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Spinal schwannomas are commonly presented with minor symptoms, including radicular pain, sensory deficits, and minor neurologic deficit. Acute neurologic deterioration is uncommon. In this study, a case of cauda equina schwannoma presented with acute neurologic deficit after movement of spinal schwannoma is presented. It is noted that movement of spinal schwannoma and resultant acute neurologic deterioration should be considered during the follow-up. [ABSTRACT FROM AUTHOR]

Dumbbell-shaped spinal schwannomas with intradural and extradural components are associated with higher complication rates. This may be in part due to epineurial dissection of the extradural component, which inevitably damages the functioning nerve fibers beneath the epineurium and may lead to dural defects that are often difficult to repair. The objective was to describe a radical intracapsular dissection technique that provides a simpler operative field with no need for dural repair and a better chance of preserving functioning nerve fibers. The technique comprised the following: 1) exposure of the tumor while preserving spinal stability; 2) a single incision encompassing the dura and epineurium; 3) microsurgical dissection of the tumor just beneath the epineurium, preserving the viable nerve fibers; and 4) primary closure of the duroepineurial incision. We describe a case series of 7 patients in whom this type of tumor was excised using this technique. Gross total excision was achieved in 5 patients. In 1 patient with a large paravertebral component, the remaining tumor was removed with an additional anterior approach. No cerebrospinal fluid leak was noted, and no recurrence was observed in the median follow-up period of 36 months. The radical intracapsular dissection technique described herein represents an alternative technique for the removal of dumbbell-shaped spinal schwannomas with intradural and extradural components. [ABSTRACT FROM AUTHOR]

Background Schwannoma comprises approximately 25% of all spinal tumors, but there is little information published in the literature regarding this subject. Our aim in this study was to discuss diagnostic and prognostic factors for spinal schwannoma. Methods A retrospective study was performed to analyze the clinical and immunohistochemical data of patients with spinal schwannoma surgically treated in our center between 2005 and 2013. Results A total of 524 patients with spinal schwannoma were included in the study. The mean follow-up period was 58.3 months. Forty-eight patients developed recurrence, and 26 died. Findings from the statistical analyses suggested duration of preoperative symptoms, Sridhar classification, tumor size, bone damage, Ki67 labeling index, and S100 expression were different between benign schwannoma and the malignant subtype. Recurrence was associated with resection mode, segments of involvement, pathology grade, CD57 expression, Ki67 labeling index, and S100 expression. The overall survival was closely related with recurrence, location in sacrum, pathology grade, Ki67 labeling index, and P53 expression. Conclusions Compared with the benign subtype, malignant schwannoma has a shorter duration of preoperative symptoms, larger tumor size, greater Sridhar classification, and poorer prognosis. Total resection can significantly reduce recurrence but not guarantee a better survival, which is associated location and pathology grade. A Ki67 labeling index >5% was not only an index for malignant subtype but also a prognostic indicator for recurrence and poor survival. Moreover, S100-negative was a prognostic indicator for recurrence, whereas P53-positive was associated with a poor prognosis. Highlights • Ki67 and S100 expression were different between benign and malignant subtypes. • Recurrence was associated with resection mode, segments of involvement, and pathology. • Overall survival was related to recurrence, location in sacrum, and pathology grade. • Ki67 was an independent prognostic indicator for recurrence and overall survival. • S100 and P53 were associated with recurrence and poor prognosis, respectively. [ABSTRACT FROM AUTHOR]

Background Hydrocephalus and intracranial hypertension are rare signs of spinal tumors when presenting in isolation, particularly with benign tumors. Case Description Herein reported is a case of a 53-year-old woman who presented with headache, blurry vision, communicating hydrocephalus, and intracranial hypertension. No primary intracranial pathology was identified, and there were no clinical signs or symptoms of intraspinal pathology. Lumbar puncture revealed elevated opening pressure, cerebrospinal fluid protein, and suspected tumor cells in the cerebrospinal fluid, thus prompting spinal imaging. A primary lumbar schwannoma was subsequently determined to underlie her symptoms, which resolved with tumor resection. Conclusions Clinical suspicion of spinal pathology should be maintained in patients with unexplained intracranial hypertension, even in the absence of localizing signs of spinal pathology. Highlights • Patient presented only with signs of intracranial hypertension but was found to have lumbar schwannoma. • CSF cytology demonstrated tumor cells, an unexpected finding with a benign tumor such as a schwannoma. • Clinician should consider broader differential of spinal pathology in cases of IC hypertension unexplained by IC causes. [ABSTRACT FROM AUTHOR]

