Surgical Outcome of Spinal Neurilemmoma

Neurilemmoma commonly occurs from the fourth to sixth decades of life with an incidence of 3 to 10 per 100,000 people, and is rare in adolescence. This case report describes the clinical and radiographic features of 2 rare cases with intraspinal neurilemmoma of the cervical and thoracic spine. A 29-year-old man who experienced middle back pain with prominent right lower limb weakness, and an 11-year-old boy who suffered from sudden onset neck pain with left arm weakness and hand clawing for 2 weeks before admission to our department were included in this case report. Magnetic resonance imaging of both patients revealed an intraspinal mass causing spinal cord compression at the cervical and thoracic spine. The patients subsequently received urgent posterior spinal cord decompression and tumor resection surgery. The histopathology reports revealed neurilemmoma. The 2 patients recovered and resumed their normal lives within 1 year. Intraspinal neurilemmoma is rare but should be considered in the differential diagnosis of spinal cord compression. Advances in imaging techniques and surgical procedures have yielded substantially enhanced clinical outcomes in intraspinal neoplasm cases. Delicate preoperative study and surgical skill with rehabilitation and postoperative observation are critical. (Medicine 94(5):e490) Abbreviations: H&E = hematoxylin and eosin, JOA = Japanese Orthopedic Association, MRI = magnetic resonance imaging, OPD = outpatient department, VAS = visual analog scale. INTRODUCTION , Tzai-Chiu Yu, M n, MD, ung Wang, MSc, and Wen-Tien Wu, MD, PhD schwannoma, typically occurs in the fourth to sixth decade of life and is a rare benign neoplasm that comprises <0.2% of primary bone tumors, with an incidence of 3 to 10 per 100,000 people. The most common axial skeleton site of involvement is the mandible, and rare cases involving the mobile spine have been reported. We report 2 cases of solitary intraspinal neurilemmoma that caused neurologic deficit, one at the cervical spine and the other at the thoracic spine. CASE REPORT This study was approved by the Research Ethics Committee of Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan. The informed consents of the 2 patients were included in the data for the ethics committee review. Case 1 A 29-year-old man, who is a telecommunications engineer, experienced back soreness and muscle cramping in the abdomen for 8 months. Progressive weakness of both lower limbs with an unstable gait was noted for 1 month before surgery. Numbness in the bilateral lower limbs and lower abdomen (below the umbilicus) occurred simultaneously. Positive myelopathy with prominent right lower limb weakness was noted at the outpatient department (OPD). The preoperative Nurick score was 3 and the visual analog scale (VAS) for upper back pain was 7. T2-weighted magnetic resonance imaging (MRI) of the entire spine revealed a 5.1 1.4 1.5 cm irregular mass from the vertebral body with a compressed spinal cord at the T10–T12 level. Irregular enhancement was observed in T1weighted images after gadolinium administration (Figure 1A, B). Emergent surgical excision and decompression with T9-L1 posterior instrumented fusion was performed (Figure 1C). The tumor was observed to be well demarcated and extending into paravertebral areas and the spinal canal. No adhesions were identified between the dura and tumor without nerve involvement. A follow-up MRI at 3 years postsurgery revealed a patent spinal canal (Figure 1D). Case 2 An 11-year-old boy experienced the sudden onset of left forearm pain for 1 month after lifting heavy wood. Within 2 weeks, exacerbated neck pain, progressive left arm weakness, and a clawing hand were noted. His body leaned to the right side at that time. Left elbow flexion and extension weakness with ulnar side numbness was noted at the OPD. Positive spurling and abduction relief signs with knee and ankle jerk hyperreflexia were found. Acute myelopathy with radiculopathy was ted MRI study revealed a 3.1 1.5 s at the level of C6–C7 with a comon the left side (Figure 2A, B). Tumor www.md-journal.com | 1