814 - Dorsal Root Ganglia Nerve Stimulator Therapy in the treatment of a Pain secondary to Peripheral Nerve Sheath Schwannoma

Thursday, February 22, 2024

5:00 PM – 6:30 PM EDT

Presenting Author(s)

SD

Sabrina Dunn, MD student

Medical Student
Jacobs School of Medicine and Biomedical Sciences (SUNY BUFFALO)
Buffalo, New York, United States

Co-Author(s)

MF

Michael Farrell, DC, MD

Interventional Pain Management Physician
Erie County Medical Center
Buffalo, New York, United States
MC

Michael Cicchetti, MD

Spine and Sports Medicine
Buffalo Spine and Sports Medicine
Williamsville, New York, United States

Case Diagnosis: Peripheral Nerve Sheath Schwannoma

Case Description: M.S. is a 85-year-old woman with a two-year history of neuropathic pain along the S1 dermatomal distribution in the right lower extremity. Her symptoms have decreased her ability to stand and sit without pain severely limiting her function. MRI of the pelvis demonstrated two soft tissue masses along the sciatic nerve believed to be schwannomas. Due to a lack of improvement with other conservative medical interventions, she was determined to be a candidate for a trial of Dorsal Root Ganglia stimulator therapy at the S1 level.

Discussions: Shwannomas are a rare tumor of the myelin sheath in peripheral nerves. Typically sporadic and asymptomatic, these tumors can grow to compress on the encapsulated nerve, eventually causing symptomatology. If symptoms are severe or there is rapid growth suggestive of malignancy, neurosurgical resection is the prototypical intervention. However, surgery is not perfect, nor without risk. Success rates with complete resection vary based on etiology, with an 82% rate in those with NF2-related schwannomatosis, and 92.5% in spontaneous tumors. The rate of postoperative new neurological deficits is approximately 15.2%. Conversely, the rate of adverse events in Dorsal Root Ganglia Nerve Stimulator is less than one percent, and only 8% of those are new neurological symptoms. With this knowledge, the next step is to study the implementation of Dorsal Root Ganglia Stimulator Therapy for benign Shwannomas and compare outcomes to invasive surgical interventions.

Conclusions: The Purpose of this trial is to observe the functional outcomes from a novel treatment regimen for a peripheral nerve schwannoma. We are exploring how Dorsal Root Ganglia Stimulator Therapy can improve function and pain in those with Peripheral Schwannomas. This stimulation trial is awaiting insurance approval, but pathophysiology and current literature suggest that this intervention will have promising results.