Background Spinal intradural tumors are usually removed with laminectomy/laminotomy with a midline dural incision. Pain, discomfort, postoperative kyphosis, and instability may be minimized with unilateral microsurgery. Methods Seventy patients with schwannoma (73 tumors) and 27 patients with meningioma (29 tumors) were operated on with unilateral hemilaminectomy (June 2000 to March 2014). Surgery was generally kept to 1 or 2 levels, removing all the craniocaudal ligamentum flavum. Careful radioscopic identification is mandatory; in thoracolumbar schwannomas, the tumor may be mobile; in the prone position, it may move cranially than appears on magnetic resonance imaging. The dura was opened paramedially, and the tumor was dissected and removed either en bloc or piecemeal after ultrasonic debulking. Neurophysiologic monitoring was performed. The tumor was approached tangentially with no cord rotation or minimal manipulation. Average duration of surgery was 160 minutes (100–320 minutes). Removal was total in 72 of 73 schwannomas; Simpson grade was 1 in 10 meningiomas and 2 in 19. Results Patients with no complications were discharged on day 5–7. Ten patients had orthostatic headaches; 2 had pseudomeningocele that required reoperation. Pain improvement (Dennis Scale) was significant either at discharge or at follow-up ( P < 0.0001 schwannomas, P < 0.001 meningiomas). Neurologic results (McCormick Scale, Karnofsky Performance Score) were excellent/good: of 39 patients with preoperative neurologic impairment, 19 recovered completely, 17 had minor spasticity, and 3 had moderate spasticity but autonomous ambulation. Sphincters recovered in 5 of 10 patients At follow-up, average Karnofsky Performance Score improved from 60 to 90 ( P < 0.0001) and the McCormick score decreased from 121 to 55 ( P < 0.0001). No spinal instability was observed. Conclusions Neurologic and oncologic results were good and postoperative pain and discomfort were reduced. Stability was preserved with a unilateral technique. No bracing was necessary, permitting early rehabilitation. [ABSTRACT FROM AUTHOR]

Objective Comparing different surgical approaches for spinal schwannoma, the safety and efficacy of the minimally invasive surgery (MIS) approach were demonstrated, and a suitable indication for each surgical approach was analyzed. Methods This study comprised 49 consecutive patients with intradural extramedullary schwannoma who underwent surgical resection: 31 patients via MIS approach (MIS group; 6 patients via a muscle-splitting approach using a tubular retractor and 25 patients via unilateral hemilaminectomy preserving the contralateral paraspinal muscle) and 18 patients via total laminectomy (TL group). Medical records including perioperative data and radiologic data were reviewed. Results On initial magnetic resonance imaging, the mean maximal sagittal diameter of the tumor was 23.9 mm in the MIS group and 26.9 mm in the TL group, and the mean maximal axial diameter was 16.1 mm in the MIS group and 22.8 mm in the TL group ( P = 0.452 and P = 0.011, respectively). The foraminal extension of tumor was identified in 8 patients in the MIS group and 9 patients in the TL group ( P = 0.081). The tumor location was the lumbar spine in 20 patients in the MIS group and the cervicothoracic spine in 17 patients in the TL group ( P = 0.001). Intraoperatively, all tumors in the MIS group could be totally resected with reduced operative time and blood loss. During the follow-up period of 38.2 months in the MIS group and 51.2 months in the TL group, the clinical improvement was not different between the surgical approaches ( P = 0.332). Conclusions Safe and complete resection of intradural extramedullary schwannoma was obtained through the MIS approach. Regardless of sagittal extension of the tumor, a schwannoma with an axial diameter of 16 mm located in the lumbar spine can be effectively treated with the MIS approach, including foraminal extension. [ABSTRACT FROM AUTHOR]