Surgical Strategies in the Management of Spinal Nerve Sheath Tumors

Nanda, Anil; Kukreja, Sunil; Ambekar, Sudheer; Bollam, Papireddy; Sin, Anthony

doi:10.1016/j.wneu.2015.01.020

Cited by 35 publications

(26 citation statements)

References 46 publications

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“…11 Nanda et al reported 18 complications in 61 patients for a rate of 30%, which included pseudomeningocele and CSF leak in 5 cases (8%), instability in 2 cases (3%), wound infection in 3 cases (5%), and 1 case each of DVT, pulmonary embolism, incomplete recurrent laryngeal nerve injury, trigeminal nerve injury, and pseudarthrosis. 18 In the current study we describe neurological outcomes and surgical complications in a series of 221 tumors treated at a single center. There was no difference in age, sex, clinical presentation, symptom duration, or extent of resection among patients when comparing those with new or worsening neurological outcomes and surgical com-plications and those without such outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…3,6,8,11,14,[22][23][24] Studies focusing purely on surgical complications are limited. Among the studies in which surgical complications are defined as events such as wound infections, CSF leaks, deep venous thrombosis (DVT), or pulmonary complications, those by Fernandes et al 11 and Seppälä et al 23 cite rates of around 10%, whereas Nanda et al 18 cite rates up to 30%; however, this latter study includes recurrence as a type of complication. When examining neurological outcomes such as new or worsening motor and sensory deficits, rates range from 5% to 30%.…”

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confidence: 99%

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Neurological outcomes and surgical complications in 221 spinal nerve sheath tumors

Safaee

Lyon

Barbaro

et al. 2017

SPI

112

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OBJECTIVE Among all primary spinal neoplasms, approximately two-thirds are intradural extramedullary lesions; nerve sheath tumors, mainly neurofibromas and schwannomas, comprise approximately half of them. Given the rarity of these lesions, reports of surgical complications are limited. The aim of this study was to identify the rates of new or worsening neurological deficits and surgical complications associated with the resection of spinal nerve sheath tumors and the potential factors related to these outcomes. METHODS Patients were identified through a search of an institutional neuropathology database and a separate review of current procedural terminology (CPT) codes. Age, sex, clinical presentation, presence of neurofibromatosis (NF), tumor type, tumor location, extent of resection characterized as gross total or subtotal, use of intraoperative neuromonitoring, surgical complications, presence of neurological deficit, and clinical follow-up were recorded. RESULTS Two hundred twenty-one tumors in 199 patients with a mean age of 45 years were identified. Fifty-three tumors were neurofibromas; 163, schwannomas; and 5, malignant peripheral nerve sheath tumors (MPNSTs). There were 70 complications in 221 cases, a rate of 32%, which included 34 new or worsening sensory symptoms (15%), 12 new or worsening motor deficits (5%), 10 CSF leaks or pseudomeningoceles (4%), 11 wound infections (5%), 5 cases of spinal deformity (2%), and 6 others (2 spinal epidural hematomas, 1 nonoperative cranial subdural hematoma, 1 deep venous thrombosis, 1 case of urinary retention, and 1 recurrent laryngeal nerve injury). Complications were more common in cervical (36%) and lumbosacral (38%) tumors than in thoracic (18%) lesions (p = 0.021). Intradural and dumbbell lesions were associated with higher rates of CSF leakage, pseudomeningocele, and wound infection. Complications were present in 18 neurofibromas (34%), 50 schwannomas (31%), and 2 MPNSTs (40%); the differences in frequency were not significant (p = 0.834). Higher complication rates were observed in patients with NF than in patients without (38% vs 30%, p = 0.189), although rates were higher in NF Type 2 than in Type 1 (64% vs 31%). There was no difference in the use of intraoperative neuromonitoring when comparing cases with surgical complications and those without (67% vs 69%, p = 0.797). However, the use of neuromonitoring was associated with a significantly higher rate of gross-total resection (79% vs 66%, p = 0.022). CONCLUSIONS Resection is a safe and effective treatment for spinal nerve sheath tumors. Approximately 30% of patients developed a postoperative complication, most commonly new or worsening sensory deficits. This rate probably represents an inevitable complication of nerve sheath tumor surgery given the intimacy of these lesions with functional neural elements.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Neurological outcomes and surgical complications in 221 spinal nerve sheath tumors

Safaee

Lyon

Barbaro

et al. 2017

SPI

112

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“…In the current series, five patients had schwannoma, three patients had meningioma, and one patient had neurofibroma. Although the tumors size larger than 3 cm and ventral location were technically difficult [ 5 ], the gross total resection was achieved in every patient in our study. Several factors may be responsible for this condition.…”

Section: Discussionmentioning

confidence: 98%

“…Spinal extramedullary tumors in the CCJ pose considerable difficulties in the operative management regarding surgical approach and technique of fixation. Several surgical approaches have been reported in literature including anterior, lateral, or posterior approaches [ 4 , 5 ]. As posterior approach facilitates resection and limits postoperative morbidity, it is widely used for surgical resection of spinal extramedullary tumor in CCJ regardless of the tumor location relative to the spinal cord [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Occipito-cervical fusion following gross total resection for the treatment of spinal extramedullary tumors in craniocervical junction: a retrospective case series

