Clinical Profile and Surgical Outcomes of Giant Presacral Schwannomas: A Retrospective Descriptive Study from Tamil Nadu, India

Introduction: Presacral tumours are an extremely rare entity. Schwannomas account for only 3% of tumours in this region. Schwannomas are benign, unifocal and often asymptomatic. Presacral lesions are usually asymptomatic, although a few of these patients may present with compressive symptoms or neurogenic pain. Diagnosis and characterisation of nerve sheath tumours, of which schwannoma is a part, is usually done with Magnetic Resonance Imaging (MRI). Surgical excision is the mainstay of management, although it is associated with high morbidity. Although a few case reports are available, large datasets are sparse. Aim: To study the clinical presentation, imaging features and management of patients who underwent excision of presacral schwannomas. Materials and Methods: The present retrospective descriptive study was conducted in General Surgery Unit-IV in Christian Medical College and Hospital, Vellore, Tamil Nadu, India, from July 2013 to July 2024. All patients above 18 years of age, histopathologically confirmed presacral schwannomas, were identified and included. The demographic profile, presenting symptoms, imaging findings, preoperative assessment, surgical details, postoperative complications, and follow-up were recorded. Descriptive statistics were calculated, with mean and median serving as the measure of central tendency and the standard deviation representing the measure of dispersion. Results: A total of 20 patients were identified with a mean age of 41.3 years (±14.05), with 13 patients being male and the remaining female. Eleven patients presented with pressure symptoms due to direct compression of the pelvic organs. Imaging of choice was MRI in 19 patients. Seventeen patients had preoperative biopsy done, of which 16 were schwannoma and one was neurofibroma. Median largest diameter of these tumours at the time of presentation was 10.55 cm with a range of 6.8 to 25 cm. 19 patients underwent a laparotomy (transperitoneal approach) with intracapsular excision of the tumour. The mean operating time was 2.85 hours (±1.12), with a mean blood loss of approximately 500 mL (±240). 10% of patients developed postoperative neurological deficits. Three patients had neuropathic pain, which settled with medication in the postoperative period. Five patients developed a surgical site occurrence. The mean duration of hospitalisation for these patients was 7.7 days. The mean follow-up period was 27.8 months. 90% (18) of the patients had classical schwannoma on histopathology. Conclusion: Management of large presacral tumours is a daunting task even for the most experienced surgeons. Intracapsular excision of these tumours needs to be considered while planning these operations, based on the possible morbidity profile for these patients.