Risk Factors for Local Recurrence after Surgical Resection of Spine Schwannomas: Retrospective Analysis of 169 Patients from a Multicenter International Database (original) (raw)
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Turkish Neurosurgery, 2015
tumors, particularly in adults (8). Rarely, SS have possibility of malignancy and therefore the recommended primary treatment of choice is gross-total resection (GTR) with preservation of neurological function. GTR of these lesions, which is the main goal of surgical treatment, leads to good results. Giant dumbbell SS, which extends anteriorly to invade the bones, vascular structures, and soft tissues and fill the abdominal and thoracic cavities as same as extradural location █ InTRODuCTIOn S pinal schwannomas (SS) are well known, macroscopically solid encapsulated, spindle cell mesenchymal tumors which are called neurinomas in the literature. Although they are mostly benign entities derived from neoplastic schwann cells, SS have possibility of malignant transformation (10,15). SS represent the most common intradural extramedullary lesions, accounting for about one fourth of all nerve sheath AIM: Spinal schwannomas (SS) represent the most common intradural extramedullary lesions, accounting for approximately 24% of all nerve sheath tumors in adults. Schwannomas have infrequent, but existent possibility of malignancy. In this study, long-term outcomes of 49 consecutive SS have been presented. MATERIAL and METhODS: Medical records were retrospectively reviewed in 371 cases of spinal tumors who underwent surgery between the years 2005 and 2014. Cases confirmed as schwannoma histopathologically were included in this study. Patients' complaints, localizations, recurrence rate and complications were evaluated. RESuLTS: Forty-nine cases were detected in 47 (26 female, 21 male) patients. The mean age was 45.8±13.7 years. The mean follow-up period was 61.4±21.5 months. The most common complaint was local pain. Eleven were cervical, ten thoracic, twentyfour lumbar, and four in the sacral spine. Thirty-three cases were intradural-extramedullary, fifteen cases were the extradural type, and one case was the extra-intradural type. Recurrence rate was 4.08%. Gross-total resection (GTR) was achieved in forty-seven patients. The most common complications were surgical site infection and intraoperative instability that were seen in three patients each. Posterior instrumentation was performed in two patients. COnCLuSIOn: SS is mostly benign and intradural-extramedullary. To treat patients with SS, there is no need for adjuvant treatments; GTR with preservation of neurological functions is the best treatment to relieve patients' complaints and to reduce the recurrence rate of SS. To avoid serious complications, we recommend intraoperative neurophysiological monitoring and laminoplasty, especially in young patients. Dumbbell SS may require extensive bone resection. Posterior instrumentation can be used if instability occurs.
Spine, 2015
Retrospective analysis of 169 adult patients operated for a conventional spinal schwannoma from the AOSpine Multicenter Primary Spinal Tumors Database. To identify risk factors for local recurrence of conventional spinal schwannoma in patients who had surgery. 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. 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. 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 pat...
An Analytical Study on the Surgical Outcome of Intradural Extramedullary Spinal Neoplasms
International Journal of Medical Reviews and Case Reports, 2022
Background: Spinal cord neoplasms constitute one of the major aspects of neurosurgical practice. Of the different types based on location, intradural extramedullary neoplasms are the commonest. Most are benign, including nerve sheath tumours and meningiomas. Methods: A series of 41 cases of intradural extramedullary spinal tumours located at different levels, surgically excised at our centre over a period of 2 years from 2018 are evaluated. Demographic distribution, clinical presentations, radiological aspects, pathological classifications and postoperative clinical status of the patients are being analysed along with the correlation of functional outcome with histopathology. Results: Age and sex distribution of IDEM tumours were such that there was an almost equal number of males and females, while most belonged to the group of 20-50 years. Lesions were common at the dorsal level followed by the lumbar region. Cervicothoracic junction tumours were rare. Benign nerve sheath tumours viz. schwannoma and neurofibroma were the commonest types followed by meningioma and myxopapillary ependymoma. The mean symptom duration till radiological diagnosis is 8 months. Commonly seen symptoms were backache, limb weakness and radicular pain. Sphincter disturbances were less common. According to modified Frankel grading, the majority of the patients belonged to grades D and E both preoperatively and after surgery. On a visual analogue scale for pain, mean values dramatically decreased over a period of 1 year after surgery. Complications were relatively rare. Mild worsening of neurological functional status was noted in 5 patients. No instances of surgical site infection noted. Neurological worsening was seen only in cases of anteriorly located meningiomas and malignant peripheral nerve sheath tumours.
