Subscribe to RSS
DOI: 10.1055/s-0041-1739502
Minimally Invasive Surgical Technique for the Management of Giant Dumbbell Spinal Schwannoma
![](https://www.thieme-connect.de/media/jnlsa/202303/lookinside/thumbnails/10-1055-s-0041-1739502_202998oa-1.jpg)
Abstract
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.
Publication History
Received: 03 December 2020
Accepted: 31 May 2021
Article published online:
15 December 2021
© 2021. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
-
References
- 1 Pokharel A, Rao TS, Basnet P, Pandey B, Mayya NJ, Jaiswal S. Extradural cervical spinal schwannoma in a child: a case report and review of the literature. J Med Case Reports 2019; 13 (01) 230
- 2 Guerrero-Suarez PD, Magdaleno-Estrella E, Guerrero-López P, Vargas-Figueroa AI, Martínez-Anda JJ. Intradural spinal tumors: 10 - years surgical experience in a single institution. Clin Neurol Neurosurg 2018; 169: 98-102
- 3 Ozawa H, Kokubun S, Aizawa T, Hoshikawa T, Kawahara C. Spinal dumbbell tumors: an analysis of a series of 118 cases. J Neurosurg Spine 2007; 7 (06) 587-593
- 4 Sridhar K, Ramamurthi R, Vasudevan MC, Ramamurthi B. Giant invasive spinal schwannomas: definition and surgical management. J Neurosurg 2001; 94 (2, Suppl): 210-215
- 5 Raco A, Esposito V, Lenzi J, Piccirilli M, Delfini R, Cantore G. Long-term follow-up of intramedullary spinal cord tumors: a series of 202 cases. Neurosurgery 2005; 56 (05) 972-981 , discussion 972–981
- 6 Gonçalves VM, Santiago B, Ferreira VC, Cunha E Sá M. Minimally invasive resection of an extradural far lateral lumbar schwannoma with zygapophyseal joint sparing: surgical nuances and literature review. Case Rep Med 2014; 2014: 739862
- 7 McCormick PC, Torres R, Post KD, Stein BM. Intramedullary ependymoma of the spinal cord. J Neurosurg 1990; 72 (04) 523-532
- 8 Louis DN, Perry A, Reifenberger G. et al. The 2016 World Health Organization Classification of Tumors of the Central Nervous System: a summary. Acta Neuropathol 2016; 131 (06) 803-820
- 9 Vergara P. A novel less invasive technique for the excision of large intradural and extradural dumbbell lumbar schwannomas: the “dual approach.”. World Neurosurg 2016; 95: 171-176
- 10 Deng Q, Tian Z, Sheng W, Guo H, Dan ME. Surgical methods and efficacies for cervicothoracolumbar spinal schwannoma. Exp Ther Med 2015; 10 (06) 2023-2028
- 11 Seppälä MT, Haltia MJ, Sankila RJ, Jääskeläinen JE, Heiskanen O. Long-term outcome after removal of spinal schwannoma: a clinicopathological study of 187 cases. J Neurosurg 1995; 83 (04) 621-626
- 12 Celli P, Trillò G, Ferrante L. Spinal extradural schwannoma. J Neurosurg Spine 2005; 2 (04) 447-456
- 13 Kim WH, Yoon SH, Kim CY. et al. Temozolomide for malignant primary spinal cord glioma: an experience of six cases and a literature review. J Neurooncol 2011; 101 (02) 247-254
- 14 Lu DC, Chou D, Mummaneni PV. A comparison of mini-open and open approaches for resection of thoracolumbar intradural spinal tumors. J Neurosurg Spine 2011; 14 (06) 758-764
- 15 Maiti TK, Bir SC, Patra DP, Kalakoti P, Guthikonda B, Nanda A. Spinal meningiomas: clinicoradiological factors predicting recurrence and functional outcome. Neurosurg Focus 2016; 41 (02) E6
- 16 Nakamura H, Komagata M, Nishiyama M, Taguchi M, Kawasaki N. Resection of a dumbbell-shaped thoracic neurinoma by hemilaminectomy: a case report. Ann Thorac Cardiovasc Surg 2007; 13 (01) 36-39
- 17 Weil AG, Obaid S, Shehadeh M, Shedid D. Minimally invasive removal of a giant extradural lumbar foraminal schwannoma. Surg Neurol Int 2011; 2: 186
- 18 Haji FA, Cenic A, Crevier L, Murty N, Reddy K. Minimally invasive approach for the resection of spinal neoplasm. Spine 2011; 36 (15) E1018-E1026
- 19 Lu DC, Dhall SS, Mummaneni PV. Mini-open removal of extradural foraminal tumors of the lumbar spine. J Neurosurg Spine 2009; 10 (01) 46-50
- 20 Agrawal A, Reddy VU, Santhi V, Sandeep Y. Giant lumbar dumbbell extradural schwannoma in a child. Asian J Neurosurg 2019; 14 (02) 535-537
- 21 Chang HS, Baba T, Matsumae M. Radical intracapsular dissection technique for dumbbell - shaped spinal schwannoma with intradural and extradural components. World Neurosurg 2019; 129: e634-e640
- 22 Shah M, Kaminsky J, Vougioukas VI. Minimally invasive removal of an extradural intraradicular lumbar schwannoma. Acta Neurochir (Wien) 2008; 150 (07) 691-693 , discussion 693–694
- 23 Lee S, Srikantha U. Surgical management of giant lumbar extradural schwannoma: report of 3 cases. Int J Spine Surg 2015; 9: 18
- 24 Shaikh ST, Thareja V, Mohanty CB, Deopujari CE. Giant extradural spinal schwannoma in a non-neurofibromatosis child-case report and review of literature. Childs Nerv Syst 2021; 37 (04) 1327-1331
- 25 Jeng TC, Abdullah JM, George J. et al. Extradural spinal schwannoma in 12 year old child: a case report. Malays J Med Sci 2005; 12 (02) 60-63
- 26 Halvorsen CM, Rønning P, Hald J. et al. The long-term outcome after resection of intraspinal nerve sheath tumors: report of 131 consecutive cases. Neurosurgery 2015; 77 (04) 585-592 , discussion 592–593
- 27 Nzokou A, Weil AG, Shedid D. Minimally invasive removal of thoracic and lumbar spinal tumors using a nonexpandable tubular retractor. J Neurosurg Spine 2013; Dec; 19 (06) 708-15