Coexistence of indural meningioma and schwannoma in different segments of the cervical spine:a case report and literature review

Abstract

Abstract Background:Complications of schwannoma with meningioma in the spinal canal are rare and associated with schwannomatosis. To improve clinicians’ understanding of schwannoma and meningioma coexisting in different cervical spine segments, we analysed the clinical manifestations and diagnostic and therapeutic procedures through a case report and literature review. Case Presentation: The patient was a 54-year-old male with numbness and weakness of the limbs for more than one year, aggravated by difficulty in walking and weak bowel movements for three months. The main clinical manifestation was asymmetric cervical spinal cord compression in the left and right limbs. Magnetic resonance imaging showed a rounded abnormal signal in the spinal canal at the cervical 2 vertebrae level, 1.5–1.7 cm in size, a low-signal shadow in T1-weighted sequences, and a high-signal shadow in T2 fat-suppressed sequences. A nodular abnormal signal 1.3–1.6 cm in size was seen in the cervical canal at the cervical 6–7 vertebrae level. An equal-signal shadow and an abnormal signal were seen in T1-weighted sequences; an equal-signal shadow was also evident in T2-weighted sequences. The T2 fat-suppressed sequences showed uneven and slightly high-signal shadows, all of which compressed the corresponding segments of the spinal cord. The preliminary diagnosis was multiple lesions in the cervical spinal canal. Pathological examination revealed that the mass at cervical level 2 was a schwannoma, and the mass at cervical level 6–7 was a meningioma. High-throughput DNA sequencing showed the patient had mutations in the SMARCB1 and LZTR1 genes. The patient underwent posterior cervical laminectomy, intradural excision of the mass, and fusion with internal fixation. After surgery, the patient’s pain disappeared, and sensation and muscle strength recovered significantly. Conclusions:When a single tumour cannot explain complex signs, clinicians should be alert to the possibility of concurrent tumours. Appropriate decompression and fixation methods should be selected based on a comprehensive assessment of the spinal biomechanics and neurological symptoms of the patient. For symptomatic patients with schwannomatosis, multifaceted interventions should be used to improve their long-term quality of life.