Sun Ibrahim, Pamir M Necmettin
Department of Neurosurgery, Acıbadem University School of Medicine, Istanbul, Turkey.
Front Neurol. 2017 Jul 17;8:318. doi: 10.3389/fneur.2017.00318. eCollection 2017.
Schwannomas are the most frequent primary tumors of the spine with an incidence of 0.3-0.5/100,000 person per year. Current treatment for non-syndromic spinal schwannomas is total resection of the tumor with preservation of neurovascular structures. This study aims to report neurologic and radiologic outcome following treatment of non-syndromic spinal schwannomas along with a novel tumor classification used in our clinic. A retrospective case series was carried out with a patient sample of 82 male and female patients with non-syndromic spinal schwannomas. All patient data were retrospectively collected from the hospital records. As a routine procedure, after admittance and primary evaluation, patients' tumors were classified using CT or MRI in accordance with our proposed classification method, which employs a dual designation method with tree groups (A, B, and C) for tumor volume and four types (I, II, III, and IV) for tumor localization. Subsequent resection surgery was followed by neurological assessments and follow up at 45th, 180th, and 360th postoperative day. Along with Karnofsky performance status scale, pain, sensory deficits, and motor weakness were scored to assess neurologic recovery. Our finding indicates that patients with different tumor types significantly differ in their neurological scores and show consistent but differential neurological recovery at early and late time points postsurgery. Complications during and postsurgery were minimal, occurring only in two patients. Our findings further reinforce the established safety of total resection operations and indicate that our proposed classification is a simple, effective tool that has proven helpful in preoperative planning and avoiding unnecessary surgical approaches.
神经鞘瘤是脊柱最常见的原发性肿瘤,每年发病率为0.3 - 0.5/10万人口。目前,非综合征性脊柱神经鞘瘤的治疗方法是在保留神经血管结构的情况下完全切除肿瘤。本研究旨在报告非综合征性脊柱神经鞘瘤治疗后的神经学和影像学结果,以及我们诊所使用的一种新型肿瘤分类方法。对82例患有非综合征性脊柱神经鞘瘤的男性和女性患者进行了回顾性病例系列研究。所有患者数据均从医院记录中回顾性收集。作为常规程序,患者入院并进行初步评估后,根据我们提出的分类方法,使用CT或MRI对患者的肿瘤进行分类,该方法采用双重命名法,肿瘤体积分为三组(A、B和C),肿瘤定位分为四种类型(I、II、III和IV)。随后进行切除手术,术后第45天、180天和360天进行神经学评估和随访。除了卡诺夫斯基功能状态量表外,还对疼痛、感觉缺陷和运动无力进行评分,以评估神经恢复情况。我们的研究结果表明,不同肿瘤类型的患者神经学评分存在显著差异,并且在术后早期和晚期显示出一致但有差异的神经恢复情况。手术中和手术后的并发症极少,仅发生在两名患者身上。我们的研究结果进一步证实了全切除手术已确立的安全性,并表明我们提出的分类是一种简单、有效的工具,已证明有助于术前规划和避免不必要的手术方法。