Gross-total resection of a large conus-region intradural extramedullary schwannoma with dense adhesion: Operative video and 11-year follow-up

Background: Large conus-region tumors may be difficult to remove when the tumor-conus interface is indistinct and dense adhesion to the conus/rootlets is present. Case Description: A 47-year-old male with 4 years of leg pain and bladder dysfunction rapidly deteriorated to wheelchair dependence over 1 week. Magnetic resonance imaging showed a large thoracolumbar intradural extramedullary mass with an unclear interface with the conus. Emergency T12-L2 laminectomy was performed. After internal decompression, meticulous sharp dissection along the tumor-neural interface with preservation of surface microvasculature enabled identification of the root of origin and gross-total resection. Pathology confirmed schwannoma. Motor function recovered and he returned to work within 1 month, but sphincter dysfunction persisted. No recurrence was noted at 11 years. Conclusion: A stepwise strategy - sharp interface dissection with vascular preservation - can facilitate safe gross-total resection of large conus-region tumors despite dense adhesion or an ill-defined interface.