A Multidisciplinary Approach to Managing Pregnancy-Associated Spinal Schwannoma: Case Report of Neurological and Obstetric Challenges with Surgical Management

Abstract

Spinal schwannomas are rare during pregnancy and pose unique diagnostic and therapeutic challenges, as their symptoms may mimic common gestational complaints. We report the case of a 28-year-old woman, gravida 3 para 2, who presented at 33 weeks + 1 day of gestation with progressive left lower limb weakness.
Magnetic resonance imaging (MRI) performed at 33+5 weeks revealed an extradural tumor at the D9 vertebral level, causing significant spinal cord compression. A multidisciplinary team—including obstetrics,  eurosurgery, anesthesiology, and neonatology—developed a sequential management strategy. At 34 weeks gestation, the patient experienced spontaneous preterm premature rupture of membranes. Labor was induced using a Foley catheter, and she delivered a healthy female infant weighing 2.15 kg, with Apgar scores of 7 and 8 at one and five minutes, respectively. At 34+4 weeks, she underwent D9 laminectomy and complete tumor excision under
general anesthesia. Histopathological examination confirmed a benign schwannoma. Postoperatively, her neurological deficits improved markedly, and by day 11 she had regained near-normal strength in her lower limbs. This case underscores the importance of early recognition of neurological deficits during pregnancy, the utility of MRI for timely diagnosis, and the critical role of multidisciplinary collaboration. Individualized planning and well-coordinated obstetric and neurosurgical interventions can lead to favorable outcomes for both mother and child in these rare but high-risk clinical situations.