Minimally Invasive Resection of an Extradural Far Lateral Lumbar Schwannoma with Zygapophyseal Joint Sparing: Surgical Nuances and Literature Review

Abstract

Introduction. Spinal schwannomas are benign nerve sheath tumors. Completely extradural schwannomas of the lumbar spine are extremely rare lesions, accounting for only 0,7–4,2% of all spinal NSTs. Standard open approaches have been used to treat these tumors, requiring extensive muscle dissection, laminectomy, radical foraminotomy, and facetectomy. In this paper the authors present the case of a minimally invasive resection of a completely extradural schwannoma. Operative technique literature review is presented. Material & Methods. A 50-year-old woman presented with progressive complains of chronic right leg pain and paresthesia. The magnetic resonance imaging revealed a giant well-encapsulated dumbbell-shaped extradural lesion at the L3-L4 level. The patient underwent a minimally invasive gross total resection of the tumor using a tubular expandable retractor system. Results. The patient had complete resolution of radiculopathy in the immediate postoperative period and she was discharged home, neurologically intact, on the second postoperative day. Postoperative MRI demonstrated no evidence of residual tumor. At latest follow-up (18 months) the patient remains asymptomatic. Conclusion. Although challenging, this minimally invasive procedure is safe and effective, being an appropriate alternative, with many potential advantages, to the open approach.

Minimally Invasive Direct Lateral Transpsoas Approach for the Resection of a Lumbar Plexus Schwannoma: Technique Report

“…Gonçalves et al utilized an expandable tubular retractor system and reported successful removal of an extradural far lateral lumbar schwannoma. 24 This result, as well as our own, corroborates the efficacy of minimally invasive approaches that utilize an expandable retractor.…”

Minimally invasive resection of extradural dumbbell tumors of thoracic spine: surgical techniques and literature review

“…In recent years, minimally invasive surgery has been successfully used on the resection of spinal tumors, and the results, when compared with standard open approaches, demonstrated reduced soft tissue destruction (muscle atrophy and denervation), blood loss, and length of hospitalization [17][18][19][20]. Tredway et al published their study including a series of six patents with intradural tumors and demonstrated that minimally invasive approaches are safe and effective with comparable resection and complication rates when compared to historical control.…”

Intradural Intramedullary Mixed Type Hemangioma: Optimizing the Surgical Management through Intraoperative Neurophysiological Monitoring

“…Each of these categories has its own differential diagnosis that aid in the process of establishing diagnosis. Most extradural tumors consist of metastases even though some cases of malignant or benign tumor had been reported [ 10 , 11 ]. The majority of intramedullary spinal cord tumors are gliomas which are mostly ependymomas and astrocytomas.…”