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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.
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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,
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Poblete J, Martinez Anda JJ, Mendoza AAR, Torales J, Somma AD, Torne R, Fuster S, Enseñat J. Minimally Invasive Surgical Technique for the Management of Giant Dumbbell Spinal Schwannoma. J Neurol Surg A Cent Eur Neurosurg 2021; 84:219-226. [PMID: 34911086 DOI: 10.1055/s-0041-1739502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Completely extradural spinal schwannomas have a unique morphology (dumbbell tumors) with an intra- and extraspinal component. When they compromise two contiguous vertebral bodies or have an extraspinal extension >2.5 cm, they are classified as giant spinal schwannomas. The aim of this study is to present our experience in the surgical management of completely extradural giant spinal schwannomas with a minimally invasive approach. METHODS This study is a case series of patients treated at the Neurosurgery Department of the University Clinical and Provincial Hospital of Barcelona, Spain, between January 2016 and December 2019. RESULTS Fifteen patients met the inclusion criteria, with thoracic and lumbar spines being the most frequent locations. All patients underwent surgical treatment, with a mini-open interlaminar and far-lateral technique. Total gross resection was accomplished in all patients and spine instrumentation was not necessary. CONCLUSIONS Microsurgery is the treatment of choice for spinal schwannomas, and gross total resection with low morbidity must be the surgical goal. Mini-open interlaminar and far-lateral access is a valid surgical option, with low morbidity in experienced hands, and there is no need for spinal instrumentation.
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Affiliation(s)
- Jose Poblete
- Neurological surgery Department, Faculty of Medicine, Barcelona University, Clinical Hospital, Barcelona, Spain
| | - Jaime Jesus Martinez Anda
- Spine Surgery Department, Faculty of Medicine, Barcelona University, Clinical Hospital, Barcelona, Spain
| | - Angel Asdrubal Rebollar Mendoza
- Neurological Surgery Department, Military School for Public Health Graduates, Army and Air force University of Mexico, Central Military Hospital, Mexico City, Mexico
| | - Jorge Torales
- Neurological surgery Department, Faculty of Medicine, Barcelona University, Clinical Hospital, Barcelona, Spain
| | - Alberto Di Somma
- Neurological surgery Department, Faculty of Medicine, Barcelona University, Clinical Hospital, Barcelona, Spain
| | - Ramon Torne
- Neurological surgery Department, Faculty of Medicine, Barcelona University, Clinical Hospital, Barcelona, Spain
| | - Salvador Fuster
- Spine Surgery Department, Faculty of Medicine, Barcelona University, Clinical Hospital, Barcelona, Spain
| | - Joaquim Enseñat
- Neurological surgery Department, Faculty of Medicine, Barcelona University, Clinical Hospital, Barcelona, Spain
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Lu Y. In Reply: A Novel Classification and its Clinical Significance in Spinal Schwannoma Based on the Membranous Hierarchy. Neurosurgery 2020; 88:E126-E127. [PMID: 33231253 DOI: 10.1093/neuros/nyaa482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Yuntao Lu
- Department of Neurosurgery Nanfang Hospital Southern Medical University Guangzhou, China.,Nanfang Neurology Research Institution Nanfang Hospital Southern Medical University Guangzhou, China.,Nanfang Glioma Center Guangzhou, China
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