ABSTRACT
Most lumbar intradural schwannomas present initially as radiculopathies with sensory disturbances. However, neurogenic bladder dysfunction may be one of the earliest manifestations and can cause long-term disability. We present the case of a patient with a L3-4 schwannoma (newly diagnosed owing to recurrent urinary retention and urinary tract infection) who finally underwent surgical resection. Improvement of bladder sensation was documented by urodynamic study and the patient was subsequently weaned off her Foley catheter with satisfactory outcome.
Subject(s)
Neurilemmoma/surgery , Spinal Cord Neoplasms/surgery , Urinary Bladder, Neurogenic/surgery , Urinary Catheterization , Urinary Retention/surgery , Aged, 80 and over , Cystography , Female , Gadolinium/administration & dosage , Humans , Laminectomy/instrumentation , Laminectomy/methods , Low Back Pain/etiology , Low Back Pain/surgery , Lumbar Vertebrae , Magnetic Resonance Imaging/methods , Neurilemmoma/complications , Neurilemmoma/diagnostic imaging , Recurrence , Spinal Cord Neoplasms/complications , Spinal Cord Neoplasms/diagnostic imaging , Urinary Bladder, Neurogenic/diagnostic imaging , Urinary Bladder, Neurogenic/etiology , Urinary Retention/diagnostic imaging , Urinary Retention/etiology , Urinary Tract Infections/etiology , UrodynamicsABSTRACT
BACKGROUND AND PURPOSE: Spinal arteriovenous malformations (AVMs) are rare but debilitating lesions of the central nervous system. This study evaluated the outcome in patients with spinal AVMs treated surgically, and the relationship between outcome and the vascular anatomy of the lesions. METHODS: These AVMs were classified into four types: dural AVM (type I), glomus AVM (type II), juvenile AVM (type III), and intradural direct arteriovenous fistula (type IV). Either interruption of the feeding vessels or excision of the AVMs was performed in all patients. RESULTS: Intradural AVMs manifested as subarachnoid or intramedullary hemorrhages, whereas dural AVM manifested as epidural hemorrhage in two patients, and as an episode of subarachnoid hemorrhage in one patient. The nidus in five of the six dural AVMs was below the mid-thoracic level. In six of the seven patients with intradural AVMs, the nidus was located in the cervical region. The prognosis of patients with dural AVMs was generally good, but in patients with intradural AVMs, motor recovery was worse and resection was more difficult. CONCLUSIONS: Correct diagnosis and classification of spinal AVMs are the key prerequisites for successful treatment. The surgical outcome is closely related to the vascular anatomy of the lesion. For dural AVMs, only surgical interruption of the arteriovenous shunting at the dural sleeve of the nerve is required and good surgical results are often obtained. Intradural direct arteriovenous fistula responded well to surgery, whereas combined endovascular and microsurgical techniques can minimize the chance of rebleeding in intramedullary AVMs.