Lumbar Schwannoma Research Articles

Minimally invasive removal of dumbbell shaped schwannomas with transforaminal lumbar fusion: a retrospective study with a minimum 3-year follow-up

To evaluate the effectiveness and long-term results of minimally invasive resection of dumbbell-shaped lumbar schwannomas Eden type 2 and 3 combined with transforaminal lumbar interbody fusion and transpedicular stabilization. A retrospective study included 13 patients (8 men and 5 women) with lumbar dumbbell tumors Eden type 2 and 3 who underwent minimally invasive facetectomy through posterolateral anatomical corridor, microsurgical tumor resection and MI TLIF. We analyzed intraoperative parameters, neurological functions (ASIA scale), clinical characteristics (ODI, SF-36), and complications. Resection quality and area of the multifidus muscle were assessed according to MRI data. All patients were followed-up throughout at least 3-year. Surgery time was 147 min, blood loss - 118 ml, hospital-stay - 7 days. Clinical parameters significantly improved in the follow-up period: ODI score decreased from 72 to 12 (p=0.004), SF-36 PCS increased from 26.24 to 48.51 (p=0.006) and MCS score increased from 29.13 to 53.68 (p=0.002). According to MRI data, no tumor recurrences and severe muscle atrophy (>30%) were observed after 3 years in all cases. Superficial wound infection occurred in 1 (7.7%) case. There were normal neurological functions (ASIA type E) in all patients. Minimally invasive facetectomy through posterolateral approach with MI TLIF technology can be used for safe and effective resection of dumbbell-shaped schwannomas Eden type 2 and 3.

Management of migrating spinal schwannomas: a surgeon's dilemma. Illustrative case.

A migrating spinal tumor is a rare phenomenon in the medical literature. Efficient management of these tumors is critical to avoid extended laminectomies. In this article, the authors present the case of a patient with a migrating lumbar schwannoma. They summarize a literature review of similar cases, highlighting the intraoperative challenges faced, and provide management guidelines for similar cases from their experience. Surgeons dealing with spinal intradural extramedullary lesions should always consider the possibility of tumor migration. Routine preoperative counseling regarding potential tumor migration and its efficient management is essential, as it reduces the risk of unplanned extensive laminectomy or durotomy, minimizing morbidity and medicolegal concerns and enhancing patient care.

Factors Related to the Deterioration of Postoperative Lower Back Pain in Hemilaminectomy Approach for Lumbar Spinal Schwannoma Resection.

This study aimed to explore the related risk factors in patients who underwent hemilaminectomy for lumbar spinal schwannoma resection and who experienced deterioration of postoperative lower back pain in comparison to preoperative pain levels. This retrospective study recruited 61 patients from the First Affiliated Hospital of An Hui Medical University between January 2018 and June 2019. All data were collected from clinical records and analyzed at 1-month and at 1-year follow-up. The visual analog scale (VAS) was used to evaluate pain, and neurologic function was assessed using the Modified McCormick Scale. Intraoperative neurophysiological monitoring was used to assess neuronal integrity and mitigate injury. Statistical analysis of the data was performed using the SPSS version 19 software. Preoperative pain improved dramatically in the 1-year follow-up (VAS: preoperative, 3.84±2.19; 1-year follow-up, 2.13±2.26; P<0.001). The pain-improved group and worsened group showed a significant difference at 1-month (VAS: 1.76±1.56; 5.54±1.26; P<0.05) and at 1-year (VAS: 0.83±1.09; 4.80±1.58; P<0.05) follow-up. The pain-improved and worsened groups had a significant difference in tumor size and hemilaminectomy removal segments at 1-month and 1-year follow-up, but A-train occurrence on electromyography could only be seen as a statistical difference in the 1-month follow-up. Logistic regression analysis revealed that tumor size was an independent risk factor for postoperative lower back pain deterioration. The hemilaminectomy approach is a safe and effective method that can dramatically relieve pain in spinal lumbar schwannoma resection. Tumor size is an independent risk factor for postoperative lower back pain. A-train on spontaneous electromyography has been shown to be a reliable predictive factor for the evaluation of postoperative lower back pain. However, further detailed analysis of A-train characteristics can provide a more accurate warning during surgery.

Paramedian Wiltse Approach for Giant Paraspinal Lumbar Schwannoma: Technical Note and Alternative Approaches.

