1
|
Jia Q, Lou Y, Chen D, Li X, Liu Y, Chu R, Wang T, Zhou Z, Li D, Wan W, Huang Q, Yang X, Wang T, Wu Z, Xiao J. Long-term postoperative outcomes of spinal cellular schwannoma: study of 93 consecutive cases. Spine J 2024; 24:858-866. [PMID: 38272127 DOI: 10.1016/j.spinee.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 01/03/2024] [Accepted: 01/16/2024] [Indexed: 01/27/2024]
Abstract
BACKGROUND CONTEXT Cellular schwannoma (CS) is a rare tumor that accounts for 2.8%-5.2% of all benign schwannomas. There is a dearth of up-to-date information on spinal CS in the literature. PURPOSE The aims of this study were to identify the proportion of CS cases amongst spinal benign schwannoma, describe the clinical features of spinal CS, and identify prognostic factors for local recurrence by analyzing data from 93 consecutive CS cases. STUDY DESIGN Retrospective review. PATIENT SAMPLE We analyzed 93 PSGCT screened from 1,706 patients with spine CS who were treated at our institute between 2008 and 2021. OUTCOME MEASURES Demographic, radiographic, operative and postoperative data were recorded and analyzed. METHODS We compared the clinical features of spinal CS from the cervical, thoracic, lumbar and sacral segments. Prognostic factors for local recurrence-free survival (RFS) were identified by the Kaplan-Meier method. Factors with p≤.05 in univariate analysis were subjected to multivariate analysis by Cox regression analysis. RESULTS The proportion of spinal CS in all benign schwannomas was 6.7%. The mean and median follow-up times for the 93 patients in this study were 92.2 and 91.0 months respectively (range 36-182 months). Local recurrence was detected in 11 cases, giving an overall recurrence rate of 11.7%, with one patient death. Statistical analysis revealed that tumor size ≥5 cm, intralesional resection, and Ki-67 ≥5% were independent negative prognostic factors for RFS in spinal CS. CONCLUSIONS Whenever possible, en bloc resection is recommended for spinal CS. Long-term follow-up should be carried out for patients with tumor size ≥5 cm and postoperative pathological Ki-67 ≥5%.
Collapse
Affiliation(s)
- Qi Jia
- Department of Orthopedic Oncology, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Yan Lou
- Department of Orthopedic Oncology, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Dingbang Chen
- Department of Orthopedic Oncology, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Xiaolin Li
- Department of Orthopedic Oncology, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Yiqian Liu
- Department of Medical Center, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Ruitong Chu
- Department of Anesthesiology, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Ting Wang
- Department of Orthopedic Oncology, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Zhenhua Zhou
- Department of Medical Center, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Dong Li
- Department of General Surgery, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Wei Wan
- Department of Orthopedic Oncology, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Quan Huang
- Department of Orthopedic Oncology, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Xinghai Yang
- Department of Orthopedic Oncology, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Tao Wang
- Department of Orthopedics, The second affiliated hospital of Anhui Medical University, No.678 Furong Road, Jingkai district, Hefei, Anhui provice, China
| | - Zhipeng Wu
- Department of Orthopedic Oncology, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Jianru Xiao
- Department of Orthopedic Oncology, Changzheng Hospital, Naval Medical University, Shanghai, China.
| |
Collapse
|
2
|
Carbullido MK, Page PS, Hanna A. Clavicular window for brachial plexus schwannoma removal. Surg Neurol Int 2024; 15:135. [PMID: 38741996 PMCID: PMC11090597 DOI: 10.25259/sni_824_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 02/14/2024] [Indexed: 05/16/2024] Open
Abstract
Background Schwannomas are benign nerve sheath tumors that can either be sporadic or part of neurofibromatosis type 2 (NF2). Tumors of the brachial plexus (BP) with both supra- and infraclavicular components are uncommon and represent a challenge to complete surgical resection. There are few reports on single clavicular osteotomies for BP exposure; however, there are currently no reports of utilization of a clavicular window for a large schwannoma resection. Case Description We report a case of a patient with a schwannoma spanning the BP roots to the cords, with the majority involving the retro clavicular inferior trunk in the setting of NF2. The patient underwent previous subtotal resection and had postoperative enlargement of the residual mass. A gross total resection was made possible by the creation of a clavicular window to expose the BP. A 2 cm segment piece of the mid-clavicle was removed, allowing for roughly 6 cm of mediolateral exposure through clavicular distraction. This clavicular window facilitated complete exposure of the BP schwannoma underneath the clavicle as well as unobstructed exposure of supraclavicular and infraclavicular tumor. The segment was then refixed with a plate after resection of the tumor. Conclusion The use of a clavicular window allowed for extensive exposure of the trunks and divisions of the BP to achieve a gross total resection in this case. The clavicular window approach may provide a benefit for optimizing exposure in the setting of lesions involving the trunks and divisions that the clavicle would traditionally obstruct.
