Spinal neurinomas: retrospective analysis and long-term outcome of 179 consecutively operated cases and review of the literature

doi:10.1016/S0090-3019(03)00537-8

Surgical Neurology

Volume 61, Issue 1, January 2004, Pages 34-43

https://doi.org/10.1016/S0090-3019(03)00537-8 Get rights and content

Abstract

Background

We present a series of 179 spinal neurinomas consecutively observed at the Department of Neurosurgery at the University of Florence for a period of 30 years (between 1967 and 1997). We decided to limit the retrospective study to obtain at least 5 years of follow-up. Therefore, 20 additional neurinomas treated between 1997 and 2002 were excluded.

Methods

All the cases are evaluated under statistical, clinical, neuroradiological, and surgically technical profiles based on data from clinical records and from periodic check-ups after surgery. In particular, the results are analyzed on the basis of an accurate pre- and postsurgical evaluation using Karnofsky's scale and Kleklamp-Samii's scoring system.

Results

We treated 179 spinal neurinomas in 152 (93 male and 59 female) patients. The mean age was 44.3. In 33 cases the neurinoma was sited in the cervical tract, in 59 cases in the dorsal tract, and in 87 cases in the lumbo-sacral tract. Eleven patients harbored Recklinghausen's neurofibromatosis (7 NF1 and 4 NF2 of which 1 was intramedullary). In 123 cases the neurinoma was intradural, in 11 cases it was extradural, in 2 intra/extradural, in 9 it had a dumbbell form, and in 2 cases it was intramedullary; the remaining cases had neurofibromatosis. The most common presurgical symptom was segmental pain. Total removal of the lesion was possible in the first operation for 174 neurinomas. We encountered 3 cases of malignant neurinoma of which 1 was in NF2. The result of surgery was recovery in 108 cases; 2 patients with NF2 died, and local recurrence occurred even after total exeresis (excision) and radiotherapy in the cases of malignant neurinoma.

Conclusions

Schwannomas represent the most frequent tumor lesions of the spine with prevalence for the cervical-inferior tract and the dorso-lumbar passage. Intramedullary neurinomas are rarely observed. The total surgical removal of neurinomas is often an attainable goal, and clinical improvement is the common outcome with exception to malignant forms and NF2 neurofibromatosis. We describe a series of 179 treated schwannomas.

Section snippets

Selection of patients

An analysis of the clinical records of patients who underwent surgery for primitive intraspinal tumor at the Department of Neurosurgery of Florence included retrieval of the series of spinal neurinomas treated during the period between 1967 and 1997. We purposely limited the retrospective study to obtain at least 5 years of follow-up. Therefore, 20 neurinomas treated between 1997 and 2002 were excluded.

All the tumors that were surgically excised were reexamined using new histopathological

Statistics

There were 179 spinal neurinomas in 152 patients treated: 93 (61.18%) male and 59 (38.82%) female. The mean age was 44.3 (minimum 7, maximum of 80). Minimal difference in the relation between age and level of the lesion was observed. More precisely, the mean age in cervical lesions was 45.4, in the dorsal lesions 48.9, and in the lumbo-sacral lesions 43.2. Thirteen patients underwent surgery at an age <20 (8.55%). Eleven (7.23%) had Recklinghausen's neurofibromatosis (7 cases of NF1 and 4 of

Discussions and considerations

The neurinomas are the most frequent primal tumors of the spine 39, 54, 58, 76, 77, 84; there is no significant prevalence in literature between males and females [77]. In our series, on the contrary, we noted a clear prevalence in males, 93 cases (61.18%), with respect to females, 59 cases (38.82%). The age of manifestation in the different case reports varies between the 3rd and the 4th decade 39, 77. The site of the lesion is mostly intradural, less frequently extradural or dumbbell, and

