The Long-term Outcome After Resection of Intraspinal Nerve Sheath Tumors

Halvorsen, Charlotte Marie; Rønning, Pål; Hald, John; Johannesen, Tom Børge; Kolstad, Frode; Langmoen, Iver A.; Lied, Bjarne; Holme, Sigrun Skaar; Helseth, Eirik

doi:10.1227/neu.0000000000000890

Cited by 26 publications

(15 citation statements)

References 21 publications

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“…However, our finding that NF3+ is associated with the increased recurrence of schwannomas has been echoed in other series. 13 Overall rates of GTR in our cohort were 44.9% for neurofibromas and 76.7% for schwannomas, which are lower than implied by Kim et al in their large retrospective series. 15 All patients in our series received intraoperative neurophysiological monitoring; Levi et al reported an increase in the residual tumor in patients monitored intraoperatively, perhaps accounting for our lower rates.…”

Section: Discussioncontrasting

confidence: 64%

Management of peripheral nerve sheath tumors: 17 years of experience at Toronto Western Hospital

Guha

Davidson

Nadi

et al. 2018

Journal of Neurosurgery

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OBJECTIVE A surgical series of 201 benign and malignant peripheral nerve sheath tumors (PNSTs) was assessed to characterize the anatomical and clinical presentation of tumors and identify predictors of neurological outcome, recurrence, and extent of resection. METHODS All surgically treated PNSTs from the Division of Neurosurgery at Toronto Western Hospital from 1993 to 2010 were reviewed retrospectively. Data were collected on patient demographics, clinical presentation, surgical technique, extent of resection, postoperative neurological outcomes, and recurrence. RESULTS One hundred seventy-five patients with 201 tumors had adequate follow-up for analysis. There were 182 benign and 19 malignant PNSTs. Of the benign lesions, 133 were schwannomas, 21 of which were associated with a diagnosis of schwannomatosis. There were 49 neurofibromas, and 26 were associated with neurofibromatosis Type 1 (NF1). Patients presenting with schwannomas were significantly older than those with neurofibromas. Schwannomas were more readily resected than neurofibromas, with the extent of resection of the former influenced by tumor location. Patients with benign PNSTs typically presented with a painful mass and less frequently with motor deficits. The likelihood of worsened postoperative motor function was decreased in patients with fully resected tumors or preoperative deficits. Recurrence of schwannomas and neurofibromas were seen more frequently in patients diagnosed with NF3 and NF1, respectively. Subtotal resection was associated with the increased recurrence of all benign lesions. CONCLUSIONS Outcomes following resection of benign PNSTs depend on tumor histopathology, tumor location, and genetic predisposition syndrome. Gross-total resection should be attempted for benign lesions where possible. The management of malignant PNSTs remains challenging, requiring a multimodal approach.

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Section: Discussioncontrasting

confidence: 64%

Management of peripheral nerve sheath tumors: 17 years of experience at Toronto Western Hospital

Guha

Davidson

Nadi

et al. 2018

Journal of Neurosurgery

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“…Although many new surgical corridors have been conceived since that time, laminectomy remains one of the primary approaches for removing intradural pathology. However, long-term outcomes on patients who underwent laminectomies, particularly in vulnerable populations such as children, have raised concerns of post-operative instability and kyphosis [7,8,10,19].…”

Section: Discussionmentioning

confidence: 99%

The Optimal Surgical Approach to Intradural Spinal Tumors: Laminectomy or Hemilaminectomy?

Goodarzi

Clouse

Capizzano

et al. 2020

Cureus

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Traditionally, laminectomy has been the preferred surgical approach for the resection of intradural spinal tumors. Recent trends towards minimally invasive techniques have generated interest in hemilaminectomy as an effective alternative surgical approach to resect spinal tumors. However, it remains unclear if the potential benefits of hemilaminectomies, used in other routine spinal procedures, apply to intradural spinal tumors. This report presents a sixyear single institutional analysis of open resection of intradural tumors using laminectomies as compared to hemilaminectomies. Methods A single institution, multisurgeon, retrospective review of 52 patients undergoing resection of intradural spinal tumors over a six-year period was performed. Estimated blood loss, operative time, post-operative complications, length of stay, and post-operative clinical spinal instability were analyzed and compared between the two surgical techniques.

