Solitary Thoracic Intramedullary Schwannoma Report of Two Cases

Abstract

Schwannomas are the most common tumors of the spinal cord. Nevertheless, sporadic intramedullary location of this entity is a very rare condition. We present two cases of solitary thoracic intramedullary schwannoma, located at the T6 and T10 levels respectively, in patients without evidence of Von Recklinghausen's disease. Two males, 71 and 51 years old respectively, presented with signs and symptoms of progressive thoracic myelopathy. In both cases, magnetic resonance imaging disclosed a spinal cord tumor, located at T6 and T10 levels respectively. Both patients were treated surgically. Patient 1 underwent an operation via a posterolateral extrapleural approach. The second patient was submitted to surgical resection of the tumor via a posterior approach. In both patients, total excision of an intramedullary lesion was achieved and histological and immunohistochemical findings were consistent with a typical schwannoma. Postoperative magnetic resonance imaging demonstrated no evidence of residual tumor in either case. The first patient is currently symptom-free and neurologically intact, almost five years after surgery. About one year after operation, patient 2 presents nearly complete resolution of his motor and sensory disturbances. Solitary intramedullary schwannomas are rare. Controversy remains regarding the origin of these tumors. In the majority of the cases, intramedullary schwannomas are benign, non-infiltrating tumors, hence amenable to aggressive surgery. Radical excision remains the gold standard in the treatment of such lesions.