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Objective: This study aims to explore the current hot topics and future research trends in spinal schwannoma imaging research, providing a reference for related studies and promoting the development of spinal schwannoma imaging. Methods: We conducted a literature search in the Web of Science database using the search terms (((TS = (Spinal schwannoma)) AND TS = (Imaging)) OR TS = (Spinal schwannoma)) AND TS = (image) to retrieve relevant articles. The collected data, including authors, keywords, journals, countries, institutions, and references, were subjected to visual analysis using the visualization software CiteSpace 6.4.2R and VOSviewer 1.6.19. Results: A total of 310 relevant articles were identified. After further screening based on time limits, inclusion, and exclusion criteria, 179 articles were included in the study, consisting of 132 original articles and 42 reviews. These articles were authored by 1,034 authors from 35 countries and 324 institutions and were published in 82 different journals. The included articles cited a total of 6,583 references from 1,314 journals. Conclusion: Although the field of spinal schwannoma imaging research is not a popular research area in the medical community, there has been an increasing international interest in this field in recent years. While China ranks high in terms of the number of published articles, there is still a gap in terms of the quality and research level compared to developed countries in Europe and America. MRI, as the gold standard for diagnosing spinal schwannomas, is expected to be a research hotspot in terms of feature analysis, enhancement characteristics, and quantitative analysis. It is also hoped that China can increase its investment in research and contribute to the field by publishing high-quality articles in the future. [ABSTRACT FROM AUTHOR]

Abstract Objective To present our experience in the surgical management of completely extradural dumbbell spinal schwannomas with a new surgical strategy. Method This study is a case series of patients treated at the Neurosurgery Department of the First Affiliated Hospital of USTC, between January 2018 and June 2021. Results 24 patients met the inclusion criteria, with cervical and lumbar spines being the most frequent locations. All patients underwent surgical treatment. Total gross resection was accomplished in all patients. Two cases had numbness and no case exhibited motor deficit. There was no postoperative CSF leakage or wound infection. Conclusion Based on a limited number of observations, we conclude that our technique was feasible and effective for the treatment of extradural dumbbell spinal schwannomas. Clinical trial http://www.chictr.org.cn/ , No. ChiCTR2400086171.

Objective: To present our experience in the surgical management of completely extradural dumbbell spinal schwannomas with a new surgical strategy. Method: This study is a case series of patients treated at the Neurosurgery Department of the First Affiliated Hospital of USTC, between January 2018 and June 2021. Results: 24 patients met the inclusion criteria, with cervical and lumbar spines being the most frequent locations. All patients underwent surgical treatment. Total gross resection was accomplished in all patients. Two cases had numbness and no case exhibited motor deficit. There was no postoperative CSF leakage or wound infection. Conclusion: Based on a limited number of observations, we conclude that our technique was feasible and effective for the treatment of extradural dumbbell spinal schwannomas. Clinical trial: http://www.chictr.org.cn/, No. ChiCTR2400086171. [ABSTRACT FROM AUTHOR]

Objective: Spinal schwannomas are the most common intradural extramedullary tumors, and their complete removal is recommended to avoid tumor recurrence. Although laminoplasty provides a sufficient window for tumor resection, this approach may increase tissue trauma and cause postoperative instability compared with unilateral hemilaminectomy. This study aimed to compare the efficacy and clinical outcomes of the two approaches. Materials and methods: We included 100 consecutive patients who underwent unilateral hemilaminectomy or laminoplasty for resection of spinal schwannomas between January 2015 and February 2023. The patients’ baseline characteristics, including sex, age, tumor location, percentage of tumor occupying the intradural space, operative time, postoperative length of hospital stay, intraoperative bleeding volume, visual analog scale score, and neurologic results, were retrospectively analyzed. Results: Hemilaminectomy patients who underwent unilateral hemilaminectomy had smaller intraoperative bleeding (p = 0.020) volume, shorter operative time (p = 0.012), and shorter postoperative length of hospital stay (p = 0.044). The mean VAS scores at the last follow-up were similar between the two groups (p = 0.658). Although the postoperative McCormick and Karnofsky Performance scores were not significantly different between the laminoplasty and unilateral hemilaminectomy groups (p = 0.687 and p = 0.649, respectively), there was a statistically significant improvement based on postoperative neurological results compared to preoperative neurological results for both groups. The incidence of postoperative complications was 5% and 11.7% in the unilateral hemilaminectomy and laminoplasty groups, respectively (p = 0.308). Conclusions: For spinal schwannoma resection, unilateral hemilaminectomy has more advantages than laminoplasty, including a shorter postoperative hospital stay, faster procedure, and less intraoperative blood loss while achieving the same desired result. [ABSTRACT FROM AUTHOR]

ObjectiveThis study aims to explore the current hot topics and future research trends in spinal schwannoma imaging research, providing a reference for related studies and promoting the development of spinal schwannoma imaging.MethodsWe conducted a literature search in the Web of Science database using the search terms (((TS = (Spinal schwannoma)) AND TS = (Imaging)) OR TS = (Spinal schwannoma)) AND TS = (image) to retrieve relevant articles. The collected data, including authors, keywords, journals, countries, institutions, and references, were subjected to visual analysis using the visualization software CiteSpace 6.4.2R and VOSviewer 1.6.19.ResultsA total of 310 relevant articles were identified. After further screening based on time limits, inclusion, and exclusion criteria, 179 articles were included in the study, consisting of 132 original articles and 42 reviews. These articles were authored by 1,034 authors from 35 countries and 324 institutions and were published in 82 different journals. The included articles cited a total of 6,583 references from 1,314 journals.ConclusionAlthough the field of spinal schwannoma imaging research is not a popular research area in the medical community, there has been an increasing international interest in this field in recent years. While China ranks high in terms of the number of published articles, there is still a gap in terms of the quality and research level compared to developed countries in Europe and America. MRI, as the gold standard for diagnosing spinal schwannomas, is expected to be a research hotspot in terms of feature analysis, enhancement characteristics, and quantitative analysis. It is also hoped that China can increase its investment in research and contribute to the field by publishing high-quality articles in the future.

Spinal Schwannomas are rare, benign tumors originating from Schwann cells around peripheral nerves in the spinal canal, with significant clinical implications due to their potential to cause life-threatening neurological impairments. This comprehensive literature review integrates insights from pathology, anatomy, genetics, physiology, and radiology to offer a holistic understanding of spinal schwannomas, covering their clinical characteristics, diagnosis, management, and recent research developments. The aim is to enhance understanding, facilitate accurate diagnosis, develop targeted therapies, and improve clinical management, thereby contributing to better patient care and expanding knowledge on spinal schwannomas.

