Turkish Neurosurgery 2017 , Vol 27 , Num 2
Long-term Surgical Outcomes of Spinal Schwannomas: Retrospective Analysis of 49 Consecutive Cases
Erhan EMEL1,Anas ABDALLAH1,Ozden Erhan SOFUOGLU1,Ali Ender OFLUOGLU1,Muslum GUNES1,Betul GULER1,Bilge BILGIC2,
1Bakirkoy Research and Training Hospital for Neurology Neurosurgery and Psychiatry, Department of Neurosurgery, Istanbul, Turkey
2Istanbul University, Faculty of Medicine, Department of Pathology, Istanbul, Turkey
DOI : 10.5137/1019-5149.JTN.15678-15.1 AIM: Spinal schwannomas (SS) represent the most common intradural extramedullary lesions, accounting for approximately 24% of all nerve sheath tumors in adults. Schwannomas have infrequent, but existent possibility of malignancy. In this study, long-term outcomes of 49 consecutive SS have been presented.

MATERIAL and METHODS: Medical records were retrospectively reviewed in 371 cases of spinal tumors who underwent surgery between the years 2005 and 2014. Cases confirmed as schwannoma histopathologically were included in this study. Patients" complaints, localizations, recurrence rate and complications were evaluated.

RESULTS: Forty-nine cases were detected in 47 (26 female, 21 male) patients. The mean age was 45.8±13.7 years. The mean follow-up period was 61.4±21.5 months. The most common complaint was local pain. Eleven were cervical, ten thoracic, twentyfour lumbar, and four in the sacral spine. Thirty-three cases were intradural-extramedullary, fifteen cases were the extradural type, and one case was the extra-intradural type. Recurrence rate was 4.08%. Gross-total resection (GTR) was achieved in forty-seven patients. The most common complications were surgical site infection and intraoperative instability that were seen in three patients each. Posterior instrumentation was performed in two patients.

CONCLUSION: SS is mostly benign and intradural-extramedullary. To treat patients with SS, there is no need for adjuvant treatments; GTR with preservation of neurological functions is the best treatment to relieve patients" complaints and to reduce the recurrence rate of SS. To avoid serious complications, we recommend intraoperative neurophysiological monitoring and laminoplasty, especially in young patients. Dumbbell SS may require extensive bone resection. Posterior instrumentation can be used if instability occurs. Keywords : Spinal schwannoma, Intradural-extramedullary, Extradural, Gross-total resection, Laminoplasty