Department of Neurosurgery and Spine Surgery, University Hospital Essen, 45122 Essen, Germany.
Medicina (Kaunas). 2022 Mar 1;58(3):357. doi: 10.3390/medicina58030357.
Spinal schwannomas are benign tumours that can present with various symptoms such as pain, radiculopathy and neurological deficit. Gross total resection (GTR) is of key importance for local recurrence. The aim of this study is to describe the clinical characteristics, resection rate, clinical outcome, as well as tumour recurrence, in patients with non-syndromic spinal schwannomas and to clarify which factors affect the resection rate. Patients with non-syndromic spinal schwannomas that underwent surgical resection between January 2009 and December 2018 at a single institution were included. Demographic parameters, clinical symptoms, tumour localisation and size, surgical approach and complications were noted. Factors influencing the extent of resection, the surgeon's decision regarding the approach and the occurrence of new postoperative deficits were evaluated. Fifty patients (18 females) were included. The most common presenting symptom was radiculopathy (88%). The lumbar spine was the most commonly affected site (58%). Laminotomy (72%) was the preferred surgical approach overall and specifically for exclusively intraspinal schwannomas ( = 0.02). GTR was achieved in 76.0% ( = 38). In multivariate analysis, only tumour localisation within the spinal canal ( = 0.014) independently predicted GTR, whereas the type of approach ( = 0.50) and tumour volume ( = 0.072) did not. New postoperative persisting deficits could not be predicted by any factor, including the use and alteration of intraoperative neuromonitoring. Recurrence was observed in four cases (8%) and was significantly higher in cases with STR ( = 0.04). In this retrospective study, GTR was solely predicted by tumour localisation within the spinal canal. The decision regarding the utilisation of different surgical approaches was solely influenced by the same factor. No factor could predict new persisting deficits. Tumour recurrence was higher in STR.
椎管内神经鞘瘤是一种良性肿瘤，可表现出多种症状，如疼痛、根性病变和神经功能缺损。全切除（GTR）对局部复发至关重要。本研究旨在描述非综合征性椎管内神经鞘瘤患者的临床特征、切除率、临床结果以及肿瘤复发情况，并阐明哪些因素影响切除率。
纳入 2009 年 1 月至 2018 年 12 月在单机构接受手术切除的非综合征性椎管内神经鞘瘤患者。记录了人口统计学参数、临床症状、肿瘤定位和大小、手术入路和并发症。评估了影响切除程度、手术医生选择手术入路的因素以及新术后神经功能缺损的发生。
纳入 50 例患者（18 例女性）。最常见的首发症状是根性病变（88%）。最常受累的脊柱节段是腰椎（58%）。总体而言，椎板切开术（72%）是首选的手术入路，特别是对于单纯椎管内神经鞘瘤（ = 0.02）。GTR 达到 76.0%（ = 38）。多变量分析显示，只有肿瘤位于椎管内（ = 0.014）可独立预测 GTR，而手术入路类型（ = 0.50）和肿瘤体积（ = 0.072）则不能。任何因素，包括术中神经监测的使用和改变，都不能预测新的术后持续存在的神经功能缺损。4 例（8%）出现复发，STR 组的复发率明显更高（ = 0.04）。
在这项回顾性研究中，GTR 仅由肿瘤位于椎管内预测。不同手术入路的使用决策仅受同一因素影响。没有因素可以预测新的持续存在的神经功能缺损。STR 组的肿瘤复发率更高。