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Clinical Characteristics and Surgical Outcomes of 2542 Patients with Spinal Schwannomas: A Systematic Review and Meta-Analysis
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This study was conducted to systematically analyze the data on the clinical features, surgical treatment, and outcomes of spinal schwannomas.
We conducted a systematic review and meta-analysis under the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A search of bibliographic databases from January 1, 2001, to May 31, 2021, yielded 4489 studies. Twenty-six articles were included in our final qualitative systematic review and quantitative meta-analysis.
Analysis of 2542 adult patients' data from 26 included studies showed that 53.5% were male, and the mean age ranged from 35.8 to 57.1 years. The most common tumor location was the cervical spine (34.2%), followed by the thoracic spine (26.2%) and the lumbar spine (18.5%). Symptom severity was the most common indicator for surgical treatment, with the most common symptoms being segmental back pain, sensory/motor deficits, and urinary dysfunction. Among all patients analyzed, 93.8% were treated with gross total resection, which was associated with better prognosis and less chance of recurrence than subtotal resection. The posterior approach was the most common (87.4% of patients). The average operative time was 4.53 hours (95% confidence interval [CI], 3.18–6.48); the average intraoperative blood loss was 451.88 mL (95% CI, 169.60–1203.95). The pooled follow-up duration was 40.6 months (95% CI, 31.04–53.07). The schwannoma recurrence rate was 5.3%. Complications were particularly low and included cerebrospinal fluid leakage, wound infection, and the sensory-motor deficits. Most of the patients experienced complete recovery or significant improvement of preoperative neurological deficits and pain symptoms.
Our analysis suggests that segmental back pain, sensory/motor deficits, and urinary dysfunction are the most common symptoms of spinal schwannomas. Surgical resection is the treatment of choice with overall good reported outcomes and particularly low complication rates. gross total resection offers the best prognosis with the slightest chance of tumor recurrence and minimal risk of complications.
Clinical Features and Surgical Management of Intramedullary Schwannoma of the Spinal Cord
2024, World Neurosurgery
Intramedullary schwannoma is a relatively rare tumor with only a few literature reports. This study was aimed to report the clinical characteristics of intramedullary schwannoma and discuss imaging findings and treatment strategies.
The inclusion criterion was consecutive patients with intramedullary schwannomas who were surgically treated in our institution between 2017 and 2022. Data included clinical characteristics, radiologic features, surgical management, and prognosis. Clinical and follow-up details of all cases were collected and reviewed.
This study included 3 male and 8 female patients. The mean age was 45 years (range 26–77 years). Cervical spine (4 cases, 36.4%), thoracic spine (4 cases, 36.4%), and lumbosacral spine (3 cases, 27.3%) involvement was found. Weakness, numbness and pain of limbs were the main symptoms at administration. Preoperative magnetic resonance imaging demonstrated lesion with spinal cord medullary invasion and well demarcated margins. The postoperative histologic examination showed benign lesions and confirmed the schwannoma.
This article presented a series of 11 cases of intramedullary schwannoma with sharp margins and well-enhanced features. Prognosis and functional recovery were good after gross total resection.
Risk factors for recurrence and regrowth of spinal schwannoma
2023, Journal of Orthopaedic Science
Spinal schwannoma recurs after initial surgery at a rate of 4%–6%, with known risk factors including subtotal resection, multilevel involvement, large tumor size, and malignant histopathology. This study examined risk factors for schwannoma recurrence and residual tumor regrowth.
Sixty-five patients who underwent resection of spinal schwannoma in our department between July 2010 and December 2018 and were followed up for more than 1 year were retrospectively analyzed for age, sex, follow-up duration, imaging and surgical data, recurrence, reoperation, and Japanese Orthopaedic Association scores before and 1 year after surgery. Patients with postoperative recurrence or residual tumor regrowth of >10% at the final visit (R+ group) were compared with patients without recurrence or regrowth (R– group). Multivariate logistic regression analysis was performed to analyze concurrent effects of risk factors on recurrence and regrowth.
The 65 patients (mean age 52.4 years at surgery) had schwannomas involving cervical (n = 14), thoracic (n = 25), and lumbar (n = 26) spinal levels. Mean follow-up duration was 58 months. Location was intradural in 65%, extradural in 17%, and both intradural and extradural in 18%. There were 4 recurrences (6.2%), and the mean interval between surgery and recurrence was 18.8 months. Seven patients (10.8%) experienced regrowth. Comparing group R+ (n = 11) and group R– (n = 54), univariate analysis showed significant differences in Sridhar tumor classification, giant tumor (Sridhar classification II, IVb, and V), left–right and cranial–caudal tumor size, largest diameter, operative time, blood loss, subtotal resection, reoperation, fusion surgery, and follow-up duration. Multivariate logistic regression analysis revealed giant tumor (Sridhar classification types II, IVb, and V) as an independent risk factor for recurrence and regrowth.
