2009 Volume 23 Issue 2 Pages 259-264
A series of 9 patients with spinal extradural schwannomas (1 neurofibroma and 8 schwannomas) was surgically treated during a 2-year period. The purpose of this article is to present some pointers for the surgical management of spinal extradural schwannomas. The tumors were more prevalent in women (6 of 9 cases). The patients' median age was 46.4 years. The tumor was located in the cervical region in 7 patients (78%) and in the lumbosacral region in 2 cases (22%). The clinical syndromes produced by the tumors were nonspecific because of their spinal levels and their epidural position. Data pertaining to tumor characteristics and the results of surgery were analyzed. After confirming that stimulation of the distal part of the root of the tumor produced no response, the root giving rise to the tumor was sacrificed. Complete resection was achieved in all patients. Worsening of preoperative neurological deficits was observed in 2 patients : one patient, in whom the tumor capsule and surrounding connective tissues tightly adhered to the C5-7 nerves, and another patient, in whom the tumor capsule was very thin. Although their motor impairments have been improving over the 2 years since their operations, their neurological impairment continues to be worse than it was preoperatively. However, no recurrence was observed in all cases at 2-year follow-up. Based on our series of 9 surgically treated cases of spinal extradural schwannoma, it can be seen that sacrifice of the nerve root is often required to achieve total removal of the tumor, and that resection does not always result in a postoperative neurological deficit. Intraoperative stimulation can help the surgeon decide whether the root may be divided without incurring a postoperative deficit. With respect to tumor recurrence, complete resection of the tumor, including the tumor capsule, is preferred over intracapsular enucleation alone.
