Giant Sacral Schwannoma Treated with a 360 Approach: A Rare Case and Systematic Review of the Literature

World Neurosurg. 2018 Jul;115:65-72. doi: 10.1016/j.wneu.2018.03.203. Epub 2018 Apr 5.


Background: Sacral schwannomas are very rare and typically have a benign nature. They occur in a permissive anatomical location leading to nonspecific symptoms that can result in them going unnoticed before reaching a considerable size.

Case description: We report a rare case of a giant sacral schwannoma (130 × 110 × 90 mm) in a 38-year-old man originating from the S2 nerve root, encompassing the neural canal with sacral erosion and extension in to the pelvis. The patient presented with a history of abdominal pain associated with increased urinary frequency and a sensation of incomplete bladder emptying. Magnetic resonance imaging demonstrated a giant pelvic mass with sacral erosion and involvement of the nerve roots. Subsequently, he went on to have a 2-stage procedure in which complete resection of the schwannoma was achieved by both a posterior hemilaminectomy and laparotomy with the aid of neuromonitoring. The postoperative course was uneventful, with complete resolution of symptoms.

Conclusions: We report one of the largest benign sacral schwannoma originating inside the spinal canal with pelvic extension to be resected without complications. We discuss our successful management and conduct a systematic review of the literature to provide the most up to date guidance on managing this tumor, including the application of neuromonitoring and a 360 approach in 2 stages.

Keywords: Nerve sheath tumor; Neuromonitoring; Sacrum; Schwannoma.

Publication types

  • Case Reports
  • Review
  • Systematic Review

MeSH terms

  • Adult
  • Humans
  • Magnetic Resonance Imaging / methods
  • Male
  • Neurilemmoma / diagnosis
  • Neurilemmoma / surgery*
  • Pelvis / diagnostic imaging*
  • Sacrum / diagnostic imaging
  • Sacrum / surgery*
  • Spinal Neoplasms / diagnosis
  • Spinal Neoplasms / surgery*
  • Tomography, X-Ray Computed / methods