Spontaneous resolution of schwannoma?

[perthling]

My wife recently had an episode of what appeared to be a prolapsed intervertebral disc. Her symptoms were almost purely peripheral with casebook L5 distribution. Being a former physiotherapist, and recognising that after 2 weeks her condition had not improved as anticipated (if a PID), we proactively pursued this further.

A nerve root sheath injection under CT was recommended. However during the preliminary CT an abnormality was identified. This was confirmed two days later on MRI and suspected schwannoma on the L5 nerve (10mm diameter, along 17mm length; mostly extraforaminal, not impinging on the spinal cord). Not bad to pick this up in under 3 weeks (as reading the medical literature, it appears cases are generally diagnosed between 4 months and many years).

My wife is currently in constant pain (analgesics reduce but do not alleviate the pain), allodynia / abnormal heightened and altered sensations, no more than 60-90 minutes sleep per night for the last 3 weeks, ambulates with crutches, has significant atrophy of her affected lower limb, unable to work (is being replaced now, hopefully can return as casual when able), unable to care for our darling 3yo daughter, and I'm also losing out on heaps of sleep and falling behind at work.

What surprises me (and I would love to know your thoughts) is the neurosurgeon has recommended conservative management. Admitedly this was in an ED setting and not a normal consult in one's offices. He recommended a 3 month follow up MRI. I challenged him that my understanding was schwannomas are very slow growing, and that a MRI done in October (8 months before) showed no signs at all; as a baseline, this suggests atypical growth rates (not necessarily indicative of anything more sinister, but hard to justify the "wait and see" approach). He revised his recommendation to a 6-8 week follow up, however given her present symptoms and disruption to our lives it still doesn't make sense...

WILL A SYMPTOMATIC SCHWANNOMA SPONTEOUSLY RESOLVE?

That's the only conclusion I can come up with concerning his recommended mode of management and reading between the lines. Reading further in the literature, it seems that resection is the recommended course for symptomatic extramedullary schwannomas, avoiding further growth and potential involvement of the spinal cord. I have not read anything in support of conservative management (except in the case of asmptomatic lesions) nor spontaneous resolution. The only peculiarity I can see that might influence whether a surgical course is taken is a mild sacralisation of the L5 transverse process, but that wouldn't preclude a partial laminectomy(?). Are we right in pushing for a second opinion?

[millelacskay]

I do think that they can collapse but it is rare that it happens. My MRI in Oct. 2011 indicated that my schwannoma was slightly smaller than it was in April 2011 so they thought that it was possibly involuting and recommended waiting 6 months for another MRI to see if it was growing since I was not having any significant symptoms. Now I am having more symptoms and the tumor has increased in size so my NS recommended
surgery which is scheduled for this month. The major concerns were bowel and bladder problems, loss of strength and slight atrophy in my right leg plus pain at night. It seems that it has to be growing and causing significant problems before they will recommend surgery which may be why they want to wait for another MRI. Was her previous MRI with and without contrast? I would think that if they are sure it was not on the first MRI and now it is the size it is in such a short period of time, it would warrant quicker action on their part. Yes, if I were you I would get a second opinion and definitely contact Dr. Jallo. They gave me a prescription for Tramadal which helped a lot for the night pain. Best wishes for a speedy resolution - the waiting seems to be the hardest part.

Kay

[perthling]

Thanks for the comments. Given the rather severe symptoms and major disruption to life, I can't understand any justification (actually, there hasn't been one put forward) to play 'wait and see'. Amy red flag signs (bowel / bladder) definitely shouldn't be ignored.

Quick reply to the other points:
- 1st MRI not done with contrast. No abnormalities noted, so not indicated.
- Unable to take Tramadol ("allergy", let's call it)
- Have managed to attract attention, and have consult with preeminent neurosurgeon (for complex spine) within 2 weeks, which is very good. Hopefully a more clear picture (even of recommendation is to wait) after that.

[kansasmom]

I'd definitely go for more opinions. Have her symptoms progressed since her diagnosis, or are they stable?

[perthling]

Neurosurg consult this coming Tuesday (4 days!). Symptoms (pain and allodynia) intensifying, despite have stepped up medication. No cauda equine symptoms nor absent sensations (just significantly modified) so we find solace in that.

(ps reading your tag line, our experience sounds like a walk in the park. Hope you're getting some answers and results in 2012)

[Beth Primus]

My MRI in 2008 showed no tumors, but I felt the pain and 3 years later I was diagnosed with a good sized shwannoma on T11 and had it removed 1 month later because it was compressing the spinal cord by 1/3 of its size, a couple months later another one was found on the S1 nerve root. I went to the Mayo clinic for genetic testing for shwannomatosis and she said not to remove the second one until I could no longer endure the pain because they have a very high reoccurance rate and I will inevitably have to have it removed many times also, the pain where the first one was never went away even without the tumor there. The doctor said that this is commonly reported but there is no research explaining why. She said the best thing to do was to find a way to manage the pain, which I have not been able to do so far. I go through phases of pain and when the lower one hurts, the spot where the old one was hurts as well. I am frusterated. I don't know if your wife has gone through genetic testing, but in the case of two shwannomas, especially if she is young, there is a good chance that she has it, and a 50% chance that your daughter has inherited it. My blood test came back negative, the Mayo doctor said it probably would and now I have to wait for the tumor to be taken out so they can test that. She said that, although the first tumor grew quickly, that does not mean the second one will.