Simple Summary: Spinal schwannomas are the second most common primary intradural spinal tumor. Although these tumors are histologically benign, they can cause spinal cord compression with acute or chronic neurological deficits. Health-related quality of life (HRQoL) can be described as quality of life relative to a person's health or disease status and HRQoL measures may therefore be considered as measures of self-perceived status. Despite the fact that some studies have evaluated the neurological outcomes after surgery for spinal schwannomas, no studies have been conducted on HRQoL and return to work after surgery. In this population-based cohort study, 94 cases of surgically treated spinal schwannomas were followed for a median 7.3 years [4.8–10.6] to assess their HRQoL compared to a sample of the general population. We found that HRQoL was equal between the spinal schwannoma sample and the general population sample in all but one dimension; men in the spinal schwannoma sample reported more moderate problems in the usual activities dimension than men in the general population. The frequency of return to work was 94%. Thus, surgery of spinal schwannomas should be considered a safe procedure with good long-term HRQoL. Spinal schwannomas are the second most common primary intradural spinal tumor. This study aimed to assess health-related quality of life (HRQoL) and the frequency of return to work after the surgical treatment of spinal schwannomas. HRQoL was compared to a sample of the general population. Patients operated for spinal schwannomas between 2006 and 2020 were identified in a previous study and those alive at follow-up (171 of 180) were asked to participate. Ninety-four (56%) responded and were included in this study. Data were compared to the Stockholm Public Health Survey 2006, a cross-sectional survey of a representative sample of the general population. An analysis for any potential non-response bias was performed and showed no significant differences between the groups. HRQoL was equal between the spinal schwannoma sample and the general population sample in all but one dimension; men in the spinal schwannoma sample reported more moderate problems in the usual activities dimension than men in the general population (p = 0.020). In the schwannoma sample, there were no significant differences between men and women in either of the dimensions EQ-5Dindex or EQVAS. Before surgery, a total of 71 (76%) were working full-time and after surgery almost all (94%) returned to work, most of them within 3 months of surgery. Eighty-nine (95%) of the patients responded that they would accept the surgery for their spinal schwannoma if asked again today. To conclude, surgical treatment of spinal schwannomas is associated with good HRQoL and with a high frequency of return to work. [ABSTRACT FROM AUTHOR]

Simple Summary: Spinal schwannomas are the second most common form of primary intradural spinal tumor. Clinically and histologically, they are classified as nerve sheath tumors. These tumors may give rise to spinal cord compression with acute or chronic neurologic dysfunction. The primary treatment is surgical resection. In this population-based cohort study, we retrospectively reviewed 180 cases of surgically treated spinal schwannomas to assess postoperative complications and long-term clinical and radiological outcomes, as well as progression-free survival. The median follow-up time was 4.4 years. Significant neurological improvement was seen following surgical treatment. Gross total resection was achieved in 83% of cases and was associated with a higher chance of progression-free survival. Spinal schwannomas are the second most common form of primary intradural spinal tumor. Despite being benign, they may cause spinal cord compression and subsequently acute or chronic neurological dysfunction. The primary treatment is surgical resection. The aim of this study was to identify pre- and postoperative predictors of favorable outcomes after surgical treatment for spinal schwannoma. All adult patients surgically treated for spinal schwannoma between 2006 and 2020 were eligible for inclusion. Medical records and imaging data were retrospectively reviewed. The primary outcome measures were neurological improvement according to the modified McCormick Scale (mMC) and changes in motor deficit, sensory deficit, gait disturbance, bladder dysfunction, and pain at long-term follow-up. In total, 180 patients with a median follow-up time of 4.4 years were included. Pain was the most common presenting symptom (87%). The median time between symptom presentation and surgery was 12 months, while the median time between diagnosis (first MRI) and surgery was 3 months. Gross total resection (GTR) was achieved in 150 (83%) patients and the nerve root could be preserved in 133 (74%) patients. A postoperative complication occurred in 10 patients (5.6%). There were significant postoperative improvements in terms of motor, sensory, gait, and bladder functions, as well as pain (p < 0.001). Of these symptoms, bladder dysfunction was the one most often improved, with complete symptom resolution in all cases. However, no other predictors of improvement could be identified. There were three cases of recurrence after GTR and nine cases of regrowth after STR. Reoperation was performed in six (3.3%) cases. GTR was associated with a significant improvement in neurological status at long-term follow-up and increased the chance of progression-free survival. [ABSTRACT FROM AUTHOR]

Spinal Schwannomas are rare, benign tumors originating from Schwann cells around peripheral nerves in the spinal canal, with significant clinical implications due to their potential to cause life-threatening neurological impairments. This com)prehensive literature review integrates insights from pathology, anatomy, genetics, physiology, and radiology to offer a holistic understanding of spinal schwannomas, covering their clinical characteristics, diagnosis, management, and recent research developments. The aim is to enhance understanding, facilitate accurate diagnosis, develop targeted therapies, and improve clinical management, thereby contributing to better patient care and expanding knowledge on spinal schwannomas. [ABSTRACT FROM AUTHOR]

Objective: Spinal intradural tumors are commonly removed using laminectomy or laminotomy; however, these approaches can lead to postoperative pain, discomfort, kyphosis, and instability. Unilateral hemilaminectomy (UHL) is a minimally invasive alternative that may minimize these issues by using a smaller incision and less disruption to spinal structures. Materials and Methods: From 2010 to 2021, 79 patients with schwannoma underwent UHL surgery. Surgery was generally limited to three levels, and the tumor was removed en bloc or piecemeal after ultrasonic debulking. Paramedial opening of the dura was performed, and neurophysiological monitoring was performed. Baseline medical data on demographic and clinical variables were analyzed, including patients' sex, age, tumor location and volume, overall operative time, length of postoperative immobilization, duration of hospitalization, preoperative (1-month/3-month postoperative Denis Pain Scale value), comorbidities, and modified McCormick Scale. Results: Of these patients, 35 were female and 44 were male, with ages ranging from 19 to 72 years (mean 48.9±14.6). Pain and radiculopathy were the first symptoms in 56 (70.8%) and 36 (45.5%) patients, respectively. No spinal instability was observed postoperatively, and the mean estimated blood loss was 285 mL, ranging from 245-420 mL. The maximal sagittal diameter of the tumor was measured on contrastenhanced T1-weighted images, with a mean of 26.0±12.4 mm (range, 8.2-36.2 mm). Conclusion: Unilateral microsurgery for spinal intradural tumor removal has resulted in good neurologic and oncologic outcomes and reduced postoperative pain and discomfort. In addition, this approach has preserved spinal stability, eliminating the need for bracing, and enabling earlier rehabilitation. [ABSTRACT FROM AUTHOR]

