Clinical, Radiological, and Surgical Insights into Sciatic Schwannoma: A Rare Peripheral Nerve Tumour

Abstract

This case report describes the clinical presentation, radiological findings, surgical management, and postoperative outcomes of a patient with sciatic schwannoma, emphasising the importance of early diagnosis and nerve-preserving surgical excision for optimal functional recovery. A 44-year-old man presented with a one-year history of progressive dull, aching pain in the posterior right thigh, radiating to the leg and foot, associated with numbness and aggravated by prolonged sitting. Neurological examination revealed a positive Tinel's sign, and the pain score was 7 on the Visual Analogue Scale (VAS). Contrast-enhanced MRI revealed a 49 × 43 × 34 mm encapsulated sciatic nerve tumour suggestive of a schwannoma. Following routine preoperative evaluation, microsurgical intracapsular excision was performed with preservation of the nerve fascicles. Histopathological examination confirmed a benign schwannoma. The patient experienced complete symptomatic relief without neurological deficit; the VAS score improved to 3, and no recurrence was observed during the one-year follow-up. This case highlights the value of considering sciatic schwannoma in persistent atypical sciatica and illustrates the roles of magnetic resonance imaging and nerve-preserving microsurgical excision in its diagnosis and management.