Ancient schwannomas of the spine: a case report and review of confirmed cases

• This study presents one of the youngest reported cases of thoracic spinal ancient schwannoma with histological confirmation. • Comprehensive review of 23 histologically proven spinal ancient schwannomas defines clinical, radiologic, and pathological patterns. • Thoracic predilection, chronic symptom duration, and diagnostic delays are consistent hallmarks of spinal ancient schwannomas. • Gross total resection yields excellent neurological outcomes despite alarming histological atypia mimicking malignancy. We report a rare case of thoracic spinal ancient schwannoma in a young adult and review confirmed spinal cases to highlight key clinicopathological features, imaging findings, surgical approaches, and outcomes, aiming to support accurate diagnosis and management. A 25-year-old male presented with a three-month history of bilateral radicular pain and lower limb paresthesia, progressing to motor weakness. MRI revealed a 2.7 × 1.1 × 1.4 cm intradural-extramedullary cystic mass at the T8 vertebral level, compressing the spinal cord. The patient underwent T8 laminectomy and complete microsurgical excision. Histopathological and immunohistochemical analyses confirmed the diagnosis of ancient schwannoma. A pooled analysis of 23 reported cases was also conducted to evaluate demographics, tumor features, surgical approach, and outcomes. At the six-month follow-up, he showed significant clinical improvement. His ambulatory function improved markedly, and the radicular pain that had been prominent preoperatively had substantially diminished. Neurological examination revealed full motor strength (5/5) in both upper and lower extremities, indicating complete motor recovery. Sensory examination demonstrated residual hypesthesia in the right lower extremity, from the T8 dermatome distally. In 23 reported cases of spinal ancient schwannoma, the mean patient age was 47.2 years with a male predominance (73.9 %) and thoracic spine involvement being most common (43.5 %). MRI typically showed well-defined intradural or paraspinal lesions with degenerative features, and gross total resection was achieved in 95.7 % of cases, primarily via posterior laminectomy. Neurological outcomes were favorable in 78.3 %, with low complication (17.4 %) and recurrence (18.7 %) rates. Spinal ancient schwannomas are rare, benign tumors with nonspecific symptoms and atypical imaging that can mimic malignancy. Despite their alarming histologic features, they behave indolently and respond well to surgical resection. Early recognition based on imaging and histopathology is essential to avoid misdiagnosis and ensure optimal outcomes.