Abstract

Introduction: Spinal schwannomas during pregnancy are exceedingly rare, with most cases occurring as pregnancy-related spinal tumors (PRST). These tumors can appear or become symptomatic within a year of pregnancy. Few reports exist of third-trimester diagnoses, and their management presents unique challenges, including balancing maternal-fetal safety during diagnosis and intervention. Case Presentation: We present the case of a 35-year-old woman at 36 weeks of gestation (G2P1L1) who developed acute bilateral lower limb weakness, rapidly progressing to involve the upper limbs. Neurological examination revealed absent reflexes and sensory loss below T12. MRI without contrast identified an intradural extramedullary lesion, likely a schwannoma, at the C5-D1 level compressing the spinal cord. An emergent lower segment cesarean section (LSCS) was performed, followed by successful tumour resection via C4-D1 laminotomy. Histopathology confirmed ancient schwannoma. Postoperative recovery was gradual, with significant neurological improvement after three months. Discussion: The diagnosis of spinal tumours during pregnancy is often delayed due to symptom overlap with common pregnancy-related conditions. Surgical timing remains a contentious issue, but the literature supports intervention under general anaesthesia as safe during pregnancy when neurological symptoms are rapidly progressing. Our case demonstrates the successful use of a multidisciplinary approach involving obstetricians, anaesthetists, neurosurgeons, and neonatologists to manage maternal and fetal outcomes. Conclusion: Spinal schwannomas in pregnancy, though rare, require early diagnosis and a multidisciplinary treatment approach to optimise maternal and fetal outcomes. Timely surgical intervention can lead to favourable neurological recovery and safe delivery.

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