In this video, we highlight the anatomy involved with microsurgical resection of a giant T11/T12 conus cauda equine schwannoma. Spinal schwannoma remains the third most common intradural spinal tumor. Tumors undergoing gross total resection usually do not recur. To our knowledge, this is the first video case report of giant cauda equina schwannoma resection. A 55-year-old female presented with paraparesis and urinary retention. Lumbar spine MRI revealed contrast-enhancing intradural extramedullary tumor at the T11/T12 level. Surgery was performed in a prone position with intraoperative neurophysiology monitoring (somatosensory and motor evoked potentials - SSEP and MEP). T11/T12 laminectomies were performed. After opening the dura and arachnoid, the tumor was found covered with cauda equina nerve roots. We delineated the inferior pole of the tumor, followed by opening of the capsule and debulking the tumor. Subsequently, the cranial pole was dissected from the corresponding cauda equina nerve roots. Finally, the tumor nerve origin was identified and divided after nerve stimulation confirmed the tumor arose from a sensory nerve root. The tumor was removed; histological analysis revealed a schwannoma (WHO Grade I). Postoperative MRI revealed complete resection. The patient fully recovered her neurological function. This case highlights the importance of careful microsurgical technique and gross total resection of the tumor in the view of favorable postoperative neurological recovery of the patient. Intraoperative use of ultrasound is helpful to delineate preoperatively tumor extension and confirm postoperative tumor resection.

中文翻译：

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显微外科切除巨大 T11/T12 马尾圆锥神经鞘瘤。


在本视频中，我们重点介绍了显微手术切除巨大 T11/T12 马尾圆锥神经鞘瘤的解剖结构。脊柱神经鞘瘤仍然是第三种最常见的硬膜内脊柱肿瘤。接受全切除术的肿瘤通常不会复发。据我们所知，这是首例巨大马尾神经鞘瘤切除的视频病例报告。一名 55 岁女性因下肢轻瘫和尿潴留就诊。腰椎 MRI 显示 T11/T12 水平硬膜内髓外肿瘤增强对比。手术以俯卧位进行，并进行术中神经生理学监测（体感和运动诱发电位 - SSEP 和 MEP）。进行了 T11/T12 椎板切除术。打开硬脑膜和蛛网膜后，发现肿瘤上布满了马尾神经根。我们描绘了肿瘤的下极，然后打开胶囊并减灭肿瘤。随后，将颅极与相应的马尾神经根分离。最后，在神经刺激确认肿瘤起源于感觉神经根后，识别并划分肿瘤神经起源。肿瘤被切除；组织学分析显示神经鞘瘤（WHO I 级）。术后MRI显示完全切除。患者的神经功能完全恢复。该病例强调了仔细的显微手术技术和肿瘤全切除术对于患者术后神经功能良好恢复的重要性。术中使用超声有助于术前勾画肿瘤范围并确认术后肿瘤切除。