Microsurgical resection of a giant thoracolumbosacral Schwannoma in an adolescent with intraoperative neuromonitoring and anatomical laminoplasty reconstruction

Spinal schwannomas represent benign neoplasms arising from spinal nerve root sheaths, predominantly occurring in the cauda equina region. By reviewing this case and literature, our aim was to highlight the diagnostic and therapeutic considerations in managing such rare and challenging cases in the pediatric population. We present an exceptional pediatric case of a giant thoracolumbosacral schwannoma with multi-root involvement, neuroimaging revealed a 36-cm intradural mass extending from T10 to the coccyx, representing the longest documented spinal schwannoma to date. Taking into account the patient’s previous cervical spinal canal meningioma surgical history, the coexistence of a schwannoma added complexity to the preoperative diagnosis. Under intraoperative neurophysiological monitoring (IONM), multi-level laminectomy with anatomical reconstruction and tumor resection from T10 to S4 was performed. The pathological result confirmed it to be a schwannoma. The coexistence of two types tumors within the spinal canal is rare, in addition to MRI scans, pathological diagnosis is gold standard at this time, and surgery is still the preferred option.