Surgery on spinal tumors becomes challenging when the tumor is ventral to the spinal cord. Conventionally, we approach it posteriorly through bilateral laminectomy and rotate the cord after sectioning the dentate ligament and nerve roots. However, manipulating the cord can be hazardous, and a long bilateral laminectomy can be invasive. Meanwhile, a narrow operative field and a limited lateral viewing angle in a unilateral approach constrained the surgeon. To overcome these problems, we previously reported a technique of modified unilateral approach where we incised the skin and the fascia horizontally and placed a pair of retractors longitudinally. The current article reports our experience applying this approach in 15 patients with ventrally located spinal tumors. The approach was performed on 10 schwannomas, 2 meningiomas, and 3 others. We evaluated paraspinal muscle atrophy on postoperative magnetic resonance imaging. The modified unilateral approach provided an excellent surgical field for removing ventrally located tumors. Gross total removal was achieved in 11 patients (92% of benign tumors). No neurological complications occurred except for one case of transient weakness. We encountered no wound-related late complications such as pain or deformity. The reduction of the cross-sectional area of the paraspinal muscles on the approach side (compared to the nonapproach side) was 0.93 (95% confidence interval: 0.72-1.06), indicating 7% atrophy (statistically nonsignificant, p = 0.48). We believe this simple technique can be useful for removing spinal tumors located ventral to the spinal cord.

Schwannomas are typically solitary, well-encapsulated, benign tumors running along or attached to a nerve. An intradural-extramedullary cervical spinal schwannoma, which first manifests as a swelling in the anterior neck, has not been reported to the best of our knowledge. We present the case of a 69-year-old patient complaining of a gradually worsening painful left cervical swelling for over 8 years. First, a posterior spinal midline approach was performed for the resection of the tumor and the tumor portion in the vertebral canal was totally removed. The second operation, the anterolateral approach, was planned to be executed in a second surgical session. The patient was discharged from the hospital without neurological deficits. Histopathological diagnosis was a schwannoma. The first aim of surgery is to treat neurological deficits in patients with cervical intraspinal schwannomas with/without extension into the extra-vertebral paravertebral neck regions. The surgical strategy combines the posterior midline and the anterolateral cervical approaches in the same session or at different times.

Background Completely extradural spinal schwannomas have a unique morphology (dumbbell tumors) with an intra- and extraspinal component. When they compromise two contiguous vertebral bodies or have an extraspinal extension >2.5 cm, they are classified as giant spinal schwannomas. The aim of this study is to present our experience in the surgical management of completely extradural giant spinal schwannomas with a minimally invasive approach. Methods This study is a case series of patients treated at the Neurosurgery Department of the University Clinical and Provincial Hospital of Barcelona, Spain, between January 2016 and December 2019. Results Fifteen patients met the inclusion criteria, with thoracic and lumbar spines being the most frequent locations. All patients underwent surgical treatment, with a mini-open interlaminar and far-lateral technique. Total gross resection was accomplished in all patients and spine instrumentation was not necessary. Conclusions Microsurgery is the treatment of choice for spinal schwannomas, and gross total resection with low morbidity must be the surgical goal. Mini-open interlaminar and far-lateral access is a valid surgical option, with low morbidity in experienced hands, and there is no need for spinal instrumentation. [ABSTRACT FROM AUTHOR]

Background: Spinal schwannomas (SSs) are benign tumors affecting the nerve sheath, accounting for 25% of spinal nerve root tumors. Surgery represents the mainstay of treatment for SS patients. Following surgery, approximately 30% of patients experienced developed new or worsening neurological deterioration, which probably represented an inevitable complication of nerve sheath tumor surgery. The objective of this study was to identify the rates of new or worsening neurological deterioration in our center and accurately predict the neurological outcomes of patients with SS by developing a new scoring model. Methods: A total of 203 patients were retrospectively enrolled at our center. Risk factors associated with postoperative neurological deterioration were identified by multivariate logistic regression analysis. b-coefficients for independent risk factors were used to define a numerical score to generate a scoring model. The validation cohort at our center was used to verify the accuracy and reliability of the scoring model. Receiver operating characteristic (ROC) curve analysis was used to evaluate the performance of the scoring model. Results: In this study, five measured variables were selected for the scoring model: duration of preoperative symptoms (1 point), radiating pain (2 points), tumor size (2 points), tumor site (1 point), and dumbbell tumor (1 point). The scoring model divided the spinal schwannoma patients into three categories: low risk (0-2 points), intermediate risk (3-5 points), and high risk (6-7 points), with predicted risks of neurological deterioration of 8.7%, 36%, and 87.5%, respectively. And the validation cohort confirmed the model with the predicted risks of 8.6%, 46.4%, and 66.6%, respectively. Conclusion: The new scoring model might intuitively and individually predict the risk of neurological deterioration and may aid individualized treatment decisionmaking for SS patients. [ABSTRACT FROM AUTHOR]

Schwannomas are common benign neoplasms of the myelinating cells surrounding peripheral nerve axons. Though uncommon, lesions arising in the cervical spine may produce radicular pain and myelopathic weakness. Multiple sclerosis (MS) is a common autoimmune disorder with the capacity to mimic nearly any neurologic disease, including spinal cord neoplasms. We report the third case of synchronously presenting primary progressive MS and spinal schwannoma. A 65-year-old man presented with six months of progressive weakness and pain of the right shoulder, forearm, and hand. MRI demonstrated a contrast-enhancing transforaminal lesion at C7, most consistent with a benign nerve sheath tumor. Additional history disclosed several years of worsening fatigue, accompanied by bilateral weakness and lancinating leg pain. MRI of the neuraxis demonstrated abnormalities consistent with chronic demyelinating disease intracranially and within the spinal cord; cerebrospinal fluid (CSF) analysis revealed nine oligoclonal bands and an elevated IgG index, resulting in the diagnosis of MS. Given the symptomatic C7 lesion, the patient subsequently underwent right C6-C7 facetectomy, gross total resection of the tumor, and C6-T1 posterior instrumented fusion. Postoperatively, the patient rapidly recovered normal right upper extremity function, and pathology confirmed benign schwannoma. Synchronously presenting co-morbid neurologic diagnoses are exceedingly rare. Nonetheless, the high incidence and protean nature of MS make it particularly susceptible to such confounding clinical cases. Correspondingly, MS should be considered when neurologic abnormalities are not compatible with a focal radiographic lesion, and the present report emphasizes the value of a good history and exam in unraveling similarly challenging cases.

