Radical Intracapsular Dissection Technique for Dumbbell-Shaped Spinal Schwannoma with Intradural and Extradural Components

Chang, Han Soo; Baba, Tetsuya; Matsumae, Mitsunori

doi:10.1016/j.wneu.2019.05.232

Cited by 5 publications

(3 citation statements)

References 13 publications

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“…that dumbbell-shaped tumors commonly caused high rates of postoperative sensory function deterioration ( 26 ). 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 ).…”

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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“…In recent reports, MISS techniques have been successfully used in the resection of extradural spinal schwannomas with less soft-tissue destruction, blood loss, and length of hospitalization (►Table 2). 6,9,[17][18][19][20][21][22][23][24][25] The classification according to standardized systems is not often documented and a comparative analysis is difficult to be done as surgical technique could change significantly according to the tumor location and the intra-/extraspinal involvement. It seems from previous studies that open and MISS techniques are comparable in efficacy and safety, and MISS approaches may obviate the need for spinal instrumentation (►Table 2).…”

Section: Discussionmentioning

confidence: 99%

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

Poblete

Anda

Mendoza

et al. 2021

J Neurol Surg A Cent Eur Neurosurg

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Background Completely extradural spinal schwannomas have a unique morphology (dumbbell tumors) with an intra- and extraspinal component. When they compromise two contiguous vertebral bodies or have an extraspinal extension >2.5 cm, they are classified as giant spinal schwannomas. The aim of this study is to present our experience in the surgical management of completely extradural giant spinal schwannomas with a minimally invasive approach. Methods This study is a case series of patients treated at the Neurosurgery Department of the University Clinical and Provincial Hospital of Barcelona, Spain, between January 2016 and December 2019. Results Fifteen patients met the inclusion criteria, with thoracic and lumbar spines being the most frequent locations. All patients underwent surgical treatment, with a mini-open interlaminar and far-lateral technique. Total gross resection was accomplished in all patients and spine instrumentation was not necessary. Conclusions Microsurgery is the treatment of choice for spinal schwannomas, and gross total resection with low morbidity must be the surgical goal. Mini-open interlaminar and far-lateral access is a valid surgical option, with low morbidity in experienced hands, and there is no need for spinal instrumentation.

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“…Some authors have recommended using the intracapsular resection technique for those dumbbell-shaped schwannomas with both intradural and extradural components. 7 The use of electrophysiological monitoring, if available, could help in minimizing the risk of postoperative neurological deficit. 1,20 In our series, we had one case (5%) of STR because of its adherence of the tumor to the conus medullaris.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Surgical Treatment of Intraspinal Intradural Lumbar Schwannomas

Balaha

Shamhoot

Mokbel

2021

Egyptian Spine Journal

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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)

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Radical Intracapsular Dissection Technique for Dumbbell-Shaped Spinal Schwannoma with Intradural and Extradural Components

Cited by 5 publications

References 13 publications

Scoring model to predict postoperative neurological deterioration in spinal schwannoma

Scoring model to predict postoperative neurological deterioration in spinal schwannoma

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

Outcomes of Surgical Treatment of Intraspinal Intradural Lumbar Schwannomas

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