GIANT SACRAL SCHWANNOMA WITH INTRA-PELVIC EXTENSION - REPORT OF ONE CASE

A 48-year-old woman was admitted for acute urinary retention. Clinical pelvic examination disclosed a voluminous retro-rectal mass. Plain X- rays, pelvic echography, computerized tomography and MRI were all cons istent demonstrating the presence of a 15cm-diameter lesion in the pel vic space with sacral erosion at S3-S4 and extension in the sacral can al up to S2. After a preoperative embolization, the tumor was removed in a two-stage procedure. First, an anterior transabdominal approach d issected the superior and lateral aspects of the tumor. To make easier the intra-abdominal dissection and to avoid any rectosigmoid necrosis , hysterectomy and rectosigmoid section with an end-colostomy were per formed. Lastly, a piecemeal removal of the whole tumor was achieved us ing a posterior approach. At 6 months postoperatively, she recovered a satisfactory urinary control and the cole-rectal anastomosis was then successfully performed. Clinically only a slight hypesthesia of the l eft perineum was present. In the recent literature, 21 cases were desc ribed with similar clinical presentation and similar technical problem s to achieve a complete treatment. In the discussion, details of the s urgical anterior and posterior approaches are given. Before deciding t he most appropriate surgical approach for such a mass, a biopsy is use ful to determine whether total removal is relevant. A preoperative emb olization can help to reduce the duration of the procedure and the los s of blood.