Extradural Spinal Tumors: Report of 36 Cases and Review of Literature
Nepal Journal of Neuroscience, 2016
P revious literature on spinal tumors reveals that 55% of spinal tumors are extradurally located. 14 90% of extradural spinal tumors are metastases and they are usually from lung, breast, prostate and kidney. 31 10% of extradural spinal tumors are primary and they are neurofi bromas, Ewing's sarcoma, angiolipoma, aneurysmal bone cyst. Primary extradural spinal tumors can be benign like neurofi bromas, meningioma, Extradural Spinal Tumors: Report of 36 Cases and Review of Literature About 55% of spinal tumors are extradural arising from vertebral bodies, epidural and surrounding neural and soft tissues. More than 90% of extradural spinal tumors are metastatic lesions. Extradural spinal tumors are common cause of back pain, sensory motor defi cit and sphincters dysfunction. The wide range of lesions and varied clinical profi le, make management of spinal extradural tumors a challenging task for any neurosurgeon. Aim of this study is to analyze and discuss the results of extradural spinal tumors after surgical treatment and relevant literature will be reviewed. This is a retrospective study of 36 patients who were operated for spinal extradural tumors between May 1999 and December 2012 in our institute. Follow up period ranged from 3 years to 12 years. Functional neurological outcome was assessed by McCormick's grading. There were 20 male and 16 female and age ranged from 10 to 80 years. 30 patients presented with back pain and 15 had radicular pain. On presentation 18 patients had motor sensory defi cit and 15 had sphincters dysfunction. Most common involved level of spines were thoracic followed by cervical and lumbar. Gross total excision of masses were carried out in all cases. Common pathologies were neurofi bromas (16), Ewing's sarcoma (7), granulomas (3), metastatic lesions (2), angiolipoma (2), chondroma (2), aneurysmal bone cyst (1), plasmacytoma (1), rabdomyosarcoma (1) and neuroblastoma (1). Out of 14 patients who harbored malignant pathology 12 patients received radio and chemotherapy. Post operative wound infection occurred in 5 patients. Regarding post operative neurological status, 18 patients showed improvement, 6 patients remained same and 12 patients had deteriorated neurology. Tumor recurrence occurred in 15 patients; 12 patients with malignant and 3 patients with benign lesions on follow up period. There was no surgery related mortality, however, 11 patients died during 3 years follow up period due to adverse pathology they were having.
Management of Spinal Schwannomas in Gabriel Touré Hospital: Review of 11 Cases
Surgical Science
Background: Spinal schwannomas are common tumors of spinal neoplasm and account for about 25% of intradural spinal cord tumors in adults. They are generally benign and slow-growing. Advanced in radiologic and surgical techniques have brought about better surgical results. The goal of surgical treatment must be total resection if possible. In this report, the authors present the incidence, clinical presentation, localization, and results of surgically treated spinal schwannomas. The results of a literature review are also presented. Methods: Eleven consecutive patients with histologically confirmed spinal schwannomas were treated from January 2013 to December 2016 in the neurosurgical department of Gabriel Touré Hospital, Bamako, Mali. Neuroradiological diagnosis was made, CT scan in 7 patients, and MRI in 4 patients. All patients were operated on via the posterior approach. All cases were surgically excised, and they were confirmed to be schwannomas by pathologists. The patients were followed for 6 to 38 months (mean 28 months). Functional outcome was assessed using the motor grade and sensory change. Results: There were 11 patients with 7 (63.6%) males and 4 (36.4%) females. The mean age was 40.3 years (range 23-62 years). The most common symptom at the time of diagnosis was radicular pain in 9 (81.8%) patients followed by motor weakness in 8 (72.7%) patients. The most frequent site of spinal schwannomas was the thoracic region in 5 (45.5%) patients. During surgery, Gross-total resection was achieved in 8 patients (72.7%) and subtotal removal in 3 (27.3%) patients. Histological findings were benign schwannoma in all How to cite this paper:
Primary Spinal Schwannoma: A Single Center Study Of 37 consecutively Operated Cases
Nepal journal of neuroscience, 2022
Background: Primary spinal Schwannoma (PSS) remains uncommon nerve sheath tumor of the spine with male preponderance and presenting in fourth to fifth decades. They arise from the Schwann cells in sensory root as PSS or part of Neurofibromatosis 2. Methods: This is a retrospective study of histopathologically confirmed cases of PSS treated between 2010 to 2021. They were operated and age, sex, clinic-radiological findings, surgical technique used and outcome studied. Laminectomy or laminoplasty or combined anterior-posterior approach was used with either an intracapsular or extracapsular tumor removal. Follow-up was at 15 days, 2 months, 6 months and yearly intervals. Results: There were 37 cases operated with age ranging from 16 to 81 years and majority in the 21-40-year group (40%) followed by 41 to 60 years (32%). There were 22 males and 15 females. Localized pain in the back or cervical region was the commonest finding (75%) followed by myelopathy in 38%, radiculopathy in 35% and bladder disturbances in 13%. They were most common in the lumbar region (35%) followed by thoracic (30%). With relation to the level and sex, the cervical level showed equal sex distribution while the rest had male preponderance Conclusions: PSS although can frequently present to the spine surgeon and the diagnosis is clinched with help of an MRI. Surgery remains the main modality of treatment either by laminectomy, laminoplasty or minimal invasive spine surgery. The nerve root of origin must be preserved in all that can be aided with help of intraoperative neurophysiological monitoring.
