Minimally Invasive Resection of a Foraminal Lumbar Root Schwannoma

Abstract

Chien-Ching Lee,1,2 Hao-Yu Chuang,3,4 Che-Chao Chang,3,5 Hung-Lin Lin,6 Cheng-Hsin Cheng3,7 1Department of Anesthesia, An Nan Hospital, China Medical University, Tainan, 70965, Taiwan; 2Department of Medical Sciences Industry, Chang Jung Christian University, Tainan, 71101, Taiwan; 3Department of Neurosurgery, An Nan Hospital, China Medical University, Tainan, 70965, Taiwan; 4Department of Neurosurgery, China Medical University Beigang Hospital, Yunlin County, 65152, Taiwan; 5Neurophysiology Laboratory, Department of Surgery, National Cheng Kung University Medical Center and Medical School, Tainan, 70101, Taiwan; 6Department of Neurosurgery, China Medical University Hospital, Taichung, 40447, Taiwan; 7Graduate Institute of Medical Sciences, Chang Jung Christian University, Tainan, 71101, TaiwanCorrespondence: Cheng-Hsin Cheng, Department of Neurosurgery, An Nan Hospital, China Medical University, No. 66, Sec. 2, Changhe Road, Annan District, Tainan City, 70965, Taiwan, Email [email protected] and Importance: This video article reports a rare case of a right L5/S1 foraminal root schwannoma that presents the natural course of the disease, imaging findings, treatment protocol, operative procedure, and highlights some of the possible surgical complications.Clinical Presentation: Magnetic resonance imaging (MRI) revealed an intradural, extramedullary, well-enhanced mass at the right L5/S1 level. The operative procedure involved a right minimal L5/S1 laminotomy/foraminotomy posteriorly to open the right L5 root. The facet joints were preserved to prevent spinal instability. The tumor was located along the root after opening the right L5/S1 foramen. Intraoperative electromyography (IOM) was conducted to detect any nerve injury in the patient. After opening the dura, the tumor was carefully separated from the normal root nerve under IOM monitoring. The mass was removed piece-by-piece using mini-forceps.Conclusion: Histopathological examination confirmed the diagnosis of a schwannoma. The patient recovered without incident after surgery with minimal soreness and numbness in the right leg.Keywords: foraminal sacral root, foraminotomy, intradural extramedullary schwannoma, laminotomy, Schwannoma, spine tumor

Keywords

• foraminal sacral root
• foraminotomy
• intradural extramedullary schwannoma
• laminotomy
• schwannoma
• spine tumor.