Scoring model to predict postoperative neurological deterioration in spinal schwannoma

Abstract

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.

Gross total resection of benign retroperitonealy/intra/paraspinal giant schwannoma

“…Gross total excision of spinal schwannomas is the treatment of choice. [3][4][5]7] Here, the patient was initially treated by urology with a partial resection of a retroperitoneal schwannoma. Due to persistent pain, a lumbar MR was obtained that showed L1-L3 lateral/foraminal tumor extension.…”

“…They are typically located extradurally, or in the intradural/extramedullary compartment (i.e., 0.3–0.5/100,000). [ 1 , 2 , 5 , 6 , 9 ] Magnetic resonance (MR) scans with/without contrast are the diagnostic procedures of choice. Surgery should consist of a gross resection to obtain optimal long-term results.…”