Rare Spinal Cord Tumor Removed from a 21 Year Old Girl

Monday, September 21, 2009

In a rare incidence of spinal cord tumour, Doctors at Wockhardt Hospitals,Bannerghata Road,Bangalore, removed a giant shaped tumour from a 21 year old girl’s neck. The team led by Dr. K N Krishna, Senior Consultant, Brain & Spine, Wockhardt Hospitals,Bangalore successfully removed the tumour which is medically known as Crippling Giant Dumbell Nerve Sheath Tumour or Spinal Dumbbell Schwannoma from the girl who was paralysed for more than a year. Spinal Dumbell Schwannoma is a rare disease which afflicts around 3.75 per 10 million people.

Meenakshi, a married lady from Tumkur was complaining of progressive weakness in her limbs which compromised her mobility and was unable to perform simple day to day activities independently. Her tightness in both her legs made her unable to walk without support. She also noticed a gradually increasing swelling on the left side of neck just above the collar bone (clavicle) restricting her neck movement. Weakness in her four limbs crippled her life and she was bedridden for almost a year. Both her legs and one of her hands were totally paralysed,We consultated around 9 hospitals and all of them turned us back saying that there was not much they could do . Finally we landed up at Wockhardt Hospitals,Bangalore ,said Mahesh Krishnamurthy,Meenakshi's brother.

Finally her family brought her to Wockhardt Hospitals. An initial clinical evaluation showed a severe cervical compressive myelopathy and also a large 5cm diameter mass on the left side of neck. MRI of Cervical Spine and Neck showed an Intraspinal / Extradural Tumour on the left side of the neck pushing the spinal cord to the right side. The tumour also extended outwards through the Intervertebral Foramen reaching in front of the neck over like an hourglass shaped Tumour. The Tumor on the left side of her neck was pushing the spinal cord on the right.

According to Dr. K N Krishna, Senior Consultant, Brain & Spine, Wockhardt Hospitals “Dumbbell shaped tumours have been managed as extraordinary tumours in the spinal cord, because of their varied locations, features, clinical symptoms, different from other spinal cord tumours and therefore, their surgical treatment is also different.

In Meenakshi’s case since the tumour was complicatedly placed involving her neck muscles and blood vessels doctors had to decide on the nature of surgery and approach to the tumour. Ideally anterolateral approach that is, from the front of neck on left side would give sufficient access to remove the tumour completely including the intraspinal part but this would also require a fusion by using plate / screws at that level, which would restrict her neck movements and also add significantly to the cost.”

Finally the doctors decided to perform the surgery in two stages. First step involved removal of the intraspinal by approaching from the back of neck, removing the tumour through a minimal access technique which entails about a 3cm incision, removal of bone on only one side to maintain the stability of spine and avoid fusion.

“After few days we planned the anterior approach from the left side of neck after a thorough planning as it had engulfed the vertebral artery within it. First part of this surgery involved identifying and isolating the vertebral artery at its origin under the collar bone, so as to clip it if the engulfed part tears off while removing the tumour. Next the tumour was debunked and separated from the vertebral artery and brachial plexus (plexus of nerves which control the upper limb movements) and removed completely” Dr. Krishna added.

About Spinal Schwanoma Tumor:Spinal Schwannoma is a rare tumour with occurrence of just 2.5 in a million and Spinal Dumbbell Schwannoma is even rarer with 3.75 per 10 million people. Schwannoma originates from the sheath encasing the roots arising from the spinal cord and the cranial nerves leaving the base of skull through various foramina. About 25% of Schwannoma’s are found in the head and neck and also about one third of primary spinal cord tumors are schwannomas.

About 70 to 80% of spinal schwannomas are reported to be intradural in location, and those extending through the dural aperture as a dumbbell mass with both intradural and extradural components account for another 15%. The spinal cord tumors appear more commonly in the thoracic and lumbar spine than the cervical spine. In contrast, the dumbbell tumors are seen most commonly in the cervical spine (44%), followed by the thoracic spine (27%) and the lumbar spine (21%).

Two major unsolved problems with Spinal Schwannomas are high recurrence rate and postoperative cervical deformity especially in teenage patients. An ideal surgical strategy for cervical dumbbell tumor should be able to reduce the recurrence rate and avoid cervical deformity at the same time.

Meenakshi’s recovery was very fast after the surgery.Within a week’s time she was able to walk independently and eat with a spoon and started performing fine motor functions later.


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