Introduction: Peripheral and intraspinal schwannomas are common and clinically complex pathologies in patients with Neurofibromatosis Type 2 (NF2) and Schwannomatosis (SWNT). Functional preservation and pain relief are the major goals in treating these tumors. Methods: This retrospective observational study investigates the clinical and functional outcome of 205 operated peripheral (n = 148, 72%) and intraspinal (n = 57, 28%) schwannomas in 85 patients (53 NF2, 32 SWNT) treated at our department between 2006 and 2017. Associated factors such as genetics, age, and location were evaluated. Results: Persisting drug-resistant pain was the most common symptom (84%, n = 173) and indication for surgery (54%, n = 110). Improvement in pain intensity was postoperatively seen in 81%. Peripheral nerve schwannomas exhibited worse pain intensity preoperatively compared to intraspinal lesions (p = 0.017 NF2, p = 0.029 SWNT). More total resections could be achieved in 93% of SWNT vs. 82% of NF2-associated tumors, p = 0.030). NF2 patients with intraspinal lesions were more neurologically affected (p < 0.05). Perioperative comparison of both tumor syndromes showed more neurological deficits (p = 0.027), and less pain (p = 0.024) in NF2-associated tumors. Mosaic NF2 patients had worse pain levels before surgery, and SWNT patients had a worse neurological function and more pain compared to non-mosaic or non-mutated cases. Conclusions: Resection of peripheral and intraspinal schwannomas is an effective and low-risk treatment in both NF2 and SWNT. Patients with severe pain have a particular benefit from surgical treatment. Intraspinal lesions are associated with worse neurological function whereas peripheral lesions showed a higher pain intensity. The influence of mutations needs to be further investigated in larger cohorts. [ABSTRACT FROM AUTHOR]

Background: The authors report on a patient who presented with an extremely large presacral schwannoma and subsequent mass effect-induced hydronephrosis and kidney failure. To the authors' knowledge, this case represents the largest radiographically verified spinal schwannoma in the medical literature. The tumor presented here was more than three times as large as a typical giant schwannoma. While smaller presacral schwannomas are usually uncomplicated surgical cases, the supergiant schwannomas described here create significant surgical challenges., Observations: The extremely large size of this nerve sheath tumor introduced a level of surgical complexity not seen in most spinal schwannoma cases. The authors hope that this case informs surgeons regarding the approach to excision of giant spinal schwannomas., Lessons: The resection of giant spinal schwannomas is likely to involve one or more lengthy surgeries, and the resection volume can be limited by excessive bleeding. Physicians approaching these large, benign spinal tumors should be aware of the challenges of surgery duration and hemostasis before approaching a tumor of this kind. https://thejns.org/doi/10.3171/CASE24224.

Background and Objectives: Spinal schwannomas are benign tumours that can present with various symptoms such as pain, radiculopathy and neurological deficit. Gross total resection (GTR) is of key importance for local recurrence. The aim of this study is to describe the clinical characteristics, resection rate, clinical outcome, as well as tumour recurrence, in patients with non-syndromic spinal schwannomas and to clarify which factors affect the resection rate. Materials and Methods: Patients with non-syndromic spinal schwannomas that underwent surgical resection between January 2009 and December 2018 at a single institution were included. Demographic parameters, clinical symptoms, tumour localisation and size, surgical approach and complications were noted. Factors influencing the extent of resection, the surgeon's decision regarding the approach and the occurrence of new postoperative deficits were evaluated. Results: Fifty patients (18 females) were included. The most common presenting symptom was radiculopathy (88%). The lumbar spine was the most commonly affected site (58%). Laminotomy (72%) was the preferred surgical approach overall and specifically for exclusively intraspinal schwannomas (p = 0.02). GTR was achieved in 76.0% (n = 38). In multivariate analysis, only tumour localisation within the spinal canal (p = 0.014) independently predicted GTR, whereas the type of approach (p = 0.50) and tumour volume (p = 0.072) did not. New postoperative persisting deficits could not be predicted by any factor, including the use and alteration of intraoperative neuromonitoring. Recurrence was observed in four cases (8%) and was significantly higher in cases with STR (p = 0.04). Conclusions: In this retrospective study, GTR was solely predicted by tumour localisation within the spinal canal. The decision regarding the utilisation of different surgical approaches was solely influenced by the same factor. No factor could predict new persisting deficits. Tumour recurrence was higher in STR. [ABSTRACT FROM AUTHOR]

Abstract Localized pain in the absence of local lesion may represent referred pain from the spine, in a child, arising from a benign spinal schwannoma. It can be diagnosed by MRI. Surgical excision of the tumor relieves the symptoms.

Background: Normal-pressure hydrocephalus (NPH) and spinal intradural extramedullary benign tumors rarely exist together. Here, a 72-year-old female who presented with NPH symptoms (i.e., gait disturbance and dementia) newly developed symptoms of spinal cord compression attributed to a previously undiagnosed schwannoma. Case Description: A 72-year-old female was diagnosed with NPH without disproportionately enlarged subarachnoid space hydrocephalus. The lumbar puncture revealed an elevated cerebrospinal fluid (CSF) protein level of 0.141 g/dl, but with normal pressure. The patient's NPH symptoms improved after lumbar-peritoneal shunt placement. However, a year later, she subacutely developed a progressive Brown-Sequard syndrome. On the cervical magnetic resonance (MR), an intradural extramedullary lesion was found at the C5-C6 level which at surgery, proved to be a schwannoma. A review of this patient and three others with NPH and intradural extramedullary benign tumors revealed that 4.3 months following CSF shunting for NPH, they developed rapidly progressive cord deficits, attributed to their benign spinal tumors. Conclusion: Before the placement of shunts for NPH, patients should undergo holospinal MR imaging studies to rule out attendant spinal intradural extramedullary tumors. [ABSTRACT FROM AUTHOR]

