Student Johns Hopkins School of Medicine Baltimore, Maryland, United States
Introduction: Schwannomas are benign nerve sheath tumors derived from neural crest. Although vestibular schwannomas are most common, they can also arise in the spinal canal and peripheral nervous system (PNS), including the brachial plexus. Surgery is warranted for symptomatic lesions, and gross total resection can often be achieved; however, manipulation or sacrifice of nerve roots can result in postoperative deficits. Given their low overall incidence, studies are lacking on surgical treatment for extracranial schwannomas.
Methods: A retrospective cohort of patients operated on for extracranial schwannomas was identified. Data on patient demographics, tumor location, and functional characteristics were collected. Outcomes of interest included blood loss, length of stay, and post-operative deficits.
Results: 164 patients were included with a mean age of 48±16 years, of which 88 (54%) were female, 59 (36%) localized to the spine, 76 (46%) to the PNS, and 29 (18%) to the brachial plexus. Ten PNS schwannomas were located along the tibial nerve (13%) and 9 (12%) along the sciatic nerve. 136 (83%) received a gross total resection, including 50 (85%) spinal schwannomas, 64 (84%) PNS schwannomas and 22 (76%) brachial plexus schwannomas. Mean estimated blood loss was 236±523 mL, and mean length of stay was 4±4 days. 31 (19%) patients had an objective pre-operative motor deficit and 51 (31%) had a sensory deficit. Amongst patients with long-term follow-up and a pre-operative deficit, 17/26 (65%) with a motor deficit improved and 20/29 (69%) with a sensory deficit improved.
Conclusion : Despite their benign nature, schwannomas are a heterogeneous entity and can entail significant morbidity. Nearly half of patients in our cohort had a pre-operative neurological deficit. Gross total resection was feasible in most patients and effective in improving neurological status.
