Sacral schwannomas are very rare tumors. There are merely around 50 cases reported in the literature most of which are case presentations. In this study we present a 13-case series, which is one of the most extensive series in the literature. Thirteen giant sacral schwannoma cases operated at Ege University, Faculty of Medicine, Neurosurgery Department between 1995 and 2010 are investigated retrospectively. All patients were assessed with direct radiography, computerized tomography (CT) and magnetic resonance imaging (MRI). The patients were operated, after the diagnosis through biopsy patients with Sridhar Type V classification are included in the study. Five patients were male, eight were female and the average age was 37.1 (ranging between 14 and 55). All the patients were suffering from back and leg pain at the time of consultation. Four patients had sphincter problems and three had weakness in the leg. After the biopsy and histological analysis, intralesionary resections were performed. Five patients went through both anterior and posterior interventions, six patients had only posterior and two had just anterior intervention. One patient had iliac vein injury during the anterior surgery. This patient was reoperated for embolectomy and vein graft because of thrombosis. Average follow-up period was 8.1 years (1-15 years). All patients were assessed with MR annually. A small residual tumor was detected in two patients, however they were not reoperated. Although sacral schwannomas are rare tumors, the diagnosis is not so difficult with CT and MRI. In this study, we suggest biopsy for predetermination of the nature of the tumor as it affects the treatment choice and the method of operation. Surgically, a simple intralesionary excision is an appropriate choice.

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No relevant differences between the two methods are seen either in the published data or in our results. Adding our results to the published data, both techniques were reviewed in a discussion of the one that allows a better controlled or safer fenestration. We conclude that endoscopic fenestration of SACs is not superior to microsurgical cyst fenestration, and the latter seems safer.

Purpose: Adult spinal deformity incidence increases accordingly as the population ages. Even though surgery is the best option for the treatment, the complications due to surgery are pretty challenging. This study aims to review the complication rates of adult spinal deformity surgery. Methods: A literature review of the last decade was performed searching for the query “Adult spine deformity and complication.” This search yielded 2781 results, where 79 articles were chosen to investigate the complications of adult spinal deformity surgery. In addition, the demographic data, surgical interventions, and complications were extracted from the publications. Results: A total of 26,207 patients were analyzed, and 9138 complications were found (34.5%). Implant failure, including screw loosening, breakage, distal and proximal junctional kyphosis, were the most common complications. The neurologic complications were about 10.8%, and the infection rate was 3.6%. Cardiac and pulmonary complications were about 4.8%. Discussion: Age, body mass index, smoking, osteoporosis, and other comorbidities are the significant risk factors affecting adult spinal deformity surgery. Presurgical planning and preoperative risk factor assessment must be done to avoid complications. Furthermore, intra and postoperative complications affect the patients’ quality of life and length of stay, and hospital readmissions. Revision surgery also increases the risk of complications. Conclusion: Good patient evaluation before surgery and careful planning of the surgery are essential in avoiding complications of adult spinal deformity.

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