Background: Schwannomatosis (SWN) is genetically similar to neurofibromatosis type 2 (NF2) and represents a NF2 gene mutation. Previous studies have shown that these mutations in both neurons and Schwann cells can lead to the development of schwannomas after nerve crush injuries. Here, we reviewed the potential pathoanatomical mechanisms for the development of a trauma-induced spinal schwannomas in a 55-year-old male with SWN. Case Description: A 49-year-old male had originally undergone a L3-L5 lumbar laminectomy for stenosis; the schwannomas seen on the preoperative magnetic resonance imaging (MRI) were not resected. Now at age 55, he newly presented with low back pain and numbness in the left L5 dermatome, and he was diagnosed with an L4 vertebral level cauda equina tumor on MRI. Following gross-total resection, the histopathological assessment revealed a Ki-67 labeling index 5-10% in hotspots (i.e., slightly higher than the normal range of schwannomas) and a 20% mosaic loss of SMARCB1. Based on these criteria, he was diagnosed as having SWN. Conclusion: In this patient with SWN, compression/physical trauma to nerves of the cauda equina during the L3-L5 laminectomy 6 years ago likely caused the progression of schwannoma. [ABSTRACT FROM AUTHOR]

Abstract Background Although spinal schwannomas generally grow very slowly, it has been reported that these clinical growths and their associated neurological symptoms accelerate during pregnancy. Because these cases are rare, surgical intervention for this tumor during pregnancy poses a significant challenge. The change of pregnancy-related hormones, such as estrogen and progesterone, is considered to have an effect on the clinical symptoms of spinal tumors. Expressions of the receptors for estrogen and progesterone in orbital and vestibular schwannomas have been reported; however, those expressions in spinal schwannomas have not been examined. Case presentation A 36-year-old woman at 8 weeks' gestation suffered from developing neck pain and neurological symptoms in the right upper extremity. Magnetic resonance imaging (MRI) confirmed the presence of a cervical intradural extramedullary tumor. Under general anesthesia, using intraoperative neurophysiological monitoring of motor-evoked potentials (MEPs), spinal tumor resection following a hemi-laminoplasty was performed in a prone position at 12 weeks gestation. The pathological diagnosis following surgery was spinal schwannoma. Her neurological symptoms were significantly improved after surgery and she delivered a healthy baby in her 40th week of pregnancy. At a 12-month follow-up, no abnormalities were observed during medical examinations of both mother and child. An immunohistochemical study identified the expression of estrogen receptors, but not progesterone receptors, in the spinal schwannoma. Conclusions A cervical spinal schwannoma was successfully removed under general anesthesia at 12 weeks gestation by coordination between orthopaedic, obstetric and anesthesia teams. For the first time, an immunohistochemical analysis showed that the expression of estrogen receptors was identified in spinal schwannoma cells, suggesting the possibility that these hormone receptors in spinal schwannoma might contribute to the worsening of neurological symptoms during pregnancy.

Schwannomas are typically solitary, well-encapsulated, benign tumors running along or attached to a nerve. An intradural-extramedullary cervical spinal schwannoma, which first manifests as a swelling in the anterior neck, has not been reported to the best of our knowledge. We present the case of a 69-year-old patient complaining of a gradually worsening painful left cervical swelling for over 8 years. First, a posterior spinal midline approach was performed for the resection of the tumor and the tumor portion in the vertebral canal was totally removed. The second operation, the anterolateral approach, was planned to be executed in a second surgical session. The patient was discharged from the hospital without neurological deficits. Histopathological diagnosis was a schwannoma. The first aim of surgery is to treat neurological deficits in patients with cervical intraspinal schwannomas with/without extension into the extra-vertebral paravertebral neck regions. The surgical strategy combines the posterior midline and the anterolateral cervical approaches in the same session or at different times.

Background: A patient presented with a spinal subarachnoid hemorrhage (SAH) and subdural hematoma (SDH) attributed to a spinal schwannoma at the T12-L1 level. Case Description: A 67-year-old male acutely presented with severe back pain and L1 paraparesis/sensory loss, with urinary incontinence. CT/MR studies showed a spinal SAH and SDH within a likely T12-L1 schwannoma. At surgery, the hemorrhage within the tumor was continuous through the lower pole of the tumor into the subarachnoid and subdural spaces; tumor was dissected away from the surrounding tissues and totally removed. The postoperative course was uneventful, and the preoperative neurological deficits gradually resolved. Histopathologically, the lesion was a schwannoma with intratumoral hemorrhage. Conclusion: This case demonstrates the rare acute presentation of a T12-L1 schwannoma with an accompanying intratumoral hemorrhage resulting in both a SDH/SAH. [ABSTRACT FROM AUTHOR]

Abstract Introduction Extradural schwannoma arising from high cervical spinal root is a rare entity in children. We report a case of extradural cervical schwannoma in a 14-year-old boy. Case presentation Our patient is a 14-year-old Madhesi boy presenting with swelling in the posterior triangle of his neck. The radiological features suggested solitary extradural cervical schwannoma which was confirmed later by histopathological findings. There were no postoperative neurological complications in our patient. Conclusion Extradural spinal schwannoma is a benign tumor. Gross total resection with good clinical outcome can be achieved with minimal risks.

Background and Objectives: Spinal schwannomas are benign tumours that can present with various symptoms such as pain, radiculopathy and neurological deficit. Gross total resection (GTR) is of key importance for local recurrence. The aim of this study is to describe the clinical characteristics, resection rate, clinical outcome, as well as tumour recurrence, in patients with non-syndromic spinal schwannomas and to clarify which factors affect the resection rate. Materials and Methods: Patients with non-syndromic spinal schwannomas that underwent surgical resection between January 2009 and December 2018 at a single institution were included. Demographic parameters, clinical symptoms, tumour localisation and size, surgical approach and complications were noted. Factors influencing the extent of resection, the surgeon’s decision regarding the approach and the occurrence of new postoperative deficits were evaluated. Results: Fifty patients (18 females) were included. The most common presenting symptom was radiculopathy (88%). The lumbar spine was the most commonly affected site (58%). Laminotomy (72%) was the preferred surgical approach overall and specifically for exclusively intraspinal schwannomas (p = 0.02). GTR was achieved in 76.0% (n = 38). In multivariate analysis, only tumour localisation within the spinal canal (p = 0.014) independently predicted GTR, whereas the type of approach (p = 0.50) and tumour volume (p = 0.072) did not. New postoperative persisting deficits could not be predicted by any factor, including the use and alteration of intraoperative neuromonitoring. Recurrence was observed in four cases (8%) and was significantly higher in cases with STR (p = 0.04). Conclusions: In this retrospective study, GTR was solely predicted by tumour localisation within the spinal canal. The decision regarding the utilisation of different surgical approaches was solely influenced by the same factor. No factor could predict new persisting deficits. Tumour recurrence was higher in STR.

