Cervical intradural intramedullary collision tumor of schwannoma and hemangioblastoma origin
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How to cite this article: Singh R, Kalani M. Cervical intradural intramedullary collision tumor of schwannoma and hemangioblastoma origin. Surg Neurol Int 2021;12:155.
Primary spinal tumors are rare benign lesions that represent around 2–4% of all central nervous system neoplasms.[1,2] Intradural intramedullary tumors are predominately glial in origin and are most commonly astrocytomas or ependymomas. Intradural extramedullary tumors, on the other hand, are usually neurofibromas, schwannomas, or meningiomas. Here, we report the case of an intradural intramedullary collision tumor of schwannoma-hemangioblastoma origin.
A 61-year-old female presented with a 2-year history of the right arm numbness, weakness, and tingling. She reported some lower extremity numbness but an otherwise normal neurological examination. She had a prior carpal tunnel release that did not alleviate her symptoms. Noncontrast MRI of the cervical spine demonstrated a holocord syrinx from C2 to C7 and spondylolisthesis from C4 to C5. MRI with contrast then displayed an enhancing nodule behind the vertebral body of C4. A standard posterior approach and subperiosteal dissection were performed. Lateral mass screws were placed at C3-C5, and the laminectomy was performed en bloc. Intraoperative ultrasound was used to locate the lesion, and intraoperative dorsal column mapping was used to identify the midline before performing a midline myelotomy. The arachnoid over the lesion was opened and an extracapsular dissection was performed. Hemostasis was obtained, and a watertight dural closure was performed.
The patient tolerated the procedure well and achieved relief from cervical myelopathy symptoms. Pathology indicated positive biomarkers for S-100, SOX10, and NSE indicating a schwannoma hemangioblastoma collision tumor. This is unusual in its nature given two benign lesions with differing underlying cell types of origin.
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