Microsurgical management of non-neurofibromatosis spinal schwannoma

Altaş, Murat; Çerçi, Ajlan; Sılav, Gökalp; Sarı, Ramazan; Coşkun, Kenan; Balak, Naci; Isik, Nejat; Elmacı, İlhan

doi:10.1016/j.neucir.2012.01.002

Cited by 12 publications

(13 citation statements)

References 15 publications

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“…The average age of our patient population was 47 years, which is consistent with what has previously been reported in the literature. There was no gender predominance in our cohort (88 men and 81 women), which is similar to studies by Jeon et al 10 , Asahara et al 15 , and Atlas et al 17 However, in a surgical case series by Seppala et al 7 , there was a higher incidence of schwannomas in females whereas two other series reported a greater proportion of males. 8,14 In two multicenter Japanese studies, there was also a higher incidence of spinal schwanommas in males; however, in these studies, the histopathological features were not specified and so it is unclear whether this male predominance was in fact for conventional spinal schwannomas.…”

Section: Discussionsupporting

confidence: 90%

“…Fifth, given the higher incidence of spinal schwannomas in the Asia-Pacific population and their tendency to occur in males, it would be valuable to investigate whether there are any histopathological particularities in this group of patients and whether they should be analyzed as a separate group. Sixth, the advent of stereotactic radiosurgery as an adjuvant therapy appears to offer promising results in preventing recurrence in cases of malignant histopathology 17 and subtotal resection 28,29 ; this is also worth investigating. Finally, since peripheral nerve sheath tumors are not very common, creating an international multicenter prospective registry would allow for a higher powered analyses in future work.…”

Section: Discussionmentioning

confidence: 99%

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Risk Factors for Recurrence of Surgically Treated Conventional Spinal Schwannomas

Fehlings

Nater

Zamorano

et al. 2016

SPINE

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Study Design Retrospective analysis of 169 adult patients operated for a conventional spinal schwannoma from the AOSpine Multicenter Primary Spinal Tumors Database. Objective To identify risk factors for local recurrence of conventional spinal schwannoma in patients who had surgery. Summary of Background Data Schwannomas account for up to 30% of all adult spinal tumors. Total resection is the gold standard for patients with sensory or motor deficits. Local recurrence is reported to be approximately 5% and usually occurs several years after surgery. Methods Rates and time of local recurrence of spinal schwannoma were quantified. Predictive value of various clinical factors was assessed, including age, gender, tumor size, affected spinal segment, and type of surgery. Descriptive statistics and univariate regression analyses were performed. Results Nine (5.32%) out the 169 patients in this study experienced local recurrence approximately 1.7 years post-operatively. Univariate analyses revealed that recurrence tended to occur more often in younger patients (39.33 ± 14.58 years versus 47.01 ± 15.29 years) and in the lumbar segment (55.56%), although this did not reach significance (HR=0.96, p = 0.127; and p = 0.195, respectively). Recurrence also arose in the cervical and sacral spine (22.22%, respectively) but not in the thoracic area. Tumors were significantly larger in patients with recurrence (6.97 ± 4.66 cm versus 3.81 ± 3.34 cm), with extent in the cranial-caudal direction posing the greatest hazard (HR=1.321, p = 0.002). The location of the tumor, whether epidural, intradural, or both (p = 0.246) was not significantly related to recurrence. Regarding surgical technique, over four times as many patients who underwent intralesional resection experienced a recurrence proportionally to patients who underwent en bloc resection (HR = 4.178, p = 0.033). Conclusions The pre-operative size of the conventional spinal schwannoma and intralesional resection are the main risk factors for local post-operative recurrence.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Risk Factors for Recurrence of Surgically Treated Conventional Spinal Schwannomas

Fehlings

Nater

Zamorano

et al. 2016

SPINE

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“…1,3,7,17,18 A traditional approach to lumbar intradural schwannomas involves a midline incision, bilateral muscle dissection, and removal of the posterior spinal elements. 2,3,6,14,33 Consequently, this approach might increase risks of postoperative spinal instability. Efforts have been made to improve the surgical technique from extensive laminectomy and facetectomy, to laminoplasty, hemilaminectomy, or even semihemilaminectomy.…”

