Microsurgical management of spinal schwannomas: evaluation of 128 cases
ABSTRACT The authors conducted a study to evaluate the clinical characteristics and surgical outcomes in patients with spinal schwannomas and without neurofibromatosis (NF).
The data obtained in 128 patients who underwent resection of spinal schwannomas were analyzed. All cases with neurofibromas and those with a known diagnosis of NF Type 1 or 2 were excluded. Karnofsky Performance Scale (KPS) scores were used to compare patient outcomes when examining the anatomical location and spinal level of the tumor. The neurological outcome was further assessed using the Medical Research Council (MRC) muscle testing scale.
Altogether, 131 schwannomas were treated in 128 patients (76 males and 52 females; mean age 47.7 years). The peak prevalence is seen between the 3rd and 6th decades. Pain was the most common presenting symptom. Gross-total resection was achieved in 127 (97.0%) of the 131 lesions. The nerve root had to be sacrificed in 34 cases and resulted in minor sensory deficits in 16 patients (12.5%) and slight motor weakness (MRC Grade 3/5) in 3 (2.3%). The KPS scores and MRC grades were significantly higher at the time of last follow-up in all patient groups (p = 0.001 and p = 0.005, respectively).
Spinal schwannomas may occur at any level of the spinal axis and are most commonly intradural. The most frequent clinical presentation is pain. Most spinal schwannomas in non-NF cases can be resected totally without or with minor postoperative deficits. Preoperative autonomic dysfunction does not improve significantly after surgical management.
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ABSTRACT: A retrospective study. To assess the case files of patients who underwent surgery for cervical dumbbell schwannoma for determining the differences between schwannomas of the anterior and posterior nerve roots with respect to the incidence of postoperative radicular dysfunction. The spinal roots giving origin to schwannoma are frequently nonfunctional, but there is a risk of postoperative neurological deficit once these roots are resected during surgery. Fifteen patients with cervical dumbbell schwannomas were treated surgically. Ten men and 5 women, who were 35-79 years old (mean age, 61.5 years), presented with neck pain (n=6), radiculopathy (n=10), and myelopathy (n=11). Fourteen patients underwent gross total resection and exhibited no recurrence. Follow-ups were performed for a period of 6-66 months (mean, 28 months). Preoperative symptoms resolved in 11 patients (73.3%) but they persisted partially in 4 patients (26.7%). Six patients had tumors of anterior nerve root origin, and 9 patients had tumors of posterior nerve root origin. Two patients who underwent total resection of anterior nerve root tumors (33.3%) displayed minor postoperative motor weakness. One patient who underwent total resection of a posterior nerve root tumor (11.1%) showed postoperative numbness. Appropriate tumor removal improved the neurological symptoms. In this study, the incidence of radicular dysfunction was higher in patients who underwent resection of anterior nerve root tumors than in patients who underwent resection of posterior nerve root tumors.Asian spine journal 04/2015; 9(2):263-270. DOI:10.4184/asj.2015.9.2.263.
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ABSTRACT: Retrospective case series. The objectives of this study were to determine and discuss the surgical planning of patients who underwent operations following diagnoses of thoracal and lumbar spinal schwannomas. We also aimed to discuss the application of unilateral hemilaminectomy for the microsurgery of schwannomas. Schwannomas are located in different regions and sites. These differences require several surgical approaches. Unilateral laminectomy without stabilization of the spine provides a more minimally invasive removal of the tumor. In this retrospective study, 15 patients with spinal schwannomas were evaluated with regards to age, sex, onset history, neurological findings, tumor locations, McCormick scale, surgical procedure, and operational results. The lateral approach provides exposure of intradural structures and posterior paraspinal regions. Extensions of tumors cause problem for the surgeon in terms of approach, resectability of the tumor, and stability of the spine. Gross total resection was achieved in all cases, and none of the patients necessary required a fusion procedure. Five patients were males and 10 were females. The age interval was 29-65 years. The tumor was located in the lumbar region in 9 patients, in the thoracic region in 2 patients, and in the thoracolumbar junction in 4 patients. The intradural lesions were removed by laminectomy and the extradural lesions were resected with hemilaminectomy. The paramedian route was used to explore the extraspinal part of the tumor. Costotransversectomy was for the thoracic region. Subtotal resection was performed in 1 patient. Patient symptoms recovered gradually in the postoperative period. Resection of giant schwannomas is challenging and usually requires a different approach. We describe the complete resection of complex dumbbell or paraspinal schwannomas of the thoracic and lumbar spine by unilateral hemilaminectomy.Asian spine journal 03/2012; 6(1):43-9. DOI:10.4184/asj.2012.6.1.43
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ABSTRACT: This study aims to evaluate the hemilaminectomy approach and in situ restoration of vertebral laminae in microsurgery for thoracic intraspinal tumors. MATERIAL and METHODS: Sixteen patients with thoracic intraspinal tumors, consisting of 6 males and 10 females with a mean age of 47.5±16.4 years ranging from 21 to 71 years, underwent surgical treatment with hemilaminectomy approach and in situ restoration of vertebral laminae. All patients were followed up after surgery for 12 to 30 months, involving Frankel grade, spinal instability, and deformity. Mean operation time was 119.5±23.0 minutes. Laminotomy was performed with one vertebral plate in 2 cases, two vertebral plates in 12 cases, and three vertebral plates in 2 cases. Postoperative three-dimensional CT scanning revealed a stable bony reconstruction, and no cerebrospinal fluid leakage or subcutaneous hydrops. Surgical pathology was consistent with preoperative MRI diagnosis. With respect to neurological status, the percentage of good Frankel scale was markedly improved from 37.5% on admission to 81.3% at follow-up (p < 0.05). None of the subjects showed spinal deformity or instability. In situ restoration of vertebral laminae maximally preserves the spinal integrity and stability, and reduces postoperative complications including cerebrospinal fluid leakage, pseudomeningocele, spinal deformity, and instability.Turkish neurosurgery 09/2013; 23(5):630-638. DOI:10.5137/1019-5149.JTN.7859-12.0 · 0.53 Impact Factor