Resection of relevant nerve roots in surgery of spinal neurinomas without persisting neurological deficit

Schultheiß, R.; Gullotta, G.

doi:10.1007/bf01446992

Cited by 76 publications

(31 citation statements)

References 13 publications

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“…Kim et al 4 andothers 2,9,10,11,12 reported that sacrifice of the nerve root do not always result in postoperative neurological deficits, and when its occours, is usually a minor deficit. These facts indicate that the spinal roots giving origin to schwannoma are frequently nonfunctional at the time of surgery, and risks of causing disabling neurological deficit after sacrificing these roots are very small 2,4,9,12 .…”

Section: Sacrifice Of the Nerve Rootmentioning

confidence: 99%

“…These facts indicate that the spinal roots giving origin to schwannoma are frequently nonfunctional at the time of surgery, and risks of causing disabling neurological deficit after sacrificing these roots are very small 2,4,9,12 . The preservation of the anatomical continuity and should be attempted in functional roots like C5 and S1 2 , although this may be feasible only in cases of small tumors.…”

Section: Sacrifice Of the Nerve Rootmentioning

confidence: 99%

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Complete removal of the spinal nerve sheath tumors. Surgical technics and results from a series of 30 patients

Fernandes

Lynch

Welling

et al. 2014

Arq. Neuro-Psiquiatr.

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Objective: Observe whether a microsurgical gross total removal (GTR) of a spinal nerve sheath tumors (SNSTs) is safe and decreases the tumor recurrence. Method: We identify 30 patients with 44 SNSTs. Results: We operated upon 15 males and 15 females patients; mean age 40 years. GTR was achieved in 29 (96.6%) instances. Surgical mortality was 3.3% and the recurrence rate was 3.3%. The median follow-up time was 6.2 years. Conclusion: The surgical approach used in this group of patients afford that the great majority of tumors could be totally removed with low mortality and low recurrence rates, proving to be safe and effective.Keywords: microsurgery, neurofibroma, schwannoma, spinal nerve sheath tumors, surgical treatment. RESUMOObjetivo: Observar se a ressecção microcirúrgica completa dos shwannomas ou neurofibromas raquianos é uma técnica segura e efetiva. Método: Foram operados 30 pacientes com 44 schwannomas ou neurofibromas intrarraquiano. Resultados: A remoção total da lesão ocorreu em 27 casos (96.6%). A taxa de mortalidade cirúrgica observada nesta série foi de 3.3%. O tempo médio de seguimento foi de 6.2 anos. Conclusão: A estratégia microcirúrgica empregada com esses pacientes propiciou a remoção total dos tumores na maioria dos pacientes, com baixa mortalidade e recidiva tumoral, mostrando ser segura e efetiva.Palavras-chave: microcirurgia, neoplasia raquiana, neurofibroma, tumors da bainha dos nervos, schwannoma raquiano.The annual incidence rates for primary spinal neoplasms are reported to be in the range of 1.3 to 10.0 per 100,000 1 . One-third is nerve sheet tumors 1,2,3 . The spinal nerve sheet tumors (SNSTs) comprise the schwannomas and neurofibromas 1,2,3,4 . Nevertheless little attention has been paid to this subject within Brazilian settings, which motivated us to review and present the cases of this pathological condition treated by our medical team, and to assess the safety and efficiency of microsurgical removal of those lesions.Various terms have been used for this tumor: neuroma, neurinoma, neurilemoma, perineurial fibroblastoma, schwannoma gliome peripherique, schwannoma and neurofibroma 2,4 . The SNSTs are benign, usually solitary, slowgrowing, encapsulated neoplasms composed of differentiated neoplastic Schwann cells. The most common origin of these tumors is the posterior spinal nerve root 1,2,3,4,5,6 . METHOD Data collectionThe 30 patients registered in this retrospective study with SNSTs were operated at the Hospital Federal dos Servidores do Estado (RJ) and at Rede D'Or São Luiz between 1986 and 2012. The medical charts, pre and postoperative imaging, and pathological reports were retrospectively reviewed for each patient to confirm the diagnosis of SNSTs; creating a database from which information pertinent to the present study was collected. The intraoperative videos of 11 patients were analyzed for nuances of the microsurgical technique. The need for informed consent was waived due to the retrospective character of the study. Detailed neurological examinations were perfo...

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Section: Sacrifice Of the Nerve Rootmentioning

confidence: 99%

Section: Sacrifice Of the Nerve Rootmentioning

confidence: 99%

Complete removal of the spinal nerve sheath tumors. Surgical technics and results from a series of 30 patients

Fernandes

Lynch

Welling

et al. 2014

Arq. Neuro-Psiquiatr.

