• Kirubakaran Ragurajaprakash, Junya Hanakita, Toshiyuki Takahashi, Manabu Ueno, Manabu Minami, Yosuke Tomita, Yoshitaka Tsujimoto, and Ryo Kanematsu.
• Department of Neurosurgery, Royal Care Super Specialty Hospital, Neelambur, Coimbatore, Tamilnadu, India. Electronic address: ragurajaprakash@yahoo.com.
• World Neurosurg. 2020 Mar 1; 135: 267-272.

BackgroundSacral schwannomas are rare tumors arising from nerve sheath Schwann cells. They are classified into 3 types: first type schwannoma arising from the sacrum, second type schwannoma eroding the sacrum, and third type schwannoma extending extensively, involving anterior, posterior, and retroperitoneal space. Among these type 2 sacral tumors, according to Klimo's classification, an eroding sacrum extending all over posteriorly, anteriorly, and laterally is still rarer. Only 38 cases have been reported in literature reviews. Only 6 cases of giant tumors of >10 cm in any 1 dimension have been reported.Case DescriptionWe present such a giant sacral schwannoma, with invasiveness eroding the sacrum; compressing the ureters, aortic bifurcation, bladder, and bowel; and presenting as lower abdominal pain, hydronephrosis, dysuria, and constipation. This is the first case reported in the literature that has described a large retroperitoneal tumor compressing retroperitoneal structures-aortic bifurcation vascular compression and ureter compression causing hydronephrosis.ConclusionsThough complete resection, which caused various severe postoperative complications in the reported cases, is the best option, a less morbid procedure would be appropriate; hence we underwent subtotal excision of the tumor, with complete recovery of our patient's symptoms without neurologic deficit.Copyright © 2019 Elsevier Inc. All rights reserved.

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