Sporadic Spinal Schwannomas and Neurofibromas – a Review

Abstract

Tumours arising from the spinal nerve roots are more common in men between the third and fourth decades of life, located mainly in the intradural space of the lumbar region. The clinical symptoms of spinal schwannomas and neurofibromas are similar and depend on the location of the tumour and its relationship to the spinal cord and nerve roots. The pain (radiculalgia and/or vertebralgia) is the earliest symptom, followed by sensory deficit, while motor deficits and sphincter disorders are late symptoms. Magnetic resonance imaging is the diagnostic tool of choice and should be performed when the disease is suspected, as early and accurate diagnosis is essential for treatment outcome. The treatment of these lesions is surgical aiming at total tumour resection that promotes neurological recovery and prevents from recurrences. Subtotal removal also provides favourable outcome but at higher recurrence rates. The aim of this literature review was to study some important characteristics of sporadic spinal schwannomas (SSS) and neurofibromas (SSN), i.e. those notassociated with neurofibromatosis type I and II.

Long-Term Functional Outcomes Following Surgical Treatment of Spinal Schwannomas: A Population-Based Cohort Study

“…In line with this, authors such as Apostolov have highlighted the importance of complete tumor resection to promote full neurological recovery [12]. There is a consensus that GTR can be safely and effectively achieved for most nerve sheath tumors and that GTR reduces the risk of tumor recurrence [3,9,12,24,25]. In our cohort, GTR was achieved in 83% of cases, which is similar to the previously reported GTR rate of 80-90% [2,3,5,6,14].…”

“…Importantly, since neurological symptoms are mainly reflective of nerve root or spinal cord compression, only patients with symptomatic compression can improve. In line with this, authors such as Apostolov have highlighted the importance of complete tumor resection to promote full neurological recovery [12]. There is a consensus that GTR can be safely and effectively achieved for most nerve sheath tumors and that GTR reduces the risk of tumor recurrence [3,9,12,24,25].…”

“…Through nerve root or spinal cord compression, tumors may cause both sensory and motor dysfunction and are often associated with radicular pain [7,[9][10][11]. The treatment of choice for symptomatic spinal schwannomas is surgery, aiming for gross total resection (GTR) with preservation of the nerve and sustained or improved neurological function [3,9,12]. Surgical complications often occur in large tumors with extraforaminal extension since they require more extensive approaches [13].…”

“…Several studies have shown that GTR can be achieved with sustained or improved neurological function, thereby reducing the recurrence rate [3,9,12]. According to the literature, GTR is achieved in 74-94% of spinal schwannomas and subtotal resection (STR) in 15-21% of cases [2,3,6,14].…”

Letter to Editor regarding: “Atypical intradural extramedullary spinal schwannoma causing cauda equina syndrome: A case report and literature review”

“…Regarding the tumor location, it would be considered atypical if it were intramedullary, as such a location according to Koeller and Shih is observed in only 1.1 % of cases of spinal schwannomas [ 2 ]. The lumbar location of spinal schwannomas in their study was observed from 25.6 % to 60 % of cases, which according to Jinnai et al, is due to the anatomical characteristics of the spinal nerves, which travel a greater distance in the region of the cauda equina [ 4 , 5 ]. In this regard, the localization of the schwannoma described by Lim D.-J.…”