PMC7452436_01
1 - MRI images demonstrated multiple schwannomas at lumbar levels. 2 - left side hemilaminectomy without dissection and maintaining the integrity of the muscles and ligaments on the opposite side. 3 - the schwannomas hidden anterior to the cauda equina nerve roots. 4 & 5 - trEMG for preservation of motor nerve roots.
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T2 and T1 at L1-L3 levels with significant post-contrast homogenous enhancement. The lesions were arranged in a chain along the spinal canal and caused a shift of the conus and the cauda equina roots to the right with significant compression of the roots at the L3 level (see Fig. 1). The schwannomas were hidden anterior to the conus and the cauda equina nerve roots (Fig. 1).
1 - Endoscopic view of the up-seated schwannoma with surrounding structures from inside of spinal canal. 2 - Neurophysiological guidance by spinal roots stimulation. 3 - Sharp dissection of the motor root from schwannoma by diamond knife. 4 - Coagulation of the sensory part of the left L3 spinal root before resection. 5 - Decompressed cauda equina spinal roots after complete removal of the schwannomas.
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During careful dissection and removal of the tumors under neurophysiological guidance for preservation of motor nerve roots, it was found that all schwannomas grew from the sensory part of the same spinal root (Fig. 2). Tumors (in the amount of 6) that were compressing the conus and were densely adherent to the cauda equina roots, were gross total removed (Fig. 2).
1 - H&E stain shows compact (Antony A) in the right and loosely textured (Antony B) areas in the left. 2 - Different nodule - well-formed fibrous capsule and hyalinized blood vessels, H&E, *200. 3 - S100 immunostaining - cytoplasmatic and nuclear stain, *400. 4 - Fibrous capsule collagen stains blue with Masson trichrome special stain (left, *200).
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Pathology study (Fig. 3) demonstrated focally cellular tumors and shown separate well circumscribed nodules with compact (Antony A) and loosely textured (Antony B) areas, focal scant lymphocytic inflammatory infiltration, hyalinized blood vessels.