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Neurofibromas and schwanommas may arise at any level in the spinal cord, typically, from the posterior nerve roots. They lie extramedullary - within the spinal canal but outside the spinal medulla - and are slowly growing and benign.
Presentation is of a slowly advancing spastic paraparesis with a unilateral band of pain and distorted sensation at the level of the lesion.
Cafe au lait spots may be seen in the skin with neurofibromas because of their are association with multiple neurofibromatosis. Schwannomas tend to be most common in the 30-60 age group.
Occasionally, the tumour may 'dumbbell' through the intervertebral foramen and present as a mass in the thorax or posterior vertebral wall, readily seen on chest x-ray.
They are readily demonstrated by myelography or MRI. CT will delineate any extraspinal extension.
Complete operative removal is feasible but at the sacrifice of the nerve root at the origin of the lesion. Neurological deficit is minimised by overlap from adjacent nerve roots.