MANIFESTASI KLINIS DAN KELUARAN SCHWANNOMA SPINALIS Desi Setiowati*, Dwi Pudjonarko**, Gunadi Koesnarto***

Latar Belakang Schwannoma merupakan tumor ekstrameduler yang paling sering ditemukan (29%). 1 Penyakit ini dapat ditemukan pada semua golongan usia terutama pada dekade ke 4-6, dan pada semua jenis kelamin. 2 Predileksi schwannoma terbanyak di regio torakal (55%), diikuti regio servikal (25%), dan regio lumbosakral (20%). 3 Sebagian kecil tumor intradural ekstrameduler (2,5%) dapat berkembang menjadi ganas.2 Diagnosis ditegakkan berdasarkan gejala klinis, pemeriksaan radiologis dan patologi anatomi. 1,2,3,4 Manifestasi klinis dari tumor spinal tersebut terutama akibat dari penekanan pada medulla spinalis, yang akan menimbulkan gangguan motorik, sensorik, maupun otonom.1,2,3,4 Tujuan Serial kasus ini bertujuan untuk melaporkan manifestasi klinis dan keluaran penderita schwannoma spinalis yang dirawat di RS Dr. Kariadi Semarang. Laporan Kasus Dilaporkan enam penderita schwannoma spinalis di RSDK dengan manifestasi klinis dan keluaran yang berbeda. Usia penderita antara 34 sampai 54 tahun, empat di antaranya berjenis kelamin perempuan. Lokasi lesi di regio thorakal (empat orang), servikal (satu orang), dan lumbosakral (satu orang). Gangguan motorik didapatkan berupa paraparesis inferior spastik (empat orang), tetraparesis inferior spastik (satu orang), dan paraparesis inferior flaksid (satu orang). Lima penderita mengeluh hipestesi, sedangkan satu penderita parestesi. Gangguan otonom didapatkan pada satu penderita berupa inkontinensia uri, retensio alvi dan disfungsi ereksi. Seluruh penderita dilakukan operasi laminektomi disertai pemeriksaan patologi anatomi. Gambaran maligna ditemukan pada satu penderita sehingga dilanjutkan dengan pemberian terapi radiasi eksterna. Seluruh penderita menunjukkan perbaikan klinis pasca operasi Kesimpulan Schwannoma merupakan tumor intradural ekstrameduler yang terjadi pada semua jenis kelamin dan terutama pada usia 30-60 tahun. Tumor ini pada umumnya jinak, dan menunjukkan perbaikan klinis pasca operasi.

Kata kunci : schwannoma, tumor, medulla spinalis

* Residen Departemen Ilmu Penyakit Saraf Fakultas Kedokteran Universitas Diponegoro / RS Dr Kariadi Semarang ** Staf Pengajar Departemen Ilmu Penyakit Saraf Fakultas Kedokteran Universitas Diponegoro / RS Dr Kariadi Semarang ** Staf Pengajar Departemen Bedah Saraf Fakultas Kedokteran Universitas Diponegoro / RS Dr Kariadi Semarang

THE CLINICAL MANIFESTATIONS AND OUTCOMES OF SPINAL SCHWANNOMA Desi Setiowati*, Dwi Pudjonarko**, Gunadi Koesnarto***

Background Schwannomas are the most frequent extramedullary tumors (29%).1 These tumors can present in all age groups, most commonly in the fourth through six decades of life, and man and woman are equally affected .2 The most predilection of schwannomas is in thoracal region (55%), the remaining affecting cervical (25%), and lumbosacral region (20%).3 Rarely, these intradural-extramedullary tumors (2,5%) are malignant.2 Diagnose can be established by means of clinical manifestations, radiographic and anatomical-pathologic examinations.1,2,3,4 The clinical manifestations of these spinal tumors are commonly arised from spinal cord compression, that lead to motoric, sensibility and autonomic disorders.1,2,3,4 Objective This serial cases is aimed to report the clinical manifestations and outcomes of spinal schwannoma patients hospitalized in Dr. Kariadi Hospital Semarang. Case Report We report six spinal schwannoma patients in RSDK with different clinical manifestations and outcomes. The age are 34 through 54 years old, and four of them are women. Lesion distribution of the tumors was in thorakal (four patients), cervical (one patient), dan lumbosacral region (one patient). The motoric disorders comprised of spastic inferior paraparese (four patients), spastic tetraparese (one patient), and flaccid inferior paraparese (one patient). Five patients felt hipesthesia, while one felt paresthesia. Autonomic disorders, comprised of urinary incontinence, bowel retention and impotence, found in one patient. Laminectomy surgical were held to all of the patients, followed by anatomical-pathologic examination. Malignancy was found in one patient, needed external radiation therapy. All of the patients reported improvement of their clinical conditions after having operation. Conclusion Schwannomas are intradural-extramedullary tumors present in all sex groups and mostly in 30 through 60 years old of age. These tumors are commonly benign, and show clinical improvement after surgery.

Keywords: schwannoma, tumor, spinal cord

* Resident of Neurology Department, Medical Faculty Diponegoro University / Dr Kariadi Hospital Semarang ** Lecturer of Neurology Department, Medical Faculty Diponegoro University / Dr Kariadi Hospital Semarang *** Lecturer of Neurosurgery Department, Medical Faculty Diponegoro University / Dr Kariadi Hospital Semarang