Long-term outcome after removal of spinal neurofibroma

Seppälä, Matti; Haltia, Matti; Sankila, Risto; Jääskeläinen, Juha E.; Heiskanen, O

doi:10.3171/jns.1995.82.4.0572

Cited by 108 publications

(75 citation statements)

References 21 publications

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“…7,21 However, among all cervical tumors in our cohort, approximately half (47%) were neurofibromas and the rest were schwannomas. Unlike neurofibromas, schwannomas are more evenly distributed throughout the spine and their prevalence is higher.…”

Section: Discussionmentioning

confidence: 99%

“…Given the high number of NF1 patients with neurofibromas included in this study (40 of 53) the younger age at presentation is not unexpected on the basis of the underlying tumor biology and is consistent with other reports in the literature. 9,21 Among all NF patients included in this study, the majority (39 of 40) of neurofibromas were in patients with NF1 and the majority (10 of 12) of schwannomas were in patients with NF2. The associations between NF1 and neurofibromas and NF2 and schwannomas, as well as the underlying molecular mechanisms driving tumorigenesis, have been well described.…”

Section: Discussionmentioning

confidence: 99%

“…4,7,9,12,15,[20][21][22] These contributions are valuable but limited by sample size and age of data sets. We sought to characterize our institutional experience with the management of these lesions, focusing on patient demographics, history of NF, clinical presentation, and factors associated with extent of resection and tumor recurrence.…”

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confidence: 99%

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Association of tumor location, extent of resection, and neurofibromatosis status with clinical outcomes for 221 spinal nerve sheath tumors

Safaee

Parsa

Barbaro

et al. 2015

FOC

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OBJECT Intradural extramedullary spine tumors represent two-thirds of all primary spine neoplasms. Approximately half of these are peripheral nerve sheath tumors, mainly neurofibromas and schwannomas. Given the rarity of this disease and, thus, the limited analyses of clinical outcomes, the authors examined the association of tumor location, extent of resection, and neurofibromatosis (NF) status with clinical outcomes. METHODS Patients were identified through a search of the University of California, San Francisco, neuropathology database and a separate review of current procedural terminology codes. Data recorded included patient age, patient sex, clinical presentation, presence of NF, tumor type, tumor location, extent of resection (gross-total resection [GTR] or subtotal resection [STR]), and clinical follow-up. RESULTS Of 221 tumors in 199 patients (mean age 45 years), 53 were neurofibromas, 163 were schwannomas, and 5 were malignant peripheral nerve sheath tumors. The most common presenting symptom was spinal pain (76%), followed by weakness (36%) and sensory abnormalities (34%). Mean symptom duration was 16 months. In terms of spinal location, neurofibromas were more common in the cervical spine (74% vs 27%, p < 0.001), and schwannomas were more common in the thoracic and lumbosacral spine (73% vs 26%, p < 0.001). Rates of GTR were lower for neurofibromas than schwannomas (51% vs 83%, p < 0.001), regardless of location. Rates of GTR were lower for cervical (54%) than thoracic (90%) and lumbosacral (86%) lesions (p < 0.001). NF was associated with lower rates of GTR among all tumors (43% vs 86%, p < 0.001). The mean follow-up time was 32 months. Recurrence/progression was more common for neurofibromas than schwannomas (17% vs 7%, p = 0.03), although the mean time to recurrence/progression did not differ according to tumor type (45 vs 53 months, p = 0.63). As expected, GTR was associated with lower recurrence rates (4% vs 22%, p < 0.001). According to multivariate analysis, cervical location (OR 0.239, 95% CI 0.110–0.520) and presence of NF (OR 0.166, 95% CI 0.054–0.507) were associated with lower rates of GTR. In a separate model, only GTR (OR 0.141, 95% CI 0.046–0.429) was associated with tumor recurrence. CONCLUSIONS Resection is an effective treatment for spinal nerve sheath tumors. Neurofibromas were found more commonly in the cervical spine than in other regions of the spine and were associated with higher rates of recurrence and lower rates of GTR than other tumor types, particularly in patients with NF Types 1 or 2. According to multivariate analysis, both cervical location and presence of NF were associated with lower rates of GTR. According to a second multivariate model, the only variable associated with tumor recurrence was extent of resection. Maximal safe resection remains ideal for these lesions; however, patients with cervical tumors or NF should be counseled about their increased risk for recurrence.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Association of tumor location, extent of resection, and neurofibromatosis status with clinical outcomes for 221 spinal nerve sheath tumors