High cervical spinal schwannoma; microneurosurgical management: an experience of 15 cases
Acta Neurologica Taiwanica, 2013
PURPOSE: Schwannoma arising from high cervical spinal root are common among the spinal schwannomas.Here, we prospectively recorded the clinical features, radiological features, surgical approaches & findings,postoperative follow up & ultimate neurological outcome of high cervical spinal schwannomas and then we evaluated the records retrospectively.METHOD: Here, schwannomas arising from C1, C2 and C3 spinal nerve roots were regarded as high cervical spinal schwannoma. All patients with high cervical spinal schwannomas that were consecutively operated micro-neurosurgically from 2006-2010 were included in the study. Postoperatively all patients were followed up regularly both clinically and neuro-radiologically (MRI of cervical spine).RESULTS: Average follow up was 31.5 months. The mean age of the series was 35.8 years (range 10-61 years). There were 8 male and 7 female patients. The mean duration of symptoms at the time of presentation was 32 months (range 06 months-5 years). Two schwannomas were completely extradural, seven were intradural and rest six were interdural or hourglass type (both extra and intradural) as identified during surgery. The standard midline posterior approach was used in all patients. A C2 hemilaminectomyor C2 laminectomy with or without cutting of posterior arch of atlas was used for most intradural and large interdural C2 schwannomas. Tumor removal was complete in all cases. Preservation of the nerve root fibers was not possible in 9 cases and was possible only in 3 cases. In two patients CSF leak developed after operation. One patient who had severe myelopathic features with bed sore failed toimprove and expired 5 months after operation. Rest of the patients showed postoperative improvement in their preoperative symptoms and returned to their normal life by the end of sixth month. There was no tumor recurrence in any patient till last follow up.CONCLUSION: Proper 3-D anatomical orientation & physiological knowledge, deep neuro-radiological observation,pathological appreciations and micro-neurosurgical skill and expertization can make the surgical management of these tumors ( in a surgically complex site) simple with gratifying result (i.e.neurological outcome) without extensive bone removal or soft tissue manipulation through a standard midline posterior approach.
Spinal Schwannoma : Scrutinizing the Armamentarium of a Single Institute
Journal of the Royal Medical Services, 2018
Objectives: To investigate the clinical characteristics, epidemiological features of spinal schwannomas diagnosed at a single institution. Methods: A retrospective study carried out of all consecutives 67-patients presented with spinal schwannoma treated at the neurosurgery department in King Hussein Medical Center. Clinical information, imaging studies, and biopsy results were compiled from all consecutive patients (all cases were included) treated in our setup over a period of 10-years from January 2006 to January 2016. Results: Study cohort consisted of 38-females (56.71%) and 29-males (43.28%), with ages ranging from 17 to 75 years (mean: 41.45 ± 13.74 yr). The most common initial symptom was radicular pain (46 patients, 68.65%). The most common regions of involvement were the lumbar spine (37 patients, 55.22%), followed by cervical (16 patients, 23.88%), thoracic segments (12 patients, 17.91%) and sacral region (2 patients, 2.98%). In the total population of 67-cases, the schwannomas were intradural extramedullary in 65-cases (97.01%) and in 2-cases it was extradural (2.98%). Three cases (4.47%) recurred locally. Conclusion: Spinal schwannomas are benign tumors that can cause significant neurological deficits. Lumbar spine is the most common site of spinal schwannomas according to this study. Surgery for spinal schwannomas usually results in excellent postoperative clinical outcomes. Schwannoma is generally separable from the underlying nerve. In cases of subtotal removal, there could be a recurrence.
Neurology Research International, 2017
Background.Spinal schwannomas are common benign spinal tumors. Their treatment has significantly evolved over the years, and preserving neurological functions has become one of the main treatment goals together with tumor resection.Study Design and Aims.Retrospective review focused on clinical assessment, treatment techniques, and outcomes.Methods.A retrospective study on our surgical series was performed. Clinical and operative data were analyzed. In regard to neurophysiologic monitoring, patients were retrospectively divided into two groups comparing the outcomes before and after introduction of routine intraoperative neurophysiology tests.Results.From 1951 to 2010, 367 patients overall were treated. Diagnosis was obtained using angiography and/or myelography (pre-CT era), MRI, or CT scan. A posterior spinal approach was used for most patients; complex approaches were adopted for treatment of giant/dumbbell tumors. A trend of neurophysiology monitoring decreasing the rate of post-...