GIANT INTRASACRAL SCHWANNOMAS - REPORT OF 6 CASES

Only 4 of the 30 previously reported cases of giant sacral schwannomas have been studied with Magnetic Resonance Imaging (MRI). We are repor ting 6 more cases, 5 of which had MRI studies. There were 5 women and 1 man (average age 45 years) with long lasting symptoms consisting of lumbosacral and radicular pain accompanied by urinary disturbances and dysaesthetic sensations in the lower limbs. CT clearly defined sacral bone involvement but poorly demonstrated intraspinal tumour extension which was more evident in MRI studies. MRI also clearly showed the in trapelvic extension of the tumour, its relationship with the neighbour ing structures and the dumbell growth pattern due to tumour extension through sacral foramina which are important data for making a properat ive diagnosis and surgical planning. Surgical treatment consisted of p iecemeal tumour resection through a posterior approach in four cases. Two patients underwent operation through an abdominal transperitoneal approach followed by a sacral laminectomy. Total intracapsular resecti on was apparently achieved in 5 cases. Through an average follow-up pe riod of 9.2 years and despite a rather conservative approach, the recu rrence rare has been very low in our series and only one patient had t o be re-operated on for tumour recurrence.