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“…When a patient has a moderate tumor burden and pain is widespread there is uncertainty as to which tumor(s) should be removed. Even if the tumor is removed, the pain may not be resolved or may recur if the tumor grows back [5][6][7] . This results in a viscous cycle of multiple surgeries to hunt down the source of pain.…”

Section: Discussionmentioning

confidence: 99%

The Secretomes of Painful Versus Nonpainful Human Schwannomatosis Tumor Cells Differentially Influence Sensory Neuron Gene Expression and Sensitivity

Ostrow

Donaldson

Belzberg

et al. 2019

Preprint

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Schwannomatosis is a multiple tumor syndrome in which patients develop benign tumors along peripheral nerves throughout the body. The first symptom with which schwannomatosis patients often present, prior to discovery of tumors, is pain. This pain can be debilitating and is often inadequately alleviated by pharmacological approaches. Schwannomatosis-associated pain can be localized to the area of a tumor, or widespread. Moreover, not all tumors are painful, and the occurrence of pain is often unrelated to tumor size or location. We speculate that some individual tumors, but not others, secrete factors that act on nearby nerves to augment nociception by producing neuronal sensitization or spontaneous neuronal firing. We created cell lines from human SWN tumors with varying degrees of pain. We have found that conditioned medium (CM) collected from painful SWN tumors, but not that from nonpainful SWN tumors, sensitized DRG neurons, causing increased sensitivity to depolarization by KCl, increased response to noxious TRPV1 and TRPA1 agonists and also upregulated the expression of pain-associated genes in DRG cultures. Multiple cytokines were also detected at higher levels in CM from painful tumors. Taken together our data demonstrate a differential ability of painful versus non-painful human schwannomatosis tumor cells to secrete factors that augment sensory neuron responsiveness, and thus identify a potential determinant of pain heterogeneity in schwannomatosis. . Patients with schwannomatosis (SWN) develop multiple tumors along major nerves of the body 1 . In most cases the tumor burden is so great that they cannot be removed by surgical intervention 2 . Sixty-eight percent of SWN patients also report chronic pain, which is often debilitating 3 . Pain in SWN has been described as localized in some patients and diffuse in others 4 . The size and location of the tumor(s) do not necessarily relate to the severity of pain experienced by the patient 5 . Thus, while surgical removal of an individual tumor may provide pain relief in some cases, the surgeon is challenged with which tumor to remove. Additional confounding factors (e.g., nerve deficits, tumor recurrence, return of pain) may also affect surgical outcome 6,7 . Quality of life in Schwannomatosis patients is predominantly affected by pain, especially in those with a large tumor burden. Therefore, treatment approaches other than tumor-focused surgery needs to be developed.Neuropathic, nociceptive, and inflammatory types of pain have all been reported in SWN. The pain described by SWN patients can vary from burning to pain that feels like electric shocks 8,9 . Yet, the molecular mechanisms by which some SWN tumors, but not others, elicit unremitting pain are unknown 3 . Given the close interactions between Schwann cells and neurons, we have chosen to study the potential role of Schwann cells in neuropathic pain in schwannomatosis. It is well documented that in models of peripheral nerve injury, Schwann cells become activated and release soluble pro-inflammatory cy...

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The Long-term Outcome After Resection of Intraspinal Nerve Sheath Tumors

Cited by 26 publications

References 21 publications

Management of peripheral nerve sheath tumors: 17 years of experience at Toronto Western Hospital

Management of peripheral nerve sheath tumors: 17 years of experience at Toronto Western Hospital

The Optimal Surgical Approach to Intradural Spinal Tumors: Laminectomy or Hemilaminectomy?

The Secretomes of Painful Versus Nonpainful Human Schwannomatosis Tumor Cells Differentially Influence Sensory Neuron Gene Expression and Sensitivity

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