Midline Ventral Intradural Schwannoma of the Cervical Spinal Cord Resected via Anterior Corpectomy with Reconstruction: Technical Case Report and Review of the Literature

O’Toole, John E.; McCormick, Paul C.

doi:10.1227/01.neu.0000065182.16584.d0

Cited by 54 publications

(31 citation statements)

References 31 publications

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“…Spinal dumbbell tumors was first used to describe an intra/extra-spinal tumor of neural origin, which grow across a constricting anatomical space confined by the boundaries of the bony neural foramen and the dural of the nerve root sleeve [1, 2]. The incidence of dumbbell tumors is 13.71–17.5% in spinal cord tumors [3, 4].…”

Section: Introductionmentioning

confidence: 99%

Posterior Hemi-/Laminectomy and Facetectomy Approach for the Treatment of Dumbbell-Shaped Schwannomas in the Subaxial Cervical Spine: A Retrospective Study of 26 Cases

et al. 2017

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Objective: It is difficult to completely and safely remove a tumor that is located in the subaxial cervical spine by using the posterior approach because of the anatomical characteristics. Previous reports regarding the total removal of subaxial schwannomas using the one-stage posterior approach are still limited. This study was to evaluate the feasibility and efficacy of treating the dumbbell-shaped schwannomas in the subaxial cervical spine using the one-stage posterior approach. Methods: Patients with dumbbell-shaped schwannomas in the subaxial cervical spine were treated using the one-stage posterior approach. Surgical profile, clinical outcomes, MRI and X-ray images, and complications were investigated. Japanese Orthopaedic Association (JOA) score and McCormick functional schema score were obtained. Results: The average follow-up was 21.5 ± 5.1 months, with a range of 12–31 months. Twenty-six patients were enrolled in the study. Total resection was achieved in all patients using the one-stage posterior approach with hemi- or laminectomy and facetectomy. All cases underwent lateral mass screw fixation and fusion. JOA improved significantly (p < 0.01). The McCormick score improved significantly (p < 0.05) after the surgery. No mortality, morbidity, or tumor recurrence was observed during the follow-up period. Conclusion: Our technique was feasible and effective for the treatment of dumbbell schwannomas in the subaxial cervical spine. The tumor could be totally removed in most cases safely.

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Section: Introductionmentioning

confidence: 99%

Posterior Hemi-/Laminectomy and Facetectomy Approach for the Treatment of Dumbbell-Shaped Schwannomas in the Subaxial Cervical Spine: A Retrospective Study of 26 Cases

et al. 2017

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“…If necessary, a mono-or multisegmental vertebral body resection is done with vertebral body replacement using bone graft or cage and augmentation with bone cement [24,25]. Postoperative application of the intensity-modulated radiotherapy, radionuclide therapy, androgen suppression or application of bisphosphonates should be decided in the interdisciplinary tumor conference [26,27]. Radiotherapy alone shows neither advantage in terms of neurological outcome nor in pain reduction.…”

Section: Discussionmentioning

confidence: 99%

Therapy of Spine Metastasis Causing Paralysis Symptoms – Operation and Rehabilitation

Homagk¹,

Pataraia²

2014

Surgery

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Most common manifestation of tumor metastasis after lungs and liver is the skeletal system with 60-80% of spine metastasis. In 30% of all cancer patients with metastatic spinal complaints are initial presentation of malignant primary disease while the primary paraplegia occurs in 5-10% of all spinal metastases. Thus a further operational metastases treatment is dependent on the entire metastasis status, the type and Tomita score as well as the risk of surgery considering general patient status. From 01.01.11 to 31.12.12 we included 16 patients with tumors. In 27% of the cases the first symptoms were paraplegia, but the primary tumor was determined in only one of these cases. 73% of patients underwent surgical treatment within the first 24 hours after admission. The hospital stay was 22 days. 56.3% of patients had incomplete paralysis at admission and 71% of these patients had postoperative improvement in neurological outcomes. All patients benefited as part of operational and rehabilitative treatment of a significant reduction in pain and 50% of patients were able to be discharged home. At the onset of paralytic symptoms we recommend immediate operation. In a multidisciplinary case conference the oncological treatment regimens should be defined also for the necessary paralysis treatment. Decision guidance is the height of paralysis, tumorgenesis, ASA classification and the pain symptoms of the patient. The treatment must adjusted and individualized according to the patient's general health, life expectancy, the primary tumor, the grading of metastasis and extent of neurological deficit.

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“…The origin of the tumors included the cervical ventral roots (n=10), the thoracic ventral root (n=1), the lumbar ventral root (our case 1), and the thoracolumbar ventral root (our case 2). Including case 2 from our study there were 7 patients with giant spinal schwannomas, defined as those that extend over more than two vertebral levels [2,6]. …”

Section: Discussionmentioning

confidence: 99%

“…Some ventral schwannomas have no attachment to nerve roots and their origin is recorded as unknown in the table [2,6]. In such cases, multiple hypotheses have been offered to explain the aberrant location of Schwann-cell-based tumors.…”

Section: Discussionmentioning

confidence: 99%

“…In such cases, multiple hypotheses have been offered to explain the aberrant location of Schwann-cell-based tumors. For example, it has been suggested that their origin is the perivascular nerve plexus surrounding vessels arising from the anterior spinal artery [2,6]. Another hypothesis suggests the migration of residual neural crest progenitors into the central nervous system parenchyma during embryogenesis [2].…”

Section: Discussionmentioning

confidence: 99%

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Ventral Schwannoma of the Thoracolumbar Spine

et al. 2013

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We report two patients with ventral schwannoma in the thoracolumbar region manifesting as low back pain with or without paraparesis. In both patients magnetic resonance imaging (MRI) revealed a heterogeneously-enhanced intradural extramedullary mass in the thoracolumbar region. The tumors were successfully removed via the posterior approach. Their histology was consistent with schwannoma. Postoperative MRI showed no evidence of a tumor in either patient. Spinal schwannomas are common benign intradural extramedullary spinal neoplasms; most arise from the dorsal- and very few from the anterior roots. A literature review revealed that ventral schwannomas, including giant tumors as in the one from case 2 in our study, affect mainly the cervical region, and most are surgically addressed via the posterior approach. Careful handling of the spinal cord is mandatory for satisfactory surgical results.

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Midline Ventral Intradural Schwannoma of the Cervical Spinal Cord Resected via Anterior Corpectomy with Reconstruction: Technical Case Report and Review of the Literature

Abstract: This case exemplifies the usefulness of anterior approaches to the cervical spine in treating unusual intradural spinal cord tumors.

Cited by 54 publications

References 31 publications

Posterior Hemi-/Laminectomy and Facetectomy Approach for the Treatment of Dumbbell-Shaped Schwannomas in the Subaxial Cervical Spine: A Retrospective Study of 26 Cases

Posterior Hemi-/Laminectomy and Facetectomy Approach for the Treatment of Dumbbell-Shaped Schwannomas in the Subaxial Cervical Spine: A Retrospective Study of 26 Cases

Therapy of Spine Metastasis Causing Paralysis Symptoms – Operation and Rehabilitation

Ventral Schwannoma of the Thoracolumbar Spine

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