Outcomes of Surgical Treatment of Intraspinal Intradural Lumbar Schwannomas

Abstract

Background Data: Safe surgical resection of intradural schwannomas in the lumbar region is considered challenging. This is due to the proximity and sometimes the adhesiveness of these lesions to the cauda equina rootlets. Purpose: This article aims to evaluate the safety and efficacy of surgical excision of solitary lumbar intradural schwannomas with the excision of the affected rootlet. Study Design: A retrospective descriptive clinical case study. Patients and Methods: From January 2016 to January 2019, 20 patients presented with intraspinal intradural lumbar schwannoma were retrospectively included in this study. We evaluated all the patients preoperatively, immediately postoperatively, and after one month. The clinical and radiological outcomes were assessed. Results: The mean age of presentation was 39.45 years. The mean duration of preoperative complaint was 4.15 months. All patients presented with localized low back pain associated with radicular pain along the lower limbs according to the affected level, with some sort of voiding difficulties. The mean preoperative VAS was 8.95. No preoperative motor deficit was observed. Moreover, all lesions were solitary. Total gross resection with the division of the parent rootlet was achieved in 19 cases, and the patients showed postoperative significant pain reduction without any neurological deficit. Subtotal resection was achieved in 1 patient who had unsatisfactory pain relief. Minor complications were observed in the form of transient CSF leak in 1 case and transient superficial wound infection in 2 cases. Conclusion: Total microsurgical excision of solitary intradural intraspinal schwannoma below the level of thoracolumbar junction with the resection of the parent rootlet is considered safe and effective. (2021ESJ232)