Journal Article

Neurological outcome after resection of spinal schwannoma

Schebesch, Karl-Michael, Schmidt, Nils-Ole, Hohenberger, Christoph, Hinterleitner, Julia, Doenitz, Christian, Zeman, Florian

2020

Overview

•Large database of 90 patients with spinal neurinoma who had undergone surgery.•Surgery for spinal neurinoma significantly reduced pain as well as sensory and motor deficits.•Intraoperative electrophysiological monitoring increases the safety of spinal neurinoma surgery. Spinal schwannoma (SS) is the most frequently diagnosed benign spinal tumor, constituting approximately 25 % of all intradural tumors. Aim of our study was to identify factors that potentially affect immediate postoperative neurological outcome, and the rate of functional recovery within 12 months. Screening of our institutional database yielded 90 consecutive patients (mean age 57.1 years, 39 women [43.3 %]) with newly diagnosed SS between March 1997 and October 2018. We pre- and postoperatively reviewed patient charts, surgical reports, radiographic data, use of IOM, duration of symptoms, histopathology, co-morbidities, radiographic extension, surgical strategy, neurological performance (Japanese Orthopedic Association Score [JOA score] and Frankel Grade Classification). Mean duration of preoperative symptoms was 3.6 ± 1.6 months. Most common symptoms were local pain (n = 77, 85.6 %). Macroscopic complete resection was achieved in 84 patients (93.3 %). During follow-up, complete recovery from local pain was documented for 41 patients (59.7 %), from radiating pain for 41 (69.5 %; p < 0.001). Postoperatively, 25 (27.7 %) patients developed a new neurological deficit (motor deficits n = 3 and sensory deficits n = 23; one patient developed both); after 12 months, however, motor deficits had abated in all patients, and 16 (69.5 %) patients had completely recovered from sensory deficits. Use of intraoperative monitoring (IOM) was a significant predictor for good functional outcome (p < 0.001). Resection of SS accompanied by IOM whenever feasible should be advocated. We achieved a high number of complete resections with a low rate of morbidity. New postoperative motor or sensory deficits had a very high rate of complete recovery within 12 months.

• Publisher: Elsevier B.V,Elsevier Limited
• Subject: Asymptomatic / Back pain / Benign spinal tumors / Bone cancer / Functional outcome / Magnetic resonance imaging / Morbidity / Morphology / Neurological diseases / Neurology / Neurosurgery / Pain / Paresis / Patients / Recovery of function / Schwann cells / Spinal cancer / Spinal neurinoma / Spinal neuro-oncology / Spinal schwannoma / Spinal surgery / Surgery / Tumors