Ventral Schwannoma of the Thoracolumbar Spine
A 43-year-old woman suffered lumbago and bilateral leg pain for one month. Neurological examination revealed paresthesia of the dorsal aspects of both legs. Magnetic resonance imaging (MRI) showed a ventrally located intradural extramedullary mass at the level of T12 (). Three-dimensional computed tomography angiography (3D-CTA) revealed that the Adamkiewicz artery (AKA) ran from the L2 foramen to the spinal cord (). The patient was placed in the prone position and treated via the posterior approach. We performed T11 to L3 hemilaminectomy on the left side to expose the dorsal aspect of the spinal cord. After opening the dura mater it was seen that part of the tumor was located at the left ventral side of the spinal cord. We detached the dentate ligament on the left side from the dura mater and gently reflected it to make space ventral to the spinal cord. The tumor capsule, partially exposed by this maneuver, was cauterized and we proceeded to perform internal decompression of the tumor from this corridor using an ultrasonic aspirator. Intraoperatively, motor evoked potentials elicited by the stimulation of nerve roots attached to the tumor capsule identified the upper lumbar nerves as the tumor origin. Sharp dissection of the tumor capsule away from the pia mater of the spinal cord was carried out with ease and total removal of the tumor was achieved with resection of the associated rootlets. Postoperatively, her symptoms improved and she was discharged 10 days after the operation. The pathological diagnosis was schwannoma. Postoperative MRI showed no evidence of a residual tumor ().