This retrospective review of 65 consecutive patients with spinal schwannoma in a single institution demonstrated that 16.9% had recurrence or regrowth, demonstrating that this potential risk should be kept in mind.
Surgical treatment of a presacral schwannoma: A case report
2022, Annals of Medicine and Surgery
Schwannomas are rare benign tumors that develop from Schwann cells that represent 0.3 to 0.4 cases per 100,000 persons per year. We report a case of pre-sacral schwannoma, a rare tumor, especially in the pelvic area. This case comes to help further teams in their management as its scarcity made any attempt to make proper recommendations obsolete.
a 53-year-old otherwise healthy woman who presented with a 2-year history of right-sided sciatica. The radiologic characteristics of the mass suggested presacral schwannoma type III of the Klimo classification as the most possible diagnosis.
Therefore, surgical resection was decided, and an anterior approach was chosen. By laparotomy a 6cm retroperitoneal encapsulated mass with no invasion of the adjacent organs. We performed a digital enucleation of the tumor through a capsulotomy.
Pathology confirmed the diagnosis of schwannoma. There were no features of malignancy. The post-operative period was uneventful. A follow-up examination at 6 months showed no signs of numbness or weakness in the right leg. The previously described pain totally regressed.
Although schwannoma is a benign lesion, it may become malignant, especially when associated with neurofibromatosis making its surgical removal primordial. Its pelvic location may make its diagnosis delayed due to non-specific symptoms mainly through compression of local organs. Its surgical management can be challenging due to large size tumors with adherence to peritoneal and retroperitoneal organs. Quality of the resection is important in the recurrence and necessity for reoperation. A multidisciplinary approach is therefore recommended to ensure optimal treatment
Due to its rareness, there is no clear consensus in on the management of schwannomas therefore we chose to write our case in order to further enrich the literature to achieve one-day guidelines for schwannoma treatment.
Spinal Nerve Sheath Tumors: Factors Associated with Postoperative Residual and Recurrent Tumors: A Single-Center Experience
2022, World Neurosurgery
Spinal schwannomas (SSs) are usually benign tumors with a good prognosis when treated by surgical excision. However, complete resection can be complicated by factors such as the tumor location and configuration. In the present study, we sought to identify the factors associated with incomplete surgical resection (residual) and the factors associated with tumor recurrence.
We performed a retrospective review of 113 cases of SSs treated surgically from 2008 to 2021.
Of the 113 SSs, 102 were benign and 2 were malignant nerve sheath tumors. Of the 102 benign SSs, gross total resection (GTR) was performed for 87, with 8 displaying residual and 7, recurrent tumor. We found a significantly higher ratio of cervical and sacral tumors (P = 0.008 and P = 0.004, respectively), dumbbell and foraminal configurations (P < 0.0001 and P = 0.0006, respectively), and larger tumor volumes (P = 0.003) in the residual and recurrent cohorts compared with the GTR cohort. A second operation was performed for 2 patients in the residual and 4 patients in the recurrent cohorts. The total complication rate was 6%.
We found that most benign SSs will be amenable to GTR (85% of cases), with an excellent prognosis. The patients with residual or recurrent tumor were more likely to have had a cervical or sacral location, a dumbbell or foraminal configuration, and a larger tumor volume. Except for 1 new SS and 1 recurrent tumor that had necessitated a lateral approach, the remainder had been treated using a posterior approach. At surgery, ultrasonography of the canal is advisable to ensure that the intra- and extraspinal components of dumbbell lesions have both been entirely removed.
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Intramedullary schwannomas of brain stem and spinal cord are extremely rare. In almost all cases, homogeneous, asymmetrical or circular intensive gadolinium enhancement has been demonstrated. However, no cases reported previously with minimal contrast enhancement in cervicomedullary junction.
A 38-year old man presented with a one-month history of constant, radiative right shoulder and arm pain. There was no pathological finding in his neurological examination. Also, physical evidence or family history of neurofibromatosis was not found. Magnetic resonance imaging of brain and cervical spine showed intramedullary, solid-cystic lesion localized in the cervicomedullary junction with unobvious gadolinium enhancement. The mass was gross totally resected through a sub-occipital craniotomy via midline approach. Postoperative pathological examination confirmed diagnosis of schwannoma. No changes were detected in the neurological examination of the patient after the operation.
There are 3 previously reported intramedullary schwannomas of the cervicomedullary junction in the literature. To the best of our knowledge, this is the first case of unobvious contrast enhancing intramedullary schwannoma of the cervicomedullary junction. The possibility of schwannoma should not be excluded when a mass with slight contrast enhancement is detected in the intramedullary region of the cervicomedullary junction.