Section: Discussionmentioning

confidence: 99%

Minimally invasive removal of lumbar intradural extramedullary lesions using the interlaminar approach

Zhu

Ying

Chen

et al. 2015

FOC

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OBJECT Posterior midline laminectomy or hemilaminectomy has been successfully applied as the standard microsurgical technique for the treatment of spinal intradural pathologies. However, the associated risks of postoperative spinal instability increase the need for subsequent fusion surgery to prevent potential long-term spinal deformity. Continuous efforts have been made to minimize injuries to the surrounding tissue resulting from surgical manipulations. The authors report here their experiences with a novel minimally invasive surgical approach, namely the interlaminar approach, for the treatment of lumbar intraspinal tumors. METHODS A retrospective review was conducted of patients at the Second Affiliated Hospital of Zhejiang University School of Medicine who underwent minimally invasive resection of lumbar intradural-extramedullary tumors. By using an operative microscope, in addition to an endoscope when necessary, the authors were able to treat all patients with a unilateral, paramedian, bone-sparing interlaminar technique. Data including preoperative neurological status, tumor location, size, pathological diagnosis, extension of resections, intraoperative blood loss, length of hospital stay, and clinical outcomes were obtained through clinical and radiological examinations. RESULTS Eighteen patients diagnosed with lumbar intradural-extramedullary tumors were treated from October 2013 to March 2015 by this interlaminar technique. A microscope was used in 15 cases, and the remaining 3 cases were treated using a microscope as well as an endoscope. There were 14 schwannomas, 2 ependymomas, 1 epidermoid cyst, and 1 enterogenous cyst. Postoperative radiological follow-up revealed complete removal of all the lesions and no signs of bone defects in the lamina. At clinical follow-up, 14 of the 18 patients had less pain, and patients' motor/sensory functions improved or remained normal in all cases except 1. CONClUSIONS When meeting certain selection criteria, intradural-extramedullary lumbar tumors, especially schwannomas, can be completely and safely resected through a less-invasive interlaminar approach using a microscope, or a microscope in addition to an endoscope when necessary. This approach was advantageous because it caused even less bone destruction, resulting in better postoperative spinal stability, no need for facetectomy and fusion, and quicker functional recovery for the patients. Individualized surgical planning according to preoperative radiological findings is key to a successful microsurgical resection of these lesions through the interlaminar space.

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“…Usually multiple spinal schwannomas are associated with neurofibromatosis type 1 (NF1 - von Ricklengausen’s disease) or type 2 (NF2) [ [1] , [2] , [3] , [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] ]. In the last three decades significant number of cases of multiple schwannomas have been described that were not associated with any characteristic features of neurofibromatosis [ [1] , [2] , [3] , [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] ]. This group of patients with multiple schwannomas in the absence of typical signs of NF1 and NF2 syndromes was defined as schwannomatosis [ [1] , [2] , [3] , [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] ].…”

Section: Introductionmentioning

confidence: 99%

Single root multiple spinal schwannomas: Case report, treatment strategy and review of literature

Fedaravičius

Michaeli

Diomin

et al. 2020

International Journal of Surgery Case Reports

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Highlights Schwannomatosis is defined as multiple schwannomas without presence of neurofibromatosis and this is a relatively rare pathology. In vast majority of cases the schwannomas grew from different nerve roots. We present the case of a patient with six schwannomas of the cauda equina that grew from a single spinal root as well as discuss the treatment strategy. Multiple spinal cord schwannomas that are growing along the same part of the vertebral column can be safely removed by one side hemilaminectomy using a high-speed diamond drill with preservation of the integrity of the muscles and ligaments on the opposite side and thus maintain spinal stability. Neuromonitoring is mandatory for the surgical procedure to allow successful results and to prevent any neurological damage. The 30 degree endoscope can be a good tool for visual exploration of the spinal canal.

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Microsurgical management of non-neurofibromatosis spinal schwannoma

Cited by 12 publications

References 15 publications

Risk Factors for Recurrence of Surgically Treated Conventional Spinal Schwannomas

Risk Factors for Recurrence of Surgically Treated Conventional Spinal Schwannomas

Minimally invasive removal of lumbar intradural extramedullary lesions using the interlaminar approach

Single root multiple spinal schwannomas: Case report, treatment strategy and review of literature

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