The patient came to the clinic 17-December-2012 complaining of LBP for 40 days with left sciatica. MRI lumbar spine performed 25-October-2012 showing a huge mass filling the sacral canal behind S1-3 levels more to the left eroding the bone. The patient is anemic with metrorrhagia with Hb most of the time around 7 mg/dl. The patient was given 4 units of blood until the Hb became 11.5.

On examination: the patient has mild scoliotic stance. SLRS was 40 degrees in the right and 20 degrees in the left side without pain and there is weak planterflexion left foot 4/5. There is hypalgesia of the left S1-2-3-4 roots with diminished sensation in the left perianal region with normal micturition and defecation functions. The KJ and AJ are absent in both sides.

Skeletonization of the sacrum above the S2 and S3 levels. A bony flap was created and kept. The tumor is arising in the left side and due to its huge dimensions, it was hard to tell from which root is originating. Taking into consideration, that the tumor could be schwannoma, an incision was created parallel to the course of the nerves. The tumor was variable in consistency and color. It was removed by piece-meal fashion. There was an upper part of the tumor which was reaching the left S1 root. Fresh frozen section gave the result of schwannoma. After total resection of the tumor the left S2 root was thick  and covering the resected tumor. There is CSF leak from the axilla of S2. Several pieces of muscle was put over the defect and opened wall of the thickened dura of S1 was stitched by nylon 4 zero. It was noted that mild CSF leak is coming out from the epidural fat. For what other pieces of muscle were inserted in the left S1 axilla or lateral to the left S2 axilla. The bone flap returned to place and fixed with Vicryl. Water-tight closure of the wound.

Routine closure of the wound. The power of the left foot became better.

The patient has subclinical manifestations of cauda equina syndrome. The S2-3-4 are involved in the left side clinically, but micturition and defecation are normal.

The schwannoma was originating from the left S2 root reaching the axilla of S1 and pushing down the left S3 root.