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NeoplasmSpinal neurinomas: retrospective analysis and long-term outcome of 179 consecutively operated cases and review of the literature

Abstract

Background

Methods

Results

Conclusions

Section snippets

Selection of patients

Statistics

Discussions and considerations

J Clin Neurosci

Surg Neurol

Surg Neurol

Surg Neurol

Surg Neurol

Surg Clin North Am

Surg Neurol

Surg Neurol

Surg Neurol

Intramedullary melanotic schwannoma. Report of a case and review of the literature

Br J Neurosurg

Intramedullary nerve fiber and Schwann cell proliferation within the spinal cord (schwannosis)

Neurology

Gene for von Recklinghausen neurofibromatosis in the pericentromeric region of chromosome 17

Science

Intraparenchymal schwannomas of the central nervous systeman additional case report and review

Neurosurg Rev

Intramedullary schwannoma

Proc Inst Neurol, Madras

Multiple intramedullary schwannomascase report

Neurol Med Chir (Tokyo)

Intramedullary schwannoma of the spinal cord

J Neurosug Sci

Spinal cord schwannomacase report

Ar Qneuropsiquiatr

Syndrome cordonal postérieur unilatéral par neurinome intra-médullaire. Syncinésies homolatérales d'imitation

Rev Neurol

Intramedullary spinal neurinomas. Report of two cases

J Neurosurg

Primary spinal malignant schwannomasclinical and prognostic remarks

Acta Neurochir (Wien)

A long fallow-up study of 128 cases of intramedullary spinal cord tumors

Neurol Med Chir (Tokyo)

Spinal meningiomas in pregnancyreport of two cases and review of the literature

Eur J Gynaec Oncol XVII

Le alterazioni radiografiche nelle compressioni spinali in eta' infantile

Riv di Neuroradiologia

Tumore maligno della guaina dei nervi periferici (MPNST) post-irradiazione

Pathologica

Intramedullary schwannoma

Can Assoc Radiol J

Neurinoma intramedullar dorsal. Presentacion de un caso

Clin Neurochir

Intramedullary spinal neurofibroma diagnosed with computed tomographyreport of the case

Neurosurgery

Intramedullary tumors of the spinal cord

Acta Neurochir

I tumori intramidollari. Il Lavoro

Neuropsichiatrico

Solitary dorsal intramedullary schwannoma

J Neurosurg

Intramedullary spinal cord tumors resected with CO2 laser microsurgical techniquerecent experience in fifteen patients

Neurosurgery

Spinal subpial schwannoma

Neurol Med Chir (Tokyo)

Neurinoma cervicale intramidollare, descrizione di un caso e revisione della letteratura

Minerva Chir

Mobile Schwannoma of the cauda equina diagnosed by magnetic resonance imaging

Neurosurgery

A case of intramedullary spinal schwannoma

No Scinkei Gika

Neurinome Intramedullaire, a propos d'un cas. Revue de la litterature

Neurochirurgie

Intramedullary spinal schwannoma

J Neurol Neurosurg Psychiatry

The clinical evaluation of chemotherapeutic agents in cancer

Intramedullary tumors of the spinal cord

Arch Neurol Psychiatr

Introduction of a score system for the clinical evaluation of patients with spinal processes

Acta Neurochir (Wien)

Neoplasm
Spinal neurinomas: retrospective analysis and long-term outcome of 179 consecutively operated cases and review of the literature