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]

Study Design: A retrospective analysis of magnetic resonance imaging (MRI) was conducted.Objective: This study aims to develop an automated system for the detection of spinal schwannoma, by employing deep learning based on object detection from MRI. The performance of the proposed system was verified to compare the performances of spine surgeons.Summary Of Background Data: Several MRI scans were conducted for the diagnoses of patients suspected to suffer from spinal diseases. Typically, spinal diseases do not involve tumors on the spinal cord, although a few tumors may exist at the unexpectable level or without symptom by chance. It is difficult to recognize these tumors; in some cases, these tumors may be overlooked. Hence, a deep learning approach based on object detection can minimize the probability of overlooking these tumors.Methods: Data from 50 patients with spinal schwannoma who had undergone MRI were retrospectively reviewed. Sagittal T1- and T2-weighted magnetic resonance imaging (T1WI and T2WI) were used in the object detection training and for validation. You Only Look Once version3 was used to develop the object detection system, and its accuracy was calculated. The performance of the proposed system was compared to that of two doctors.Results: The accuracies of the proposed object detection based on T1W1, T2W1, and both T1W1 and T2W1 were 80.3%, 91.0%, and 93.5%, respectively. The accuracies of the doctors were 90.2% and 89.3%.Conclusion: Automated object detection of spinal schwannoma was achieved. The proposed system yielded a high accuracy that was comparable to that of the doctors.Level of Evidence: 4. [ABSTRACT FROM AUTHOR]

Localized pain in the absence of local lesion may represent referred pain from the spine, in a child, arising from a benign spinal schwannoma. It can be diagnosed by MRI. Surgical excision of the tumor relieves the symptoms. [ABSTRACT FROM AUTHOR]

Objective: Spinal schwannomas are the most common intradural extramedullary tumors, and their complete removal is recommended to avoid tumor recurrence. Although laminoplasty provides a sufficient window for tumor resection, this approach may increase tissue trauma and cause postoperative instability compared with unilateral hemilaminectomy. This study aimed to compare the efficacy and clinical outcomes of the two approaches., Materials and Methods: We included 100 consecutive patients who underwent unilateral hemilaminectomy or laminoplasty for resection of spinal schwannomas between January 2015 and February 2023. The patients' baseline characteristics, including sex, age, tumor location, percentage of tumor occupying the intradural space, operative time, postoperative length of hospital stay, intraoperative bleeding volume, visual analog scale score, and neurologic results, were retrospectively analyzed., Results: Hemilaminectomy patients who underwent unilateral hemilaminectomy had smaller intraoperative bleeding ( p = 0.020) volume, shorter operative time ( p = 0.012), and shorter postoperative length of hospital stay ( p = 0.044). The mean VAS scores at the last follow-up were similar between the two groups ( p = 0.658). Although the postoperative McCormick and Karnofsky Performance scores were not significantly different between the laminoplasty and unilateral hemilaminectomy groups ( p = 0.687 and p = 0.649, respectively), there was a statistically significant improvement based on postoperative neurological results compared to preoperative neurological results for both groups. The incidence of postoperative complications was 5% and 11.7% in the unilateral hemilaminectomy and laminoplasty groups, respectively ( p = 0.308)., Conclusions: For spinal schwannoma resection, unilateral hemilaminectomy has more advantages than laminoplasty, including a shorter postoperative hospital stay, faster procedure, and less intraoperative blood loss while achieving the same desired result., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Chen, Han, Mao, Xu, Guo, Ge, Meng, Teng, Wang, Mu and Wang.)

Spinal schwannoma is the most common primary spinal tumor but its genomic landscape and underlying mechanism driving its initiation remain elusive. The aim of the present study was to gain further insights into the molecular mechanisms of this kind of tumor through whole genome sequencing of nine spinal schwannomas and paired blood samples. The results showed that ATM, CHD4, FAT1, KMT2D, MED12, NF2, and SUFU were the most frequently mutated cancer-related genes. In addition, the somatic copy number alterations (CNA) was potentially associated with spinal schwannoma, among which NF2 was found to be frequently deleted in schwannoma samples. Only a few genes were located within the amplified regions. In contrast, the deleted regions in 15q15.1 and 7q36.1 contained most of these genes. With respect to tumorigenesis, NF2 had the highest variant allele frequency (VAF) than other genes, and homozygous deletion was observed in NF1, NF2, and CDKN2C. Pathway-level analysis suggested that Hippo signaling pathway may be a critical pathway controlling the initiation of spinal schwannoma. Collectively, this systematic analysis of DNA sequencing data revealed that some key genes including NF1, NF2, and CDKN2C and Hippo signaling pathway were associated with spinal schwannoma, which may help improve our understanding about the genomic landscape of spinal schwannoma.

• In 244 patients treated surgically for spinal schwannoma, postoperative motor deterioration occurred at a rate of 13.1%. • The associated risk factors were motor weakness, gait disturbance, dumbbell type, STR, and operative time. • The rate of postoperative sensory deficit was 20.5%, and the risk factors for this event were preoperative gait disturbance and subtotal resection. • TcMEP monitoring was unable to detect roots vulnerable to injury during surgery, but its use is still valuable. In a large cohort the clinical presentation, management and outcomes of spinal schwannoma and factors related to postoperative motor and sensory deficits were invesgtigated. In 244 patients (males: 126, females: 118, average age 51.8 y) at one center, significant factors related to postoperative motor and sensory deficits were identified. Tumors were in the cervical (n = 79, 32.4%), lumbar (n = 66), thoracolumbar (T11-L1) (n = 55), and thoracic (n = 39) regions, and 5 patients had sacrum tumors. The rates of postoperative motor and sensory deterioration were 13.1% and 20.5%, respectively. The risk factors for motor deterioration were preoperative motor weakness, preoperative gait disturbance, dumbbell Eden type II, subtotal resection, and operative time, and those for postoperative sensory deficit were preoperative gait disturbance and subtotal resection. Of 12 patients with significant TcMEP changes, 11 had a new motor deficit after surgery; and of 216 patients with stable TcMEP data, 196 were neurologically intact after surgery (true negative) and 20 (11.0%) had deficits in the immediate postoperative stage (false negative). These deficits resolved during hospitalization for most patients. Of 15 patients with TcMEP deterioration and recovery, 11 (93.3%) had no motor deficits after surgery (p < 0.01). [ABSTRACT FROM AUTHOR]

