Case of the Week
Section Editors: Matylda Machnowska1 and Anvita Pauranik2
1University of Toronto, Toronto, Ontario, Canada
2BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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February 5, 2015
Cystic Schwannoma of the Cauda Equina
- Spinal schwannomas are usually extramedullary intraspinal or combined intra-extraspinal tumors that arise from the Schwann cells of the sheath of peripheral nerves or spinal nerve roots. They are usually encapsulated and rarely undergo malignant transformation.
- Clinical Presentation: Patients commonly present with pain. Radicular sensory symptoms can also occur. Weakness is less common. Myelopathy may occur if the lesion is large and compresses the cord.
- Key Diagnostic Features
- The imaging appearance will depend on the amount of cystic degeneration the lesion has.
- They appear as well-circumscribed rounded or oval lesions, with the solid component being hypo- to isointense on T1, hyperintense on T2, and enhancing after contrast admisnistration.
- Schwannomas can be associated with hemorrhage, intrinsic vascular changes (thrombosis, sinusoidal dilatation), cyst formation, and fatty degeneration.
- DDx
- Myxopapillary ependymoma
- Paragangliomas may have a similar appearance, but the presence of prominent flow voids secondary to dilated vessels is the key for diagnosing these types of tumors.
- Rx Surgical resection
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