A purely midline ventral schwannoma mimicking a meningioma in the thoracic spine resected via costotransversectomy

Hsiang-Yi Hung^a, Tzu-Yung Chen^{b, c}, Ming-Hsun Li^d, Shin-Yuan Chen^{a, c}, Sheng-Tzung Tsai^{a, c}

^a Department of Neurosurgery, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
^b Department of Neurosurgery, Buddhist Tzu Chi General Hospital, Taichung, Taiwan
^c School of Medicine, Tzu Chi University, Hualien, Taiwan
^d Department of Pathology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan

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Abstract
Spinal schwannomas are intradural nerve sheath tumors typically located in a dorsolateral or ventrolateral position. Clinical presentations vary from radicular root pain to cord compression myelopathy. Prognosis is usually benign if the tumor can be removed safely. A 62-year-old man had myelopathy and incontinence due to a midline ventral intradural-extramedullary tumor of the thoracic spinal cord. Magnetic resonance imaging demonstrated that the tumor was movable and connected with one root. The tumor was removed with a unilateral costotransversectomy with a posterior approach. Histological diagnosis revealed a schwannoma. Magnetic resonance imaging is a prerequisite to differentiate a ventral and midline intradural spinal schwannoma from other tumors preoperatively. A posterior approach is an efficient and effective method of treating a purely ventral thoracic schwannoma with significant cord compression.

Keywords
Schwannoma; Spinal cord; Surgery