Giant Sacral Schwannoma Causing Bilateral Hydronephrosis: Case Report and Review of the Literature.

Abstract

Giant sacral schwannomas are very rare, and less than 1%-5% of spinal schwannomas are found in the sacral region. These frequently grow to considerable size because of permissive anatomic location and benign, slow growth of tumor. They can be unnoticed before reaching a huge size. We report a rare case of a giant sacral schwannoma in a 46-year-old man. The patient presented with difficulty in passing urine, episodic constipation, and swelling of the right lower extremity for 6 months. Magnetic resonance imaging revealed 160 x 110 x 110 mm encapsulated heterogenous solid mass originated from left S1 spinal nerve extending into the pelvis and abdomen. Sigmoid colon and rectum were displaced to the right side, and bladder was displaced anteriorly. Left side of the S1 and S2 vertebral bodies, left S1 and S2 neural foramen were also eroded. It also compressed ureters causing bilateral hydronephrosis. The patient underwent a 2-stage procedure in which complete resection was achieved. We report the second case of a completely resected giant sacral schwannoma with bilateral hydronephrosis in the literature. Performing a 2-stage procedure is important in giant sacral schwannomas. Morbidity can be minimized, and extent of resection can be maximized with the help of combined anterior/posterior approach.