Treatment of large thoracic and lumbar paraspinal schwannoma

TY - JOUR

T1 - Treatment of large thoracic and lumbar paraspinal schwannoma

AU - Krätzig, Theresa

AU - Dreimann, Marc

AU - Klingenhöfer, Mark

AU - Floeth, Frank W

AU - Krajewski, Kara

AU - Eicker, Sven O

PY - 2015/3/1

Y1 - 2015/3/1

N2 - BACKGROUND: Paraspinal neurogenic tumors usually expand into the mediastinum and retroperitoneum and can reach a considerable size before they become symptomatic. Such large tumors are rare. We describe 14 cases of large schwannomas (>2.5 cm ø) with mild and late onset of symptoms, which were treated with total surgical resection through a single-approach surgery.METHODS: In 2013 14 patients with paraspinal large schwannomas were treated in our institutions. Data were analyzed retrospectively. Magnetic resonance imaging (MRI) showed lesions suspicious for a paraspinal schwannoma with partial intraforaminal growth. In case of ambiguity regarding tumor dignity, a needle biopsy was performed before final treatment. Three different approaches and their indications were discussed.RESULTS: Fourteen patients (7 female and 7 male, ages 18-58 years, mean: 39.8 years) requiring surgical exploration because of a thoracic (6) or lumbar/lumbosacral (8) lesion were treated in our institutions. Two patients received CT-guided needle biopsy preoperatively. Complete resection of the schwannoma was possible through a mini-thoracotomy in 1 case (7 %), a retroperitoneal approach in 2 cases (14 %), and dorsal interlaminar and intercostal fenestration in 11 cases (79 %). Histological examination revealed the diagnosis of schwannoma (WHO grade I) in all cases except one with neurofibroma (WHO grade I). There were no major complications in any case.CONCLUSION: Large benign schwannomas are rare. They need a tailored treatment, which in most cases works through one surgical approach. Usually it is possible to perform a complete resection with a good postoperative prognosis.

AB - BACKGROUND: Paraspinal neurogenic tumors usually expand into the mediastinum and retroperitoneum and can reach a considerable size before they become symptomatic. Such large tumors are rare. We describe 14 cases of large schwannomas (>2.5 cm ø) with mild and late onset of symptoms, which were treated with total surgical resection through a single-approach surgery.METHODS: In 2013 14 patients with paraspinal large schwannomas were treated in our institutions. Data were analyzed retrospectively. Magnetic resonance imaging (MRI) showed lesions suspicious for a paraspinal schwannoma with partial intraforaminal growth. In case of ambiguity regarding tumor dignity, a needle biopsy was performed before final treatment. Three different approaches and their indications were discussed.RESULTS: Fourteen patients (7 female and 7 male, ages 18-58 years, mean: 39.8 years) requiring surgical exploration because of a thoracic (6) or lumbar/lumbosacral (8) lesion were treated in our institutions. Two patients received CT-guided needle biopsy preoperatively. Complete resection of the schwannoma was possible through a mini-thoracotomy in 1 case (7 %), a retroperitoneal approach in 2 cases (14 %), and dorsal interlaminar and intercostal fenestration in 11 cases (79 %). Histological examination revealed the diagnosis of schwannoma (WHO grade I) in all cases except one with neurofibroma (WHO grade I). There were no major complications in any case.CONCLUSION: Large benign schwannomas are rare. They need a tailored treatment, which in most cases works through one surgical approach. Usually it is possible to perform a complete resection with a good postoperative prognosis.

U2 - 10.1007/s00701-014-2320-5

DO - 10.1007/s00701-014-2320-5

M3 - SCORING: Journal article

C2 - 25577451

VL - 157

SP - 531

EP - 538

JO - ACTA NEUROCHIR

JF - ACTA NEUROCHIR

SN - 0001-6268

IS - 3

ER -