Minimally Invasive Surgical Technique for the Management of Giant Dumbbell Spinal Schwannoma

Poblete, José; Anda, Jaime Jesús Martínez; Mendoza, Angel Asdrubal Rebollar; Torales, Jorge; Somma, Alberto Di; Torné, Ramón; Fuster, Salvador; Enseñat, Joaquim

doi:10.1055/s-0041-1739502

Cited by 2 publications

(1 citation statement)

References 26 publications

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“…When dumbbell-shaped spinal schwannomas were removed in surgery, any functional nerve fibers beneath the tumor epineurium were sectioned at the same time, causing postoperative neurologic deterioration ( 28 ). For dumbbell tumors, other studies considered that affected nerve roots at the cervical and the lumbar spine should be preserved as there was a high risk of postoperative motor function deterioration and thoracic nerve roots caused only mild postoperative sensory loss after resection ( 29 ). We found that tumor occurring in the lumbar spine was an independent risk factor for postoperative neurological deterioration.…”

Section: Discussionmentioning

confidence: 99%

Scoring model to predict postoperative neurological deterioration in spinal schwannoma

Liu

Xu²,

Shen³

et al. 2023

Front. Oncol.

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BackgroundSpinal schwannomas (SSs) are benign tumors affecting the nerve sheath, accounting for 25% of spinal nerve root tumors. Surgery represents the mainstay of treatment for SS patients. Following surgery, approximately 30% of patients experienced developed new or worsening neurological deterioration, which probably represented an inevitable complication of nerve sheath tumor surgery. The objective of this study was to identify the rates of new or worsening neurological deterioration in our center and accurately predict the neurological outcomes of patients with SS by developing a new scoring model.MethodsA total of 203 patients were retrospectively enrolled at our center. Risk factors associated with postoperative neurological deterioration were identified by multivariate logistic regression analysis. β–coefficients for independent risk factors were used to define a numerical score to generate a scoring model. The validation cohort at our center was used to verify the accuracy and reliability of the scoring model. Receiver operating characteristic (ROC) curve analysis was used to evaluate the performance of the scoring model.ResultsIn this study, five measured variables were selected for the scoring model: duration of preoperative symptoms (1 point), radiating pain (2 points), tumor size (2 points), tumor site (1 point), and dumbbell tumor (1 point). The scoring model divided the spinal schwannoma patients into three categories: low risk (0-2 points), intermediate risk (3-5 points), and high risk (6-7 points), with predicted risks of neurological deterioration of 8.7%, 36%, and 87.5%, respectively. And the validation cohort confirmed the model with the predicted risks of 8.6%, 46.4%, and 66.6%, respectively.ConclusionThe new scoring model might intuitively and individually predict the risk of neurological deterioration and may aid individualized treatment decision-making for SS patients.

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Section: Discussionmentioning

confidence: 99%

Scoring model to predict postoperative neurological deterioration in spinal schwannoma

Liu

Xu²,

Shen³

et al. 2023

Front. Oncol.

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Minimally Invasive Facetectomy and Fusion for Resection of Extensive Dumbbell Tumors in the Lumbar Spine

et al. 2022

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Background and Objectives: Resection of dumbbell tumors can be challenging, and facet joint sparing approaches carry the risk of incomplete resection. In contrast, additional facetectomy may allow better surgical exposure at the cost of spinal stability. The aim of this study is to compare facet-sparing and facetectomy approaches for the treatment of lumbar spine dumbbell tumors. Materials and Methods: In a cohort study setting, we analyzed Eden type 2 and 3 tumors operated in our department. Conventional facet-sparing microsurgical or facetectomy approaches with minimally invasive fusions were performed according to individual surgeons’ preference. Primary outcomes were extent of resection and tumor progression over time. Secondary outcomes were perioperative adverse events. Results: Nineteen patients were included. Nine patients were operated on using a facet-sparing technique. Ten patients underwent facetectomy and fusion. While only one patient (11%) in the facet-sparing group experienced gross total resection (GTR), this was achieved for all patients in the facetectomy group (100%). The relative risk (RR) for incomplete resection in the facet-sparing cohort was 18.7 (95% CI 1.23–284.047; p = 0.035). In addition, time to progression was shorter in the facet-sparing cohort (p = 0.022) and all patients with a residual tumor underwent a second resection after a median follow-up time of 42 months (IQR 25–66). Conclusions: Minimally invasive resection of lumbar Eden type 2 and 3 dumbbell tumors including facetectomy in combination with instrumentation appears to be safe and superior to the facet-sparing approach in terms of local tumor control.

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Minimally Invasive Surgical Technique for the Management of Giant Dumbbell Spinal Schwannoma

Cited by 2 publications

References 26 publications

Scoring model to predict postoperative neurological deterioration in spinal schwannoma

Scoring model to predict postoperative neurological deterioration in spinal schwannoma

Minimally Invasive Facetectomy and Fusion for Resection of Extensive Dumbbell Tumors in the Lumbar Spine

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