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Background:   Presacral schwannomas vary greatly in size, and symptomatology. Resections may utilize anterior, posterior, or combined 360-degree approaches.    Case Description:   A 67-year-old female presented with a progressively enlarging presacral schwannoma originating from the S1 nerve root. Here, we utilized a unique all-posterior, trans-sacral tumor resection technique that did not result in any increased neurological deficit, or warrant fusion (e.g., including operative video). Further, we avoided potential urogenital, vascular, and bowel injuries that are associated with anterior approaches to such lesions.    Conclusion:   Here, we described and demonstrated successful resection of a large presacral schwannoma originating from the S1 nerve root that was safely resected utilizing an all-posterior resection without fusion.

Resection of a large presacral schwannoma from an all-posterior trans-sacral approach