A case is presented of acute spinal cord compression by a thoracic dumbbell spinal schwannoma in a young woman with neurofibromatosis type 1 (NF-1). A successful outcome was achieved with total excision of the lesion and decompression of the spinal cord. Greater recognition of the reversibility of spinal cord compression in the developing world is necessary to reduce major permanent morbidity.
Adult ; Female ; Human ; Neurilemmoma - complications ; Neurilemmoma - surgery ; Spinal Cord Compression - etiology

The Southern Highlands were first discovered and explored by Europeans in the 1930s. The first patrols led by Lloyd Yelland, a medical assistant, assessed the health of the population in the early 1950s. Thereafter, Tari Hospital was built in 1954 and first staffed by medical assistants. The first medical officer, Roger Rodrigue, was not stationed there until 1959. He performed minor operations with local or general anaesthetic using ether. The first surgeon to operate there – Bill Ramsey (1967-1968) – did so under the auspices of the Leprosy Mission. The first nurse was Judith Wilson posted in 1970. By 1972, the hospital had 100 inpatients, saw 50 outpatients a day and had a staff complement of 9 trained nurses and a matron. A research station was set up in the Tari Basin, which eventually came under the Papua New Guinea Institute of Medical Research (PNGIMR) in Goroka. In the 1970s Ian Riley (later a Professor of Public Health) and his wife, an anaesthetist, were based in Tari, studying pneumonia and pneumococcal vaccines, and managed emergency cases including trauma and caesarean sections. Stephen Flew, now a general practitioner in Northern Victoria, was superintendent of the hospital from 1989 to 1993, whilst Tim Dyke FRCS Edin was based at the PNGIMR in Tari. They offered a significant surgical service, again largely based on emergency presentations. Their tenure resulted in a number of publications and conference presentations on surgical topics, largely related to trauma. After Dyke, the hospital had no surgeon until 2007, largely due to political reasons. Médecins Sans Frontières (MSF) were invited to provide surgical services in 2009, and even in 2013 there was still no government-funded surgeon at Tari Hospital. The MSF surgical audit data in 2010-2011 showed that more than 90% of surgical cases seen at Tari Hospital required emergency surgery, most of which resulted from trauma. More than half of the trauma procedures were classified as major.