Assessment of pure single nerve root resection in the treatment of spinal schwannoma: focus on solitary spinal schwannomas located below the thoracolumbar junction

An Extremely Giant Lumbar Schwannoma: New Classification (Kotil) and Mini-Open Microsurgical Resection

“…The surgical complications of schwannomas are reported frequently with intradural tumors [6]. The incidence of neurological deficits is reportedly low after sacrificing the affected nerve root during spinal schwannoma treatment.…”

“…Recently, both minimally invasive and mini-open access were presented in many papers [3,4,6,7,8], but there was no report on this approach for an extremely large giant dumb-bell tumor. Lu et al [7] recently reported the use of an alternative approach, encompassing midline mini-open access with expandable tubular retractors.…”

“…The most difficult part of extra-canalicular capsule dissection occurs at the most anterior part, as this is the last area to be exposed through the intermuscular approach. Total resection of the tumor capsule is recommended, as there is a significant risk of recurrence at the capsule [6,7,9,11,13], and mini-open micro surgical resection is associated with less tissue destruction. If the tumor is a malignant schwannoma, the tumor may show invasion of neurovascular structures.…”

“…In addition, these tumors may grow extensively outside the spinal canal and compress the paraspinal-iliopsoas complexes as well as retroperitoneal vascular structures. Various approaches have been described for treating these tumors [1,2,4,6,7,8,9,10,11]. The combined antero-posterior approach has mostly been used but it carries the disadvantage of being a two-stage operation [7,9].…”

Three-dimensional conformal fractionated radiotherapy for spinal schwannoma with a paravertebral or an intraosseous component

“…In order to avoid spinal compression after radiotherapy, it seems reasonable to use surgery as the initial treatment to remove the tumor within the spinal canal followed by radiotherapy to treat any tumor outside of the extra-vertebral foramen. Because it is sometimes impossible to preserve both of the affected ventral nerve roots and the dorsal root [3,19], surgery for a dumbbell-shaped schwannoma is difficult, and the frequency of adverse events is higher than that for surgery of tumors within the spinal canal [3]. The combination of surgery and radiotherapy is an option for the treatment of dumbbell type schwannomas, especially for tumors with a large extradural component.…”