Spinal schwannoma is the most common primary spinal tumor but its genomic landscape and underlying mechanism driving its initiation remain elusive. The aim of the present study was to gain further insights into the molecular mechanisms of this kind of tumor through whole genome sequencing of nine spinal schwannomas and paired blood samples. The results showed that ATM, CHD4, FAT1, KMT2D, MED12, NF2 , and SUFU were the most frequently mutated cancer-related genes. In addition, the somatic copy number alterations (CNA) was potentially associated with spinal schwannoma, among which NF2 was found to be frequently deleted in schwannoma samples. Only a few genes were located within the amplified regions. In contrast, the deleted regions in 15q15.1 and 7q36.1 contained most of these genes. With respect to tumorigenesis, NF2 had the highest variant allele frequency (VAF) than other genes, and homozygous deletion was observed in NF1 , NF2 , and CDKN2C. Pathway-level analysis suggested that Hippo signaling pathway may be a critical pathway controlling the initiation of spinal schwannoma. Collectively, this systematic analysis of DNA sequencing data revealed that some key genes including NF1 , NF2 , and CDKN2C and Hippo signaling pathway were associated with spinal schwannoma, which may help improve our understanding about the genomic landscape of spinal schwannoma. [ABSTRACT FROM AUTHOR]

Background: Although spinal schwannomas generally grow very slowly, it has been reported that these clinical growths and their associated neurological symptoms accelerate during pregnancy. Because these cases are rare, surgical intervention for this tumor during pregnancy poses a significant challenge. The change of pregnancy-related hormones, such as estrogen and progesterone, is considered to have an effect on the clinical symptoms of spinal tumors. Expressions of the receptors for estrogen and progesterone in orbital and vestibular schwannomas have been reported; however, those expressions in spinal schwannomas have not been examined.Case Presentation: A 36-year-old woman at 8 weeks' gestation suffered from developing neck pain and neurological symptoms in the right upper extremity. Magnetic resonance imaging (MRI) confirmed the presence of a cervical intradural extramedullary tumor. Under general anesthesia, using intraoperative neurophysiological monitoring of motor-evoked potentials (MEPs), spinal tumor resection following a hemi-laminoplasty was performed in a prone position at 12 weeks gestation. The pathological diagnosis following surgery was spinal schwannoma. Her neurological symptoms were significantly improved after surgery and she delivered a healthy baby in her 40th week of pregnancy. At a 12-month follow-up, no abnormalities were observed during medical examinations of both mother and child. An immunohistochemical study identified the expression of estrogen receptors, but not progesterone receptors, in the spinal schwannoma.Conclusions: A cervical spinal schwannoma was successfully removed under general anesthesia at 12 weeks gestation by coordination between orthopaedic, obstetric and anesthesia teams. For the first time, an immunohistochemical analysis showed that the expression of estrogen receptors was identified in spinal schwannoma cells, suggesting the possibility that these hormone receptors in spinal schwannoma might contribute to the worsening of neurological symptoms during pregnancy. [ABSTRACT FROM AUTHOR]

• Schwannomatosis is defined as multiple schwannomas without presence of neurofibromatosis and this is a relatively rare pathology. • In vast majority of cases the schwannomas grew from different nerve roots. • We present the case of a patient with six schwannomas of the cauda equina that grew from a single spinal root as well as discuss the treatment strategy. • Multiple spinal cord schwannomas that are growing along the same part of the vertebral column can be safely removed by one side hemilaminectomy using a high-speed diamond drill with preservation of the integrity of the muscles and ligaments on the opposite side and thus maintain spinal stability. • Neuromonitoring is mandatory for the surgical procedure to allow successful results and to prevent any neurological damage. • The 30 degree endoscope can be a good tool for visual exploration of the spinal canal. Schwannomatosis is defined as multiple schwannomas without presence of neurofibromatosis and is a rare pathology. In vast majority of cases the schwannomas grow from different nerve roots or peripheral nerves. A 52-year-old woman presented with multiple intradural schwannomas arranged in a chain along the spinal canal causing significant compression. The lesions were successfully removed using a left side en-bloc hemilaminectomy technique in order to preserve maximal stability of the posterior column. Back and leg pain resolved completely. Tendon reflexes returned to normal shortly. There was decreased pain sensation in the distribution of the left L3 spinal root. The traditional surgical strategy for posterior approach by laminectomy or laminotomy is sometimes complicated with instability or deformation of the vertebral column that requires surgical stabilization. We performed a one side en-bloc hemilaminectomy thus maintaining the integrity of the muscles and ligaments on the opposite side and preserving maximal stability of the vertebral column. Densely adherent tumors required careful sharp dissection and separation under neurosurgical monitoring and stimulation for recognition and preservation of spinal roots. An additional tumor was discovered by exploration of the spinal canal using an endoscope. Multiple spinal cord schwannomas that are growing along the same part of the vertebral column can be safely removed by one-sided hemilaminectomy with preservation of the integrity of the muscles and ligaments on the opposite side and thus maintain spinal stability. The 30° endoscope can be a good tool for visual exploration of the spinal canal. [ABSTRACT FROM AUTHOR]

Background: Patients with cauda equina schwannomas usually present with slowly progressive radiculopathy. Herein, we describe a 34-year-old male who presented with acute radiculopathy attributed to a small L4 ventral root schwannoma. Case Description: A 34-year-old male suddenly developed left leg pain. Magnetic resonance imaging (with/without contrast) revealed a small intradural mass lesion involving the L4 nerve root that was enhanced with contrast (size: 9 × 12 × 12 mm). The computed tomography myelogram revealed that the tumor had originated from the L4 ventral root and compressed the dorsal root in the lateral recess. Following a decompressive laminectomy for tumor removal, the patient's radicular pain improved. The histological diagnosis was consistent with a schwannoma. Conclusion: Small cauda equina schwannomas involving ventral nerve roots can cause acute radiculopathy readily relieved with decompressive laminectomies for tumor excision. [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]

