Clinical outcomes following resection of giant spinal schwannomas: a case series of 32 patients

• Published in: Journal of neurosurgery. Spine Vol. 26; no. 4; p. 494
• Format: Journal Article
• Language: English
• Published: United States 01.04.2017
• Subjects: Adult; Aged; Aged, 80 and over; Female; Follow-Up Studies; Humans; Intraoperative Neurophysiological Monitoring; Male; Middle Aged; Neoplasm Recurrence, Local - drug therapy; Neoplasm Recurrence, Local - epidemiology; Neoplasm Recurrence, Local - radiotherapy; Neoplasm Recurrence, Local - surgery; Neurilemmoma - diagnostic imaging; Neurilemmoma - epidemiology; Neurilemmoma - radiotherapy; Neurilemmoma - surgery; Neurosurgical Procedures - adverse effects; Radiotherapy, Adjuvant; Spinal Cord Neoplasms - diagnostic imaging; Spinal Cord Neoplasms - epidemiology; Spinal Cord Neoplasms - radiotherapy; Spinal Cord Neoplasms - surgery; Tertiary Care Centers; Treatment Outcome; Tumor Burden; Young Adult; STR = subtotal resection; MPNST = malignant peripheral nerve sheath tumors; nerve sheath tumor; cellular schwannoma; spinal tumor; EMG = electromyography; giant schwannoma; GTR = gross-total resection; SRS = stereotactic radiosurgery; melanotic schwannoma; oncology
• ISSN: 1547-5646
• DOI: 10.3171/2016.9.SPINE16778

OBJECTIVE The objective of this study was to review clinical outcomes following resection of giant spinal schwannomas. METHODS The authors conducted a retrospective review of a case series of patients with giant spinal schwannomas at a tertiary cancer hospital. RESULTS Thirty-two patients with giant spinal schwannomas underwent surgery between September 1998 and May 2013. Tumor size ranged from 2.5 cm to 14.6 cm with a median size of 5.8 cm. There were 9 females (28.1%) and 23 males (71.9%), and the median age was 47 years (range 23-83 years). The median follow-up duration was 36.0 months (range 12.2-132.4 months). Three patients (9.4%) experienced recurrence and required further treatment. All recurrences developed following subtotal resection (STR) of cellular or melanotic schwannoma. There were 3 melanotic (9.4%) and 6 cellular (18.8%) schwannomas included in this study. Among these histological variants, a 33.3% recurrence rate was noted. In 1 case of melanotic schwannoma, malignant transformation occurred. No recurrence occurred following gross-total resection (GTR) or when a fibrous capsule remained due to its adherence to functional nerve roots. CONCLUSIONS Resection is the treatment of choice for symptomatic or growing giant schwannomas, frequently requiring anterior or combined approaches, with the goals of symptom relief and prevention of recurrence. In this series, tumors that underwent GTR, or where only capsule remained, did not recur. Only melanotic and cellular schwannomas that underwent STR recurred.