Collapse
Affiliation(s)
- Mary K. Carbullido
- Department of Plastic and Reconstructive Surgery, University of Wisconsin Hospitals and Clinics, Madison, Wisconsin, United States
| | - Paul Samuel Page
- Department of Neurological Surgery, University of Wisconsin Hospitals and Clinics, Madison, Wisconsin, United States
| | - Amgad Hanna
- Department of Neurological Surgery, University of Wisconsin Hospitals and Clinics, Madison, Wisconsin, United States
| |
Collapse
|
3
|
Sperber J, Zachem TJ, Prakash R, Owolo E, Yamamoto K, Nguyen AD, Hockenberry H, Ross WA, Herndon JE, Codd PJ, Goodwin CR. A blinded study using laser induced endogenous fluorescence spectroscopy to differentiate ex vivo spine tumor, healthy muscle, and healthy bone. Sci Rep 2024; 14:1921. [PMID: 38253556 PMCID: PMC10803777 DOI: 10.1038/s41598-023-50995-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 12/28/2023] [Indexed: 01/24/2024] Open
Abstract
Ten patients undergoing surgical resection for spinal tumors were selected. Samples of tumor, muscle, and bone were resected, de-identified by the treating surgeon, and then scanned with the TumorID technology ex vivo. This study investigates whether TumorID technology is able to differentiate three different human clinical fresh tissue specimens: spine tumor, normal muscle, and normal bone. The TumorID technology utilizes a 405 nm excitation laser to target endogenous fluorophores, thereby allowing for the detection of tissue based on emission spectra. Metabolic profiles of tumor and healthy tissue vary, namely NADH (bound and free emission peak, respectively: 487 nm, 501 nm) and FAD (emission peak: 544) are endogenous fluorophores with distinct concentrations in tumor and healthy tissue. Emission spectra analyzed consisted of 74 scans of spine tumor, 150 scans of healthy normal bone, and 111 scans of healthy normal muscle. An excitation wavelength of 405 nm was used to obtain emission spectra from tissue as previously described. Emission spectra consisted of approximately 1400 wavelength intensity pairs between 450 and 750 nm. Kruskal-Wallis tests were conducted comparing AUC distributions for each treatment group, α = 0.05. Spectral signatures varied amongst the three different tissue types. All pairwise comparisons among tissues for Free NADH were statistically significant (Tumor vs. Muscle: p = 0.0006, Tumor vs. Bone: p < 0.0001, Bone vs. Muscle: p = 0.0357). The overall comparison of tissues for FAD (506.5-581.5 nm) was also statistically significant (p < 0.0001), with two pairwise comparisons being statistically significant (Tumor vs. Muscle: p < 0.0001, Tumor vs. Bone: p = 0.0045, Bone vs. Muscle: p = 0.249). These statistically significant differences were maintained when stratifying tumor into metastatic carcinoma (N = 57) and meningioma (N = 17). TumorID differentiates tumor tissue from normal bone and normal muscle providing further clinical evidence of its efficacy as a tissue identification tool. Future studies should evaluate TumorID's ability to serve as an adjunctive tool for intraoperative assessment of surgical margins and surgical decision-making.
Collapse
Affiliation(s)
- Jacob Sperber
- Department of Neurosurgery, Duke University School of Medicine, Durham, USA
| | - Tanner J Zachem
- Department of Neurosurgery, Duke University School of Medicine, Durham, USA
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, USA
| | - Ravi Prakash
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, USA
| | - Edwin Owolo
- Department of Neurosurgery, Duke University School of Medicine, Durham, USA
| | - Kent Yamamoto
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, USA
| | - Annee D Nguyen
- Department of Neurosurgery, Duke University School of Medicine, Durham, USA
| | | | - Weston A Ross
- Department of Neurosurgery, Duke University School of Medicine, Durham, USA
| | - James E Herndon
- Department of Biostatistics & Bioinformatics, Duke University School of Medicine, Durham, USA
| | - Patrick J Codd
- Department of Neurosurgery, Duke University School of Medicine, Durham, USA
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, USA
- Duke Cancer Institute, Duke University Medical Center, 200 Trent Drive DUMC 3807, Durham, NC, 27710, USA
| | - C Rory Goodwin
- Department of Neurosurgery, Duke University School of Medicine, Durham, USA.
- Duke Cancer Institute, Duke University Medical Center, 200 Trent Drive DUMC 3807, Durham, NC, 27710, USA.
