[Surgical Resection of a Giant Schwannoma of the L4 Nerve Root via Retroperitoneal Approach in Collaboration with Vascular Surgery. A Case Report].

UNLABELLED: The incidence of spinal schwannomas ranges from 0.3 to 0.4 cases per 100,000 people. They account for approximately 25% of intradural spinal cord tumors in adults. Most are solitary, encapsulated, and firm, composed predominantly of neoplastic Schwann cells. Microscopically, they are characterized by high cellularity and a relative lack of Antoni B pattern.

CASE DESCRIPTION: A 33-year-old male presented with axial low back pain, dysesthesia in the right L4 dermatome, and difficulty standing. Magnetic resonance imaging revealed a well-defined right paravertebral mass measuring 46×34×52 mm, extending into the right foraminal canal at the L4-L5 level.

CASE DISCUSSION: Complete tumor resection was performed via an anterolateral retroperitoneal extraforaminal approach. The procedure was carried out jointly by a multidisciplinary team of neurosurgery and vascular surgery. The vascular surgeon ensured safe retroperitoneal exposure by identifying and carefully mobilizing major vascular structures, facilitating access to the tumor, while the neurosurgeon performed tumor dissection with preservation of neural structures. Histopathological analysis confirmed a schwannoma with positive staining for S100 and SOX10, and a Ki-67 index of 2%. The patient experienced local pain and transient dysesthesias, which gradually improved over the following days.

CONCLUSION

Successful management of schwannomas in atypical locations requires a multidisciplinary surgical approach. In this case, close collaboration between neurosurgery and vascular surgery was essential to achieve a complete and safe resection without intraoperative complications.