gms | German Medical Science

Objective: Certain types of spinal intradural extramedullary tumors may spontaneously change their position with regard to their respective spinal level. In a case report with literature review performed in 2010, twenty published cases of “migrated” intraspinal schwannoma were identified within the literature [1]. In addition to these schwannoma cases, they also found one case of ependymoma and one case of neurenteric cyst. Paraganglioma has not been reported in this context until now.

Methods: A 57 Years old, male patient presented with glutealgia and pseudoradicular bilateral leg pain. The outpatient MRI showed an intraspinal, homogeneously contrast-enhancing tumor, which was considered to be a schwannoma. The tumor had a size of 24x8x12mm and was located at LW 1/2. At the time of surgery, the MRI dated 28 days.

Results: After laminectomy of LW 1, the tumor could not be found intraoperatively despite detailed intradural inspection. After X-ray reconfirmation of the correct operation-level, the intervention was aborted. Another contrast-MRI was performed the following day. The Laminectomy at LW1 was visible as expected. The tumor, unchanged in size, configuration or contrast-enhancement, now resided at LW2/3. The measured drift in caudal direction totaled 43mm. A second operation at the same day concluded with a successful complete resection via LW2-laminectomy. Intraoperatively, the tumor showed some adherence to a structure considered to be a fascicle accompanied by a small arterial vessel, but was otherwise mobile. The histopathologic result presented a paraganglioma, WHO I.

Conclusion: Spine imaging, even when considered "up-to-date", does not provide guarantees for correct operation levels in intradural tumors. This is especially true for, but not limited to spinal intradural schwannoma.