| |
Collapse
|
4
|
Liu Z, Xu Z, Shen J, Zhang T, Lin H, Zhou L, Wu F, Zhang L, Weng Y, Zhan R, Zhu Y, Gong J. Scoring model to predict postoperative neurological deterioration in spinal schwannoma. Front Oncol 2023; 13:1086299. [PMID: 36998448 PMCID: PMC10043432 DOI: 10.3389/fonc.2023.1086299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 03/01/2023] [Indexed: 03/17/2023] Open
Abstract
BackgroundSpinal schwannomas (SSs) are benign tumors affecting the nerve sheath, accounting for 25% of spinal nerve root tumors. Surgery represents the mainstay of treatment for SS patients. Following surgery, approximately 30% of patients experienced developed new or worsening neurological deterioration, which probably represented an inevitable complication of nerve sheath tumor surgery. The objective of this study was to identify the rates of new or worsening neurological deterioration in our center and accurately predict the neurological outcomes of patients with SS by developing a new scoring model.MethodsA total of 203 patients were retrospectively enrolled at our center. Risk factors associated with postoperative neurological deterioration were identified by multivariate logistic regression analysis. β–coefficients for independent risk factors were used to define a numerical score to generate a scoring model. The validation cohort at our center was used to verify the accuracy and reliability of the scoring model. Receiver operating characteristic (ROC) curve analysis was used to evaluate the performance of the scoring model.ResultsIn this study, five measured variables were selected for the scoring model: duration of preoperative symptoms (1 point), radiating pain (2 points), tumor size (2 points), tumor site (1 point), and dumbbell tumor (1 point). The scoring model divided the spinal schwannoma patients into three categories: low risk (0-2 points), intermediate risk (3-5 points), and high risk (6-7 points), with predicted risks of neurological deterioration of 8.7%, 36%, and 87.5%, respectively. And the validation cohort confirmed the model with the predicted risks of 8.6%, 46.4%, and 66.6%, respectively.ConclusionThe new scoring model might intuitively and individually predict the risk of neurological deterioration and may aid individualized treatment decision-making for SS patients.
Collapse
Affiliation(s)
- Zongchi Liu
- Department of Neurosurgery, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Zihan Xu
- Department of Neurosurgery, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Jie Shen
- Department of Neurosurgery, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Tiesong Zhang
- Department of Neurosurgery, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, China
| | - Hongwei Lin
- Department of Neurosurgery, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Lihui Zhou
- Department of Neurosurgery, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Fan Wu
- Department of Neurosurgery, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Luyuan Zhang
- Department of Neurosurgery, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Yuxiang Weng
- Department of Neurosurgery, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Renya Zhan
- Department of Neurosurgery, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Yu Zhu
- Department of Neurosurgery, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- *Correspondence: Jiangbiao Gong, ; Yu Zhu,
| | - Jiangbiao Gong
- Department of Neurosurgery, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- *Correspondence: Jiangbiao Gong, ; Yu Zhu,
| |
Collapse
|
5
|
Minimally Invasive Facetectomy and Fusion for Resection of Extensive Dumbbell Tumors in the Lumbar Spine. Medicina (B Aires) 2022; 58:medicina58111613. [DOI: 10.3390/medicina58111613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 11/03/2022] [Indexed: 11/11/2022] Open
Abstract
Background and Objectives: Resection of dumbbell tumors can be challenging, and facet joint sparing approaches carry the risk of incomplete resection. In contrast, additional facetectomy may allow better surgical exposure at the cost of spinal stability. The aim of this study is to compare facet-sparing and facetectomy approaches for the treatment of lumbar spine dumbbell tumors. Materials and Methods: In a cohort study setting, we analyzed Eden type 2 and 3 tumors operated in our department. Conventional facet-sparing microsurgical or facetectomy approaches with minimally invasive fusions were performed according to individual surgeons’ preference. Primary outcomes were extent of resection and tumor progression over time. Secondary outcomes were perioperative adverse events. Results: Nineteen patients were included. Nine patients were operated on using a facet-sparing technique. Ten patients underwent facetectomy and fusion. While only one patient (11%) in the facet-sparing group experienced gross total resection (GTR), this was achieved for all patients in the facetectomy group (100%). The relative risk (RR) for incomplete resection in the facet-sparing cohort was 18.7 (95% CI 1.23–284.047; p = 0.035). In addition, time to progression was shorter in the facet-sparing cohort (p = 0.022) and all patients with a residual tumor underwent a second resection after a median follow-up time of 42 months (IQR 25–66). Conclusions: Minimally invasive resection of lumbar Eden type 2 and 3 dumbbell tumors including facetectomy in combination with instrumentation appears to be safe and superior to the facet-sparing approach in terms of local tumor control.
Collapse
|
6
|
Primary Benign Tumors of the Spinal Canal. World Neurosurg 2022; 164:178-198. [PMID: 35552036 DOI: 10.1016/j.wneu.2022.04.135] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/29/2022] [Accepted: 04/30/2022] [Indexed: 11/23/2022]
Abstract
Benign tumors that grow in the spinal canal are heterogeneous neoplasms with low incidence; from these, meningiomas and nerve sheath tumors (neurofibromas and schwannomas) account for 60%-70% of all primary spinal tumors. Benign spinal canal tumors provoke nonspecific clinical manifestations, mostly related to the affected level of the spinal cord. These tumors present a challenge for the patient and healthcare professionals, for they are often difficult to diagnose and the high frequency of posttreatment complications. In this review, we describe the epidemiology, risk factors, clinical features, diagnosis, histopathology, molecular biology, and treatment of extramedullary benign meningiomas, osteoid osteomas, osteoblastomas, aneurysmal bone cysts, osteochondromas, neurofibromas, giant cell tumors of the bone, eosinophilic granulomas, hemangiomas, lipomas, and schwannomas located in the spine, as well as possible future targets that could lead to an improvement in their management.
Collapse
|