Spinal schwannomas coexisting with meningiomas in patient without neurofibromatosis are extremely rare lesions. Here we present a case of 59-year-old patient with concurrent spinal meningioma and schwannoma at L1-L2 spinal level. This is the first case of the concurrent intradural tumours at the same lumbar level. [ABSTRACT FROM AUTHOR]

Background: The incidence of subarachnoid hemorrhage (SAH) is around 9/100 000 people annually, with 15-37% having no identifiable vascular source on angiography. This study aimed to define criteria to identify patients with a possible spinal origin of SAH. We present a literature review and a case of a 61-year-old patient with SAH due to lumbar spinal schwannoma., Methods: A literature search and review were conducted according to the PRISMA-P 2020 guidelines. We performed a restricted search using the keywords "SAH" and "Spinal Schwannoma"; "SAH" and "Ependymoma"., Results: Out of 297 articles, 32 were included between 1951 and 2023 for a total of 44 cases with SAH of spinal origin. Fourteen schwannomas (31.8%) and 30 ependymomas (68.2%) were included in the review. Men represented 77% of the schwannoma and 64% of the ependymoma cohort. The median age was 45 years in the schwannoma vs 29 years in the ependymoma group. Ependymomas were predominantly located in the lumbar spine (85%). Localised spinal symptoms were present in 65% of schwannoma cases, encompassing radicular pain (28%), motor deficit (22%), and incontinence (14.5%). This was 93% in ependymomas, with symptoms being radicular pain (40%), motor deficit (20%), and incontinence (17%). Lumbar punctures diagnosed 86.5% of SAHs, while only 18.2% had subarachnoid bleeding found on a cerebral CT or MRI., Conclusion: In SAH patients lacking a vascular bleeding source, any spinal symptom must prompt a complete examination of the spinal axis (i.e. MRI). Without spinal symptoms, SAH associated with spinal tumors will likely be missed., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Surgery on spinal tumors becomes challenging when the tumor is ventral to the spinal cord. Conventionally, we approach it posteriorly through bilateral laminectomy and rotate the cord after sectioning the dentate ligament and nerve roots. However, manipulating the cord can be hazardous, and a long bilateral laminectomy can be invasive. Meanwhile, a narrow operative field and a limited lateral viewing angle in a unilateral approach constrained the surgeon. To overcome these problems, we previously reported a technique of modified unilateral approach where we incised the skin and the fascia horizontally and placed a pair of retractors longitudinally.The current article reports our experience applying this approach in 15 patients with ventrally located spinal tumors. The approach was performed on 10 schwannomas, 2 meningiomas, and 3 others. We evaluated paraspinal muscle atrophy on postoperative magnetic resonance imaging.The modified unilateral approach provided an excellent surgical field for removing ventrally located tumors. Gross total removal was achieved in 11 patients (92% of benign tumors). No neurological complications occurred except for one case of transient weakness. We encountered no wound-related late complications such as pain or deformity. The reduction of the cross-sectional area of the paraspinal muscles on the approach side (compared to the nonapproach side) was 0.93 (95% confidence interval: 0.72-1.06), indicating 7% atrophy (statistically nonsignificant, p = 0.48).We believe this simple technique can be useful for removing spinal tumors located ventral to the spinal cord.

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]

Pediatric spinal schwannomas/neurofibromas constitute only 2.5%–4% of all pediatric spinal tumors. However, subarachnoid hemorrhage (SAH) because of spinal pathologies is very rare, representing 1.5% of all cases of SAH. Spinal nerve sheath tumors such as schwannomas rarely present with SAH, especially before the appearance of overt signs of spinal cord or root compression. We report a case of dorsolumbar schwannoma in an 11-year-old girl presenting clinically with signs and symptoms mimicking meningitis, but meningeal signs later proved to be due to SAH associated with spinal (D12-L1) schwannoma and hydrocephalus. Mass was excised and ventriculoperitoneal shunt was inserted. In our clinical practice, we may sometimes come across some uncommon diseases with even more uncommon presentations as happened with us at our institute. We must always consider that there is a possibility of SAH owing to silent spinal lesion in patients with angiographic negative intracranial SAH as in this case. [ABSTRACT FROM AUTHOR]

Postoperative intracranial epidural haematoma (EDH) is an extremely rare complication following spinal surgery, with only a handful of cases described in the literature. We report the case of a 16-year-old girl who underwent a successful subtotal resection of a giant lumbosacral schwannoma (L2-S2 level). Recovery from general anaesthesia was uneventful; however, her neurological status deteriorated rapidly within 24 h after surgery. A head computed tomography scan revealed a large right frontoparietal EDH with midline shift. An immediate frontotemporoparietal osteoplastic craniotomy and evacuation of the EDH were performed. At 1 year postoperatively, the patient regained full neurological recovery with no radiological signs of growth of the residual tumour. [ABSTRACT FROM AUTHOR]

Schwannomas are the most frequent primary tumors of the spine with an incidence of 0.3–0.5/100,000 person per year. Current treatment for non-syndromic spinal schwannomas is total resection of the tumor with preservation of neurovascular structures. This study aims to report neurologic and radiologic outcome following treatment of non-syndromic spinal schwannomas along with a novel tumor classification used in our clinic. A retrospective case series was carried out with a patient sample of 82 male and female patients with non-syndromic spinal schwannomas. All patient data were retrospectively collected from the hospital records. As a routine procedure, after admittance and primary evaluation, patients’ tumors were classified using CT or MRI in accordance with our proposed classification method, which employs a dual designation method with tree groups (A, B, and C) for tumor volume and four types (I, II, III, and IV) for tumor localization. Subsequent resection surgery was followed by neurological assessments and follow up at 45th, 180th, and 360th postoperative day. Along with Karnofsky performance status scale, pain, sensory deficits, and motor weakness were scored to assess neurologic recovery. Our finding indicates that patients with different tumor types significantly differ in their neurological scores and show consistent but differential neurological recovery at early and late time points postsurgery. Complications during and postsurgery were minimal, occurring only in two patients. Our findings further reinforce the established safety of total resection operations and indicate that our proposed classification is a simple, effective tool that has proven helpful in preoperative planning and avoiding unnecessary surgical approaches.