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“…McCormick [18] found no evidence of disease in six operated neurinomas after follow-ups ranging from 14 to 39 months. Despite section of the involved nerve root, no significant postoperative motor deficit occurred [12,18,25]. In Seppala's series of 32 neurofibromas [26], there were four recurrences, and two of these patients required reoperation.…”

Section: Neurinomas and Neurofibromasmentioning

confidence: 99%

Recurrence of benign spinal neoplasms

Schick¹,

Marquardt

Lorenz

2001

Neurosurg Rev

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The outcome of surgical treatment of benign spinal neoplasms is considered to be excellent, with good improvement of neurological function. The risk of recurrence is estimated to be very low, except with subtotal resections. This retrospective study was designed to establish the course of illness, clinical outcome, and recurrence rate of benign spinal tumours. We present an overview of the clinical outcome and surgical treatment of 197 benign spinal tumours carried out in our centre from 1980 to 1999. Clinical history, signs, surgical approach, outcome, and radiological reports were obtained by reviewing patient charts. The most frequent benign tumour was meningeoma (41%), closely followed by neurinoma (33%) and neurofibroma (6.1%). Of all tumours, 79.7% were completely resected. Recurrence happened in 10.2% on an average of 4.3 years postoperatively. Only 2 patients suffered from neurofibromatosis. All neurinomas were completely resected at first operation, whereas three out of seven recurrent meningeomas and all ependymomas were classified as subtotally resected. Seventy per cent were treated by repeated surgical intervention. Benign tumours usually can be completely removed without adding to patients' neurological deficits. Benign tumours recur in 10.2% of cases, thus requiring long-term follow-up. Magnetic resonance imaging (MRI) studies are recommended up to 5 years postoperatively as a routine procedure.

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“…The incidence of motor roots (C5-8) deficit after surgery in most studies ranged from 0-33% and the elderly are more prone for such complication. 10,14 In general, recurrence of SNTSs is low. In one of the largest series dealing with such tumors and included 187 cases reported by Seppala et al, 17 only 20 cases have postoperative residual tumor.…”

Section: Clinical Outcomementioning

confidence: 99%

Cervical Spine Nerve Sheath Tumor: Surgical Experience of a Clinical Case Series

Eissa¹,

El-Fol²

2013

Egyptian Spine Journal

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Background Data: Cervical spine nerve sheath tumors (SNTSs) represent a special location of interest and challenge for neurosurgeons because the lesion in this region tend more to have extradural and extraspinal component (dumb-bell tumors) than dorsal or lumbar region. These tumors extension is most likely because of short intraduradural root in the cervical region. Dumb-bell tumors require special surgical strategy and approaches to allow complete removal of these tumors from both intraspinal and extraspinal components without traction on the spinal cord. Purpose: to evaluate our experience in management of cervical spinal nerve sheath tumors with special consideration for dumb-bell tumors that operated by multidisciplinary team and discussing our result. Study Design: A prospective descriptive clinical case study. Patients and Methods:This was a prospective study including nine patients suffering from cervical spinal nerve sheath tumors who were treated from January 2006 to December 2012. Each case was analyzed according to sex, age, clinical presentation, magnetic resonance imaging (MRI) of the brain and whole spine, surgical intervention, pathology and outcomes. The patients were followed in our outpatient clinic, where they were assessed clinically and functionally by VAS score and JOA score as well as radiologically by MRI of the cervical spine. Results: There were nine cases in this study with cervical SNTSs with age ranged from 30 to 56 years in eight cases with one case reported at 6 years. There were 5 females and 4 males. Five cases in this study (56%) were dumb-bell tumors and four cases were only intraspinal. All dumb-bell tumors were operated by combined posterior and anterior approach at the same session. Six cases (67%) were schwannoma, two cases (22%) were neurofibromas and one case was malignant nerve sheath tumor. The results were generally good. 80% of patients with preoperative pain (78%) had moderate to complete pain relive. All cases with preoperative cord related motor deficit (56%) had improvement to satisfying degree. Conclusion: SNTSs are uncommon lesions and tend to have extradural component in the cervical region. Proper clinical and radiological evaluation should be performed to exclude Neurofibromatosis 1 or 2 with associated spinal and /or intracranial tumors. Multidisciplinary team management provides optimum result for removal of dumb-bell tumors but the posterior approach should be performed first to prevent neurological manipulation. The incidence for recurrence and reoperation of small residual tumor are generally low. (2013ESJ059)

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Resection of relevant nerve roots in surgery of spinal neurinomas without persisting neurological deficit

Cited by 76 publications

References 13 publications

Complete removal of the spinal nerve sheath tumors. Surgical technics and results from a series of 30 patients

Complete removal of the spinal nerve sheath tumors. Surgical technics and results from a series of 30 patients

Recurrence of benign spinal neoplasms

Cervical Spine Nerve Sheath Tumor: Surgical Experience of a Clinical Case Series

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