Surgical management of schwannomas in spinal eloquent areas

Abstract

Objective To investigate the clinical characteristics and surgical management of schwannomas in spinal eloquent areas. Methods Clinical data of 58 patients with schwannomas in spinal eloquent areas was retrospectively studied. All the tumors were excised by microsurgery assisted with intraoperative neurophysiological monitoring. If the tumor originated from cervical enlargement, somatosensory-evoked potentials (SEPs) and motor-evoked potentials (MEPs) of both upper and lower extremities and EMG of upper extremities were performed. If the tumor originated from intumescentia lumbalis and conus medullaris, SEPs and MEPs of lower extremities and EMG of lower extremities and sphincter ani were performed. All the tumors were excised through posterior median approach. Laminectomy or hemilaminectomy was chosen according to the size and location of tumors. The internal fixation was accepted for the reconstruction of spinal stability if facetectomy was performed. The intraoperative neurophysiological monitoring could be helpful during the procedure of internal fixation. Results Total resection was achieved in all of the 58 patients. There was no new neurological deficit after surgery. The preoperative pain symptoms in 42 patients disappeared in 39 patients and relieved obviously in 3 patients after operation. Twenty-two patients had numbness on the involved nerve root dominate regions, and maybe it was concerned with the resection of tumors and parent nerve roots. The preoperative weakness symptoms in 17 patients and constipation symptoms in 2 patients were significantly improved when discharge. One patient with severe weakness of bilateral lower extremities and 2 patients with sphincter dysfunction were transferred to Physiatry Department when their condition became stable. During the follow-up period of 3-12 months, the preoperative neurological deficit improved significantly and there was no tumor recurrence. Conclusion The intraoperative neurophysiological monitoring can reduce the rate of neurological complications for schwannomas originated from spinal eloquent areas, such as intumescentia lumbalis and conus medullaris. doi：10.3969/j.issn.1672-6731.2013.11.004 Video: http://www.cjcnn.org/index.php/cjcnn/pages/view/v13n11a4