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Singh A, Fletcher-Sandersjöö A, El-Hajj VG, Burström G, Edström E, Elmi-Terander A. Long-Term Functional Outcomes Following Surgical Treatment of Spinal Schwannomas: A Population-Based Cohort Study. Cancers (Basel) 2024; 16:519. [PMID: 38339270 PMCID: PMC10854979 DOI: 10.3390/cancers16030519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/20/2024] [Accepted: 01/22/2024] [Indexed: 02/12/2024] Open
Abstract
Spinal schwannomas are the second most common form of primary intradural spinal tumor. Despite being benign, they may cause spinal cord compression and subsequently acute or chronic neurological dysfunction. The primary treatment is surgical resection. The aim of this study was to identify pre- and postoperative predictors of favorable outcomes after surgical treatment for spinal schwannoma. All adult patients surgically treated for spinal schwannoma between 2006 and 2020 were eligible for inclusion. Medical records and imaging data were retrospectively reviewed. The primary outcome measures were neurological improvement according to the modified McCormick Scale (mMC) and changes in motor deficit, sensory deficit, gait disturbance, bladder dysfunction, and pain at long-term follow-up. In total, 180 patients with a median follow-up time of 4.4 years were included. Pain was the most common presenting symptom (87%). The median time between symptom presentation and surgery was 12 months, while the median time between diagnosis (first MRI) and surgery was 3 months. Gross total resection (GTR) was achieved in 150 (83%) patients and the nerve root could be preserved in 133 (74%) patients. A postoperative complication occurred in 10 patients (5.6%). There were significant postoperative improvements in terms of motor, sensory, gait, and bladder functions, as well as pain (p < 0.001). Of these symptoms, bladder dysfunction was the one most often improved, with complete symptom resolution in all cases. However, no other predictors of improvement could be identified. There were three cases of recurrence after GTR and nine cases of regrowth after STR. Reoperation was performed in six (3.3%) cases. GTR was associated with a significant improvement in neurological status at long-term follow-up and increased the chance of progression-free survival.
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Affiliation(s)
- Aman Singh
- Department of Clinical Neuroscience, Karolinska Institute, 171 76 Stockholm, Sweden; (A.S.); (A.F.-S.); (G.B.); (E.E.)
| | - Alexander Fletcher-Sandersjöö
- Department of Clinical Neuroscience, Karolinska Institute, 171 76 Stockholm, Sweden; (A.S.); (A.F.-S.); (G.B.); (E.E.)
- Department of Neurosurgery, Karolinska University Hospital, 171 76 Stockholm, Sweden
| | - Victor Gabriel El-Hajj
- Department of Clinical Neuroscience, Karolinska Institute, 171 76 Stockholm, Sweden; (A.S.); (A.F.-S.); (G.B.); (E.E.)
| | - Gustav Burström
- Department of Clinical Neuroscience, Karolinska Institute, 171 76 Stockholm, Sweden; (A.S.); (A.F.-S.); (G.B.); (E.E.)
- Department of Neurosurgery, Karolinska University Hospital, 171 76 Stockholm, Sweden
| | - Erik Edström
- Department of Clinical Neuroscience, Karolinska Institute, 171 76 Stockholm, Sweden; (A.S.); (A.F.-S.); (G.B.); (E.E.)
- Capio Spine Center Stockholm, Löwenströmska Hospital, 194 89 Upplands-Väsby, Sweden
- Department of Medical Sciences, Örebro University, 701 82 Örebro, Sweden
| | - Adrian Elmi-Terander
- Department of Clinical Neuroscience, Karolinska Institute, 171 76 Stockholm, Sweden; (A.S.); (A.F.-S.); (G.B.); (E.E.)
- Capio Spine Center Stockholm, Löwenströmska Hospital, 194 89 Upplands-Väsby, Sweden
- Department of Medical Sciences, Örebro University, 701 82 Örebro, Sweden
- Department of Surgical Sciences, Uppsala University, 752 36 Uppsala, Sweden
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Petrov M, Sakelarova T, Gerganov V. Other Nerve Sheath Tumors of Brain and Spinal Cord. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1405:363-376. [PMID: 37452945 DOI: 10.1007/978-3-031-23705-8_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
The three main types of nerve sheath tumors are schwannomas, neurofibromas and perineuriomas. Multiple neurofibromas throughout the body are the hallmark of Neurofibromatosis type 1 (NF1). Spinal nerve sheath tumors are classified in the group of intradural extramedullary spinal cord tumors, in which they are the most common type (25-30%). Their incidence is 3-4 per 1 million people. Spinal schwannomas are encountered sporadically or in the context of Neurofibromatosis type 2, while neurofibromas are typical for patients with Neurofibromatosis type 1. Neurofibromas are composed predominantly of Schwann cells and fibroblasts, alongside which are also found axons, perineurial cells, mast cells and extracellular matrix. Most of the neurofibromas are asymptomatic. Any increase in the size of a neurofibroma or the presence of pain is an indicator of a possible malignant degeneration. Neurofibromas are treated surgically. Neurofibromas involve the whole nerve and cause its fusiform enlargement which makes it impossible to preserve the nerve's functions if complete tumor removal is performed. Hence, such tumors are initially observed. In case of progressive growth, the options are either resection of the tumor and immediate reconstruction with a peripheral nerve graft (e.g., nerve suralis interposition graft) or subtotal removal and follow-up. Malignant peripheral nerve sheath tumors (MPNST) are very rare tumors with incidence of around 1 per 1,000,000 people. MPNST account for 3-10% of all soft-tissue sarcomas. The most common initial symptom of MPNST is a painless mass. Any rapid increase in a subcutaneous mass or rapid onset of symptoms should raise the suspicion of a malignant tumor. In patients with diagnosed NF1, the recent rapid increase in a known lesion should raise the suspicion of malignant degeneration of the lesion and opt for active treatment. In the case of MPNST a wide surgical excision is advocated. The resectability depends greatly on the location of the tumors and varies from around 20% in paraspinal MPNST and reaches 95% in MPNST localized in the extremities. MPNST are a rare disease and should be managed by a multidisciplinary team of neurosurgeons, radiologists and oncologists.
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Affiliation(s)
- Mihail Petrov
- University Multiprofile Hospital for Active Treatment With Emergency Medicine N. I. Pirogov, Sofia, Bulgaria.
| | | | - Venelin Gerganov
- University Multiprofile Hospital for Active Treatment With Emergency Medicine N. I. Pirogov, Sofia, Bulgaria
- International Neuroscience Institute, Hannover, Germany
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Alqurashi A, Almutairi A, Baeesa S, Alomar S. Management of multiple cervical neurofibromas with myelopathy in neurofibromatosis type 1: A systematic review, case report and technical note. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2021.101209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Orbital peripheral nerve sheath tumors. Surv Ophthalmol 2017; 62:43-57. [DOI: 10.1016/j.survophthal.2016.08.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 08/14/2016] [Accepted: 08/19/2016] [Indexed: 02/07/2023]
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Collision tumor of the facial nerve: a synchronous seventh nerve schwannoma and neurofibroma. Otol Neurotol 2012; 33:1426-9. [PMID: 22975907 DOI: 10.1097/mao.0b013e31826a52aa] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To report a novel case of a collision tumor involving an intraparotid neurofibroma and a mastoid segment facial nerve schwannoma. STUDY DESIGN Clinical capsule report. SETTING Tertiary academic referral center. