4):1833-1852. doi: 10.1007/s10143-020-01357-5.

Rai P, Bathla G, Soni N, Desai A, Rao D, Vibhute P, et al. Classification of schwannomas and the new naming convention for “neurofibromatosis-2”: Genetic updates and international consensus recommendation. Neuroradiol J. 2025 Oct;38(5):533-542. doi: 10.1177/19714009251313510

Plotkin SR, Messiaen L, Legius E, Pancza P, Avery RA, Blakeley JO, et al. Updated diagnostic criteria and nomenclature for neurofibromatosis type 2 and schwannomatosis: an international consensus recommendation. Genet Med. 2022;24(9):1967-1977. doi: 10.1016/j.gim.2022.05.007.

Land CF, Bowden BD, Morpeth BG, DeVine JG. Intradural extramedullary metastasis: a review of literature and case report. Spinal Cord Ser Cases. 2019;5:41. doi: 10.1038/s41394-019-0181-0.

Samman AM, Bardeesi AM, Alzahrani MT. Thoracic cystic schwannoma: case report and review of literature. Spinal Cord Ser Cases. 2021;7:7. doi: 10.1038/s41394-020-00376-0.

Kumar R, Mittal RS. Intramedullary schwannoma of conus medullaris: case report and review of the literature. World Spinal Column J. 2014;5:1-5. doi: 10.1038/s41394-018-0134-z.

Myrseth E, Habiba S, Rekand T, Sætran HA, Mørk S, Grønning M. Intramedullary spinal cord and filum tumours—long-term outcome: single institution case series. Acta Neurochirurgica. 2022;164(11):3047-3056. doi: 10.1007/s00701-022-05350-3.

Nori W, Abdulqader SK, Akram NN, Al-Ani RM, Hassan QA, Pantazi AC. Unusual presentation of osteoid osteoma with exacerbating pain during menses. Sultan Qaboos Univ Med J. 2025;2;25(1):162. doi: 10.18295/squmj.10.2024.067.

Slooff JL, Kernohan JW, MacCarty CS. Primary intramedullary tumors of the spinal cord and filum terminale. Philadelphia (PA): W.B. Saunders; 1964. Available at: https://cir.nii.ac.jp/crid/1971430859749032348.

Kumar S, Gulati DR. Intramedullary neurilemmoma. A case report. Neurol India. 1977;25:255–256. PMID: 614514.

Pardatscher K, Iraci G, Cappellotto P, Rigobello L, Pellone M, Fiore D. Multiple intramedullary neurinomas of the spinal cord: Case report. J Neurosurg. 1979;1;50(6):817-822. doi: 10.3171/jns.1979.50.6.0817.

Bhayani R, Goel A. Multiple intramedullary schwannomas--case report. Neurol Med Chir (Tokyo).1996;36(7):466-468. doi: 10.2176/nmc.36.466.

Bernal-García LM, Cabezudo-Artero JM, Ortega-Martínez M, Porras-Estrada LF, Fernández-Portales I, Ugarriza-Echebarrieta LF, et al. Neurocirugia (Astur). 2010;21(3):232-238. PMID: 20571727.

Mccormick WF. Intermedullary spinal cord schwannoma. A unique case. Arch Pathol (Chic). 1964;77:378–382. PMID: 14107713.

Schmitt HP. “Epi-” and intramedullary neurilemmoma of the spinal cord with denervation atrophy in the related skeletal muscles. J Neurol.1975;209:271–278. doi: 10.1007/BF00314366.

Cantore G, Ciappetta P, Delfini R, Vagnozzi R, Nolletti A. Intramedullary spinal neurinomas: Report of two cases. J Neurosurg. 1982;57:143–147. doi: 10.3171/jns.1982.57.1.0143.

Jacquet G, Czorny A, Godard J, Steimle R, Wendling D. Intramedullary neurinoma. Apropos of a case. Review of the literature. Neurochirurgie. 1992;38:315–321. PMID: 1299778.

Hejazi N, Hassler W. Microsurgical treatment of intramedullary spinal cord tumors. Neurol Med Chir (Tokyo). 1998;38:266–273. doi: 10.2176/nmc.38.266.

O’Brien DF, Farrell M, Fraher JP, Bolger C. Schwann cell invasion of the conus medullaris: Case report. Eur Spine J. 2002;12:328. doi: 10.1007/s00586-002-0484-9.

Kahilogullari G, Aydin Z, Ayten M, Attar A, Erdem A. Schwannoma of the conus medullaris. J Clin Neurosci. 2005;12:80–81. doi: 10.1016/j.jocn.2004.02.016.

Hayashi F, Sakai T, Sairyo K, Hirohashi N, Higashino K, Katoh S, et al. Intramedullary schwannoma with calcification of the epiconus. Spine J. 2009; 9:19-23. doi: 10.1016/j.spinee.2008.11.006.

Ohtonari T, Nishihara N, Ota T, Ota S, Koyama T. Intramedullary schwannoma of the conus medullaris complicated by dense adhesion to neural tissue - Case report. Neurol Med Chir (Tokyo). 2009;49:536–538. doi: 10.2176/nmc.49.536.

Nurdillah I, Rizuana IH, Syazarina SO. Spinal schwannomatosis mimicking metastatic extramedullary spinal tumor. Diagnostics. 2023;13:1254. doi: 10.3390/diagnostics13071254.

Kim GU, Chang MC, Kim TU, Lee GW. Diagnostic modality in spine disease: A review. Asian Spine J. 2020;14:910. doi: 10.31616/asj.2020.0593.

Hachicha A, Belhaj A, Karmeni N, Slimane A, Bouali S, Kallel J. Intramedullary spinal cord tumors: A retrospective multicentric study. J Craniovertebr Junction Spine. 2021;12:269–278. doi: 10.4103/jcvjs.jcvjs_64_21.

Yang T, Wu L, Yang C, Deng X, Xu Y. Coexisting intramedullary schwannoma with an ependymal cyst of the conus medullaris: A case report. Oncol Lett. 2015;9:903–906. doi: 10.3892/ol.2014.2786.

Hida K, Yano S, Iwasaki Y. Staged operation for huge cervical intramedullary schwannoma: report of two cases. Neurosurgery. 2008;62:ONS456-60. doi: 10.1227/01.neu.0000326035.54714.cc.

Ahmed R, Menezes AH, Torner JC. Role of resection and adjuvant therapy in long-term disease outcomes for low-grade pediatric intramedullary spinal cord tumors. J Neurosurg Pediatr. 2016;18:594–601. doi: 10.3171/2016.5.PEDS15356.

Tobin MK, Geraghty JR, Engelhard HH, Linninger AA, Mehta AI. Intramedullary spinal cord tumors: a review of current and future treatment strategies. Neurosurg Focus. 2015;39:E14. doi: 10.3171/2015.5.FOCUS1515.