Extensive intramedullary schwannoma of the sub-axial cervical spine – A case report

Spinal schwannomas originate from Schwann cells and as a group represent 30% of spinal cord tumors. These lesions are commonly intra-dural extramedullary in location and in fact purely intramedullary schwannomas of the spinal cord represent only 1.1% of spinal schwannomas. Almost all of these occur in patients with Neurofibromatosis. Approximately 50 cases of intramedullary schwannomas not related to neurofibromatosis have been described to date. This case report gives an account of a young male patient with no family history nor clinical signs of Neurofibromatosis whom presented to out institution with an extensive schwannoma of his sub-axial cervical spinal cord extending from C4-T2. Neurological examination of his upper limbs on manual muscle testing revealed normal shoulder and elbow power 5/5, weakness of wrist dorsiflexion 3/5 and wasting of his intrinsic hand muscles bilaterally also with power 3/5. His lower limb examination revealed an incomplete T4 sensory level with preserved sensation and on manual muscle testing no motor function 0/5 was present. Under neurophysiological monitoring he was taken to theatre where the intra-operative finding of the schwannoma being subpial and intramedullary was confirmed. A gross total resection was achieved and post operatively his upper limb function showed no deterioration and his lower limb function showed improvement. This case report gives an account of a young male patient whom presented to our department with an extensive intramedullary schwannoma of his cervical spine extending from C4-T2. The surgical management resulted in clinical improvement and prevented ascending motor weakness.