Jiang

Zhan

et al. 2015

World J Surg Onc

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BackgroundPrevious studies found that the facet joint of the C1 vertebra were removed (C1 facetectomy) before extirpation from the extramedullary tumor in craniocervical junction, leading to postoperative upper cervical instability or deformity. Occipito-cervical fusion (OCF) is a demanding and morbid surgical procedure, which can be used in such patients. This study is to analyze the clinical manifestation and surgical outcome of patients with craniocervical extramedullary tumor undergoing an extirpation of spinal tumors and OCF by one-stage posterior approach.MethodsThe surgical and clinical databases were searched for operative procedures that had been performed for patients with spinal extramedullary tumors in craniocervical junction at a single institution from January 2008 to July 2011. The following inclusion criteria were applied: (1) initial surgery for craniocervical extramedullary tumor, (2) gross total resection and occipito-cervical fusion had been performed, (3) minimum 2-year follow-up, and (4) no previous cervical spine surgery. Medical records included demographic characteristics, clinical assessment, and radiographic studies. Clinical outcomes before and after the surgery were assessed using Frankel grade and the Japanese Orthopaedic Association (JOA) score. Cervical sagittal alignment was evaluated by C0-2 angle and C2-7 angle based on X-ray.ResultsNine patients were included in the study. Five patients had schwannoma, three patients had meningioma, and only one patient had neurofibroma. All cases were followed up for 24–42 months (average, 34.2 months). At the last follow-up, three patients improved from Frankel grade C to grade D, two patients from Frankel grade C to grade E, and one patient from Frankel grade D to grade E, while two patients remained stationary at the Frankel grade D. The JOA score of the eight patients were 9.0 (range, 6–17) before surgery and were 14.6 (range, 12–17) at the most recent follow-up (p < 0.05). The mean C0-2 angle and the mean C2-7 angle before surgery were 26.2 ± 5.3° and 17.4 ± 13.1°, respectively. At the end of follow-up, the mean C0-2 angle was 25.6 ± 4.8°, and the mean C2-7 angle decreased to 12.7 ± 10.9°. However, this trend did not reach statistical significance (p < 0.05). Two patients suffered from cerebrospinal fluid leaks postoperatively. All patients had a satisfactory fusion and did not exhibit a tumor recurrence during the follow-up period.ConclusionsOCF following gross total resection appears to be a useful surgical procedure for the craniocervical extramedullary tumors requiring C1 facetectomy and does not cause postoperative kyphosis of the upper cervical spine.

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“…To ensure that these requirements were met, extensive approaches were chosen in the past, with laminectomies of 2 or more segments 1,20,24 and large exposure of the tumor area. These approaches led to problems in terms of large wounds with high infection rates and possible bleeding sources 4,17,18,23 and also predisposed patients to spinal instability 4,25 and deformities, 14,15 like the "swan neck" that was observed especially in young patients who underwent multilevel laminectomy. 7,8 This led to an increase in reports of the use of additional spinal instrumentation to solve this problem.…”

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confidence: 99%

Keyhole approaches to intradural pathologies

Mende

Krätzig

Mohme

et al. 2017

Neurosurgical Focus

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OBJECTIVESpinal tumors account for 2%–4% of all tumors of the central nervous system and can be intramedullary, intradural extramedullary, or extradural. In the past, wide approaches were used to obtain safe access to these tumors, as complete resection is the goal in treating most tumor entities. To reduce surgical complications due to large skin incisions and destabilizing laminectomies, minimally invasive approaches were established. In this study, the authors share their experience with mini-open approaches to intradural tumor pathologies.METHODSThe authors retrospectively reviewed cases involving patients with intramedullary and intradural extramedullary lesions treated between 2009 and 2016. They present their surgical mini-open approach to the spinal cord as well as unique characteristics, key steps, and postsurgical complications for specific tumor subgroups (meningioma, neuroma, and intramedullary tumors).RESULTSA total of 245 intradural tumors were surgically treated during the study period. Of these lesions, 151 were intradural extramedullary meningiomas (n = 79) or neuromas (n = 72). Nine (12.5%) of the neuromas were dumbbell neuromas. Ninety-four tumors were intramedullary. The mean age of the patients was 51.4 years, and 53.9% were female. The mean duration of follow-up was 46.0 months.All meningiomas and neuromas could be resected using a mini-open keyhole approach, but only 5.3% of the intramedullary lesions could be accessed using this technique. Of the 94 patients with intramedullary tumors, 76.6% required a laminotomy, 7.4% required a hemilaminectomy, and 10.6% required a 2-level laminectomy. Only 2 of the patients with intramedullary tumors needed stabilization for progressive cervical kyphosis during follow-up. None of the other patients developed spinal instability after undergoing surgery via the mini-open (keyhole/interlaminar) approach. There were significantly more surgery-associated complications in the large exposure group than in the patients treated with the mini-open approach (19.1% vs 9.6%, p < 0.01).CONCLUSIONSIntradural extramedullary and in selected cases intramedullary pathologies may safely be resected using a mini-open interlaminar approach. Avoiding laminectomy, laminotomy, and even hemilaminectomy preserves spinal stability and significantly reduces comorbidities, while still allowing for complete resection of these tumors.

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Surgical Strategies in the Management of Spinal Nerve Sheath Tumors

Cited by 35 publications

References 46 publications

Neurological outcomes and surgical complications in 221 spinal nerve sheath tumors

Neurological outcomes and surgical complications in 221 spinal nerve sheath tumors

Occipito-cervical fusion following gross total resection for the treatment of spinal extramedullary tumors in craniocervical junction: a retrospective case series

Keyhole approaches to intradural pathologies

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