Paraspinal lumbar schwannomas are primarily located outside of the spinal canal with minimal extension into the neural foramen. Approaching these tumors through a traditional posterior approach can be challenging given their lateral location to the spine and is likely to require extensive bony removal and potential destabilization of the spine. Alternatives approaches have been identified that may circumvent the need for extensive bony removal. To examine the use of the paramedian Wiltse approach for giant extraspinal tumors and compare the approach with other nonposterior approaches. We present 2 cases in which the paramedian Wiltse approach is used to effectively approach large paraspinal schwannomas and achieve complete tumor resection without destabilization of the spine. The paramedian Wiltse approach along with expandable retractors systems were able to achieve complete resection of the giant paraspinal schwannomas. Neural preservation was able to be achieved in one case which was facilitated by the exposure achieved through the posterior paramedian corridor that allowed for visualization of the proximal and distal ends of the tumor. The paramedian Wiltse approach is an ideal approach to target large extraspinal schwannomas for complete resection and potential neural preservation without the need for destabilization of the spine.

Recurrence of an Intradural Lumbar Schwannoma 8 Years after Gross Total Resection.

Recurrence of an Intradural Lumbar Schwannoma 8 Years after Gross Total Resection.

Outcomes of Surgical Treatment of Intraspinal Intradural Lumbar Schwannomas

Outcomes of Surgical Treatment of Intraspinal Intradural Lumbar Schwannomas

MIS removal of extraforaminal lumbar spine schwannoma using MAS–TLIF retractor: technical note

Background To report the use of Nuvasive MAS–TLIF retractor for the removal of lumbar spine schwannomas. Methods A 47-year-old man with 1-year history of back pain with progressive left sciatica underwent surgical resection of a left extraforaminal lumbar schwannoma (type IV according to Eden's classification) using the MAS–TLIF retractor. Results The patient completely recovered from the preoperative symptoms and was discharged three days after surgery. The MRI acquired 6 months postoperatively showed complete tumour removal, with no signs of instability. The MAS–TLIF retractor allows for an optimal paraspinal tissues retraction, improving the area of exposure and the manoeuverability angle. Moreover, the stability of the retraction is guaranteed by the positioning of the two transpedicular screws. Spinal fusion is not necessary because the posterior tension band is not jeopardised. Conclusions MAS–TLIF retractor allows for a minimally invasive and safe surgical removal of LSS maximising surgical exposure and avoiding spinal fusion.

Spinal Intraosseus Schwannoma: A Case Report

Introduction: Schwannomas are the most frequent extramedullary intradural spinal tumors, accounting for approximately 24% of all nerve sheath tumors in adults. In a lower percentage of cases they may be extradural or transdural (1-19%). Intramedullary schwannomas and intraosseous schwannoma are quite rare tumors representing. Case Description: A 74-year-old woman presented intense low back pain for a few months, associated with left cruralgia and dysesthesia spread to both lower limbs. Magnetic resonance and computed tomography examination demonstrated an extramedullary intradural osteolytic lesion located in the posterior part of the vertebral body and pedicles of L1. The patient underwent a first surgery 4 years earlier with complete removal of the tumor but after about two years she had a recurrence. She was then subjected to a new intervention of decompression, removal of the tumor and arthrodesis. The histological findings were compatible with a classical schwannoma characterized by intraosseous growth and multifocal bone infiltration. Conclusion: We reported a rare case of intraosseous schwannoma presenting as a recurrence four years after radical surgical removal of a classic lumbar schwannoma. Only 25 cases of these tumors have been previously reported and none of them as an intraosseous recurrence.

Postoperative Thecal Sac Compression Induced by Hydrogel Dural Sealant after Spinal Schwannoma Removal

Cerebrospinal fluid (CSF) leak is a common complication of spinal and cranial surgery, and patients undergoing spinal tumor surgery are probably particularly predisposed due to the presence of an intradural tumor and many other factors. Furthermore, a meticulous dural closure technique does not always result in watertight closure. A number of adjunctive methods have been used to assist with dural closure. Synthetic, absorbable polyethylene glycol hydrogel dural sealants are widely used and have been approved for use as adjuncts for cranial applications requiring sutured dural closure. We report a case of thecal sac compression by DuraSeal® Dural Sealant used to repair the CSF leak after intentional durotomy during lumbar schwannoma extirpation.

Minimally invasive resection of a lumbar extradural schwannoma: how I do it.

Complete surgical resection of a foraminal lumbar schwannoma may require an extended surgical exposure and facetectomy and thus secondary instrumentation. The minimally invasive technique through the use of tubular retractors may represent a valid surgical alternative. We describe the resection of a foraminal lumbar schwannoma through the use of tubular retractors, along with its advantages and limitations. A limited medial facetectomy was performed and no stabilization was needed. Minimally invasive surgery is suitable for an efficient and safe resection of foraminal schwannomas and may help in avoiding stabilization when a limited facetectomy is performed.

