Clinical Case
A 42-year-old woman in good general condition came to our centre complaining about a lumbar, a left hip pain and a left foot paraesthesia. She had no prior medical condition and did not assume any drugs.
Diagnostic procedure:
Abdomen and back MRI: presence of a solid heterogeneous mass, originating from the posterior mediastinum on the left (16x11x8,5 cm from D7 to D11). Presence of osteolysis, compression of the dural sac, dislocation of medulla. On the front, the mass touches the posterior part of the left atrium,the left ventricle, the left diaphragmatic pillar, the gastric fundus, the pancreatic tai, the medial margins of the spleen and the left kidney.
TC guided biopsy: the histological report indicates a peripheral nerve sheet tumour: coherent with a Schwann cell tumour.
Multidisciplinary staff meeting: the patient is considered eligible for surgery.
Preoperative work-up:
Aortic AngioCT
Thoraco-lumbar spine MRI
The patient underwent surgical removal of the mass on February 11th 2022.
The surgical intervention was done in steps:
-D11-L1 asportation en bloc with dural sac / D11-L1 en bloc removal including the dural sac
-Thoracotomy in 10° intercostal space, mobilization, en bloc asportation of the mass with afferent ribs and partial diaphragm asportation
Postoperative course:
After 1 night spent in ICU, the patient was awakened and extubated. She came back to our ward the day after. Her sensibility is maintained bilaterally even though she partially lost her ability to move her right leg, but she is gradually improving. Her spinal drainage was closed, and she is not experiencing other neurological symptoms. Her thoracic drainage is in site with clear serous fluid, no air leaks.
