Management of presacral schwannomas—a 10-year multi-institutional series

Presacral or sacral schwannomas are relatively rare clinical entities thought to account for only 1 in every 40,000 hospitalizations. These lesions are benign, frequently monofocal, and arise from the exiting sacral nerve roots. Lesions are often asymptomatic, but may present with bulk symptoms (constipation, urinary frequency), sciatica, lower extremity weakness, and para-axial lumbosacral pain. At present, the treatment of choice for these lesions is gross total resection, with an approach dictated by the size of the intrasacral component. Despite numerous isolated case reports, few case series exist. Of those extant series, none are multi-institutional and only a handful describe multiple alternative approaches for the treatment of these tumors. Here we describe a series of seven patients treated at two tertiary care centers for sacral schwannoma with post-operative follow-up as far as 6 years