Synchronous quadruple multilevel intradural extramedullary spinal schwannomas without clinical or radiological evidence of NF2: a case report

Background: Schwannomas are the most common benign nerve sheath tumors in the spine. Multiple synchronous spinal schwannomas without clinical or radiological evidence of neurofibromatosis type 2 (NF2) are uncommon and have primarily been described in isolated case reports and small series. Case presentation: A 21-year-old woman from Myagdi, Nepal, presented with 1 year of progressive right shoulder and forearm pain and recent right lower-limb numbness, weakness, and sensory loss below the knee. Spinal magnetic resonance imaging (MRI) revealed four distinct, well-circumscribed, contrast-enhancing intradural-extramedullary lesions at C2, T1, T10, and L2. Brain MRI showed no vestibular schwannoma or other intracranial findings suggestive of NF2; however, mosaic NF2 could not be definitively excluded because molecular testing was unavailable. Single-stage microsurgical resection was performed via multilevel laminectomies. Histopathology confirmed benign schwannomas with strong S-100 positivity. Recovery was uneventful, with complete resolution of radicular pain and significant motor improvement. Distinctive features: This case is notable for four synchronous, non-contiguous intradural extramedullary schwannomas spanning the cervical, thoracic, and lumbar spine in a young adult without clinical or radiological evidence of NF2. All lesions were successfully removed during a single operative session. Conclusion: Multiple spinal schwannomas warrant complete neuraxis imaging, assessment for NF2 and schwannomatosis, and long-term surveillance. Single-stage microsurgical resection may provide effective neural decompression and favorable recovery in appropriately selected patients, although its safety and efficacy cannot be generalized from a single case.