Coexistence of schwannomatosis and glioblastoma in two families

Schwannomatosis is a rare affection predisposing to multiple peripheral neurologic tumors development. Approximatively, one third of patients with schwannomatosis are carriers of a germline mutation in LZTR1 (Leucin Zipper Transcription Regulator 1). Tumorigenesis in schwannomatosis responds to a somatic 5-hit/3-step mechanism resulting in a loss of function (LOF) of LZTR1 and the contiguous genes of locus 22q11.2q12.2. Effectively, LZTR1 is mapped on 22q11.2 and centromeric to SMARCB1 also implicated in the determinism of schwannomatosis and NF2, responsible for neurofibromatosis type 2. On a somatic point of view, LZTR1 mutations are known to drive with a significant frequency glioblastoma (GB) development. We report here two families in which segregate both multiple schwannomas and GB. In the first family, the proband received a diagnosis with of schwannomatosis after a surgery for a lumbar schwannoma at age 43, molecularly confirmed by identification of a germline heterozygous mutation in LZTR1. Her father, having unremarkable medical history deceased from an apparently isolated GB at age 59. In the second family, LZTR1-related schwannomatosis was diagnosed in the index case at age 70 after multiple schwannomas surgeries. Her elder sister had no neurological medical history before occurrence of a lethal GB at age 78. Molecular analysis of GB sample from both affected relatives showed the presence of the familial mutation. These observations hypothesize a potential link between schwannomatosis and the GB development.

Resection of a Lumbar Intradural Extramedullary Schwannoma: 3-Dimensional Operative Video.

This 3-dimensional operative video illustrates resection of a lumbar schwannoma in a 57-yr-old female who presented with right lower extremity numbness, paresthesias, as well as a long history of lower back pain with rest. On magnetic resonance imaging (MRI), there was evidence of an intradural extramedullary enhancing lesion at L5, nearly completely encompassing the spinal canal. This video demonstrates the natural history, treatment options, surgical procedure, risks, and complications of treatment of these types of tumors. The patient underwent a posterior lumbar laminectomy with a midline dural opening for tumor resection. The tumor was encountered intradurally and electromyography recording confirmed that the tumor arose from a lumbar sensory nerve root. The sensory root was then divided and the tumor was then removed. The mass was removed en bloc and histopathologic analysis was consistent with a schwannoma. Postoperative MRI demonstrated gross total resection of the patient's neoplasm with excellent decompression of the spinal cord. The patient had an uneventful postoperative course with full recovery and complete resolution of her back pain and leg paresthesias.

Intraoperative Neurophysiologic Monitoring for Lumbar Intradural Schwannomas: Does It Affect Clinical Outcome?

Intraoperative multimodal neuromonitoring (IONM) is considered valuable for the early detection and prevention of any neurologic compromise during spine surgery. It has also become the standard of care at many institutions to improve the surgical outcome and be a safety net for both clinical and medicolegal concerns. Our experience and outcomes in 46 consecutive cases of lumbar intradural schwannoma resection were reviewed with respect to clinical outcomes and patient safety, before and after the integration of IONM into our clinical practice. Total surgical resection of schwannomas in the lumbar spine led to improved health-related quality of life for patients. The standard technique for microsurgical resection of schwannomas requires identifying and resecting the fiber of origin for the schwannoma, guided with triggered electromyographic monitoring. However, whether this changed the surgical strategy, because spinal roots that gave rise to the schwannoma were frequently found to be nonfunctional during surgery, remains unclear. In our series of 46 patients, we did not recognize any additional motor deficit after the surgery, regardless of the use of IONM. Despite our analysis proving no difference in clinical outcomes with or without the use of IONM during surgical excision of lumbar schwannomas, we still prefer using IONM as a standard approach. It adds to the confidence and ease of mind of the surgeon during resection and also provides valuable data in cases of medicolegal disputes. However, it comes with an increased cost and lengthened surgical procedure.

Mobile cauda equina schwannomas: How to deal with this rare event and avoid surgical complications.

Background:Mobile schwannomas of the cauda equina are rare. Preoperative planning should take into consideration the possibility of tumor migration, avoiding unnecessary additional laminectomy or second operation.Case Description:A patient with a previously known lumbar schwannoma was being managed conservatively until symptoms exacerbated and led to a new MR. When this study revealed caudal migration of the schwannoma from L3 to the L4–L5 levels, a right hemilaminectomy was performed for tumor resection.Conclusion:Great care must be taken in the surgical resection of schwannomas as they may migrate from their initial location.