Safaee

Parsa

Barbaro

et al. 2015

FOC

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“…1 They are uncommon, comprising approximately 3% of all spinal tumors and occur both sporadically and in association with neurofi bromatosis 1 (NF1; von Recklinghausen's disease). 2 Intramedullary spinal cord tumors in children account for 4-10% of central nervous system tumors. 3 Kim et al 4 described less than 50 cases of neurofi broma without neurofi bromatosis in all age groups.…”

Section: Introductionmentioning

confidence: 99%

A Technical Problem in Diagnosis Clarity of Solitary Spinal Cord Neurofibroma in an Eleven-month-old Boy

et al. 2017

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“…Tumor type and grade have also been shown to influence outcomes. Although resection is considered safe and effective, 21,26,34,46,55,59,60 postoperative complications vary based on patient comorbidities, tumor location, size, and extent, as well as hospital-and surgeon-related risk factors. Several singleinstitution studies 14,27,49,52,[68][69][70][71][72] have investigated long-term outcomes and associations of various preoperative risk factors with outcomes in patients undergoing resection for intradural spine tumors.…”

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confidence: 99%

Association of risk factors with unfavorable outcomes after resection of adult benign intradural spine tumors and the effect of hospital volume on outcomes: an analysis of 18, 297 patients across 774 US hospitals using the National Inpatient Sample (2002−2011)

Kalakoti

Missios

Menger

et al. 2015

FOC

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OBJECT Because of the limited data available regarding the associations between risk factors and the effect of hospital case volume on outcomes after resection of intradural spine tumors, the authors attempted to identify these associations by using a large population-based database. METHODS Using the National Inpatient Sample database, the authors performed a retrospective cohort study that involved patients who underwent surgery for an intradural spinal tumor between 2002 and 2011. Using national estimates, they identified associations of patient demographics, medical comorbidities, and hospital characteristics with inpatient postoperative outcomes. In addition, the effect of hospital volume on unfavorable outcomes was investigated. Hospitals that performed fewer than 14 resections in adult patients with an intradural spine tumor between 2002 and 2011 were labeled as low-volume centers, whereas those that performed 14 or more operations in that period were classified as high-volume centers (HVCs). These cutoffs were based on the median number of resections performed by hospitals registered in the National Inpatient Sample during the study period. RESULTS Overall, 18,297 patients across 774 hospitals in the United States underwent surgery for an intradural spine tumor. The mean age of the cohort was 56.53 ± 16.28 years, and 63% were female. The inpatient postoperative risks included mortality (0.3%), discharge to rehabilitation (28.8%), prolonged length of stay (> 75th percentile) (20.0%), high-end hospital charges (> 75th percentile) (24.9%), wound complications (1.2%), cardiac complications (0.6%), deep vein thrombosis (1.4%), pulmonary embolism (2.1%), and neurological complications, including durai tears (2.4%). Undergoing surgery at an HVC was significantly associated with a decreased chance of inpatient mortality (OR 0.39; 95% CI 0.16−0.98), unfavorable discharge (OR 0.86; 95% CI 0.76−0.98), prolonged length of stay (OR 0.69; 95% CI 0.62−0.77), high-end hospital charges (OR 0.67; 95% CI 0.60−0.74), neurological complications (OR 0.34; 95% CI 0.26−0.44), deep vein thrombosis (OR 0.65; 95% CI 0.45−0.94), wound complications (OR 0.59; 95% CI 0.41−0.86), and gastrointestinal complications (OR 0.65; 95% CI 0.46−0.92). CONCLUSIONS The results of this study provide individualized estimates of the risks of postoperative complications based on patient demographics and comorbidities and hospital characteristics and shows a decreased risk for most unfavorable outcomes for those who underwent surgery at an HVC. These findings could be used as a tool for risk stratification, directing presurgical evaluation, assisting with surgical decision making, and strengthening referral systems for complex cases.

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Long-term outcome after removal of spinal neurofibroma

Cited by 108 publications

References 21 publications

Association of tumor location, extent of resection, and neurofibromatosis status with clinical outcomes for 221 spinal nerve sheath tumors

Association of tumor location, extent of resection, and neurofibromatosis status with clinical outcomes for 221 spinal nerve sheath tumors

A Technical Problem in Diagnosis Clarity of Solitary Spinal Cord Neurofibroma in an Eleven-month-old Boy

Association of risk factors with unfavorable outcomes after resection of adult benign intradural spine tumors and the effect of hospital volume on outcomes: an analysis of 18, 297 patients across 774 US hospitals using the National Inpatient Sample (2002−2011)

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