Student Johns Hopkins School of Medicine Baltimore, Maryland, United States
Introduction: Spinal schwannomas are the second most common intradural extramedullary primary tumor of the spine, with an incidence of 0.24 cases per 100,000/year. They may present with pain, neurological deficits, or asymptomatically, and surgical resection is usually considered in symptomatic lesions. Tumors often present well-encapsulated with planes favoring gross total resection; however, surgical manipulation of the cord and nerve roots can result in post-operative deficits.
Methods: A retrospective cohort of patients evaluated for spinal 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: A retrospective cohort of 213 patients with spinal schwannomas were identified, of which 90 (43%) underwent surgical resection. Of these 90 patients, 28 (31%) tumors were cervical, 16 (18%) were thoracic, 5 (6%) were thoracolumbar, 23 (26%) were lumbar, 1 (1.1%) was lumbosacral, and 14 (16%) were sacral. Forty-four (49%) patients undergoing resection were female. Gross total resection was achieved in 70 (78%) patients. Average blood loss was 252±369 mL and average length of stay was 4.74±3.6 days. A recurrence was noted in 27 (30%) of cases, including 18 (20%) that were believed to have undergone a gross total resection. Post-operative motor deficits were noted in 7/22 (32%) patients with a preoperative motor deficit while post-operative sensory deficits were noted in 4/20 (20%) patients with a preoperative sensory deficit.
Conclusion : Schwannomas of the spine presenting for surgical resection most frequently appear in the cervical region, followed by the lumbar spine. Although a complete resection is felt to be achieved in most patients, recurrences are common. Resection can improve motor and sensory deficits in most patients.