Lumbar Spinal Angiolipoma with Expanding Left Neural Foramen Mimicking Lumbar Schwannoma; Case Report and Review of The Literature.

Aim:To describe a patient with lumbar angiolipoma mimicking schwannoma in the posterolateral side of the spinal canal with expansion of the left lumbar foramen and to discuss the clinical, radiologic, and surgical features of these lesions with literature.Methods:Without language restriction in this paper, the electronic databases; The Cochrane Collaboration the Cochrane, The Cochrane Library (Issue 2 of 12, Feb. 2011), ProQuest, US National Library of Medicine, National Institutes of Health (NLM) and PubMed dating from 1966 September to January Week 2 2017, were searched for comparative experimental studies using the terms: “OR”, “AND”. On-line literature searches were conducted using the key words “lumbar angiolipoma”, “schwannoma “, “spinal angiolipoma”, “spinal cord”, and “spinal canal”. We compared this research with our patient.Results:Bilateral L2 total laminectomy, excision of the tumors and bilateral L2-L3 transpedicular stabilization were performed, and complaints improved prominently. Pathological examination was reported as angiolipoma.Conclusion:The research shows that a probable diagnosis in such tumor cases could be made by sufficient pre-op scanning before surgical operations and although angiolipoma has been rarely seen in lumbar posterolateral space, it can be seen in lumbar region and mimic schwannoma as producing symptoms and signs of spinal cord and nerve root compression.

Intradural Schwannoma Exacerbating the Symptoms of Degenerative Lumbar Stenosis: Case Report

Introduction Schwannoma is a common intradural slow-growing, benign and encapsulated tumor that originates from the myelin sheaths of the nerve fibers. However, a lumbar schwannoma complicating the symptoms of spinal stenosis is an extremely rare association. Aim To describe the case of a woman presenting a lumbar schwannoma in association with spinal stenosis. Case Report A 53 year-old female was referred to neurosurgical evaluation due to the worsening of a lumbar pain that was irradiating to the left inferior leg along the anterolateral surface. A neurological examination revealed motor deficits for extension of the left leg and attenuation of the left patellar reflex. Magnetic resonance imaging (MRI) showed lumbar spinal stenosis due to flavum ligament hypertrophy and disc herniation in the L3L4 and L4L5 segments, and an expansive lesion with homogeneous contrast enhancement occupying the left neuroforamen of the L3L4 segment. The patient underwent surgical resection of the tumor and decompression of the stenotic segments with posterior screw instrumentation from L3 to L5. She presented an uneventful recovery and significant improvement of the lumbar pain, and was still free of symptoms 6 months after surgery. An anatomopathological examination defined the tumor as a schwannoma (Grade I – World Health Organization [WHO]). Conclusion The present study highlights that lumbar schwannoma is a possible etiology complicating the symptoms of patients with previous lumbar spinal stenosis. It is important to treat both pathologies to improve the patients' symptoms.

Giant retroperitoneal lumbar Schwannoma: A case report and review of literature

Giant retroperitoneal lumbar Schwannoma: A case report and review of literature

Giant retroperitoneal lumbar Schwannoma: A case report and review of literature

Giant retroperitoneal lumbar Schwannoma: A case report and review of literature

Giant retroperitoneal lumbar Schwannoma: A case report and review of literature

Giant retroperitoneal lumbar Schwannoma: A case report and review of literature

A Novel Less Invasive Technique for the Excision of Large Intradural and Extradural Dumbbell Lumbar Schwannomas: The “Dual Approach”

Large schwannomas with intradural and extradural extensions are often challenging surgical lesions. A variety of approaches, usually requiring large exposures, removal of facets and pars interarticularis, and spinal stabilization, have been described. The aim of this study is to describe the "dual approach," a less invasive technique for the excision of these lesions. A large intradural and extradural schwannoma with paraspinal extension (Eden type II) was removed by a unilateral approach-midline, pars and facet sparing and no supplemental instrumentation. Complete excision was achieved through the described approach, with minimal removal of bone and soft tissue disruption. There were no intraoperative or perioperative complications and no evidence of residual tumor or instability/deformity. The dual approach is a novel and unique technique that allows complete and safe removal of large intradural and extradural dumbbell tumors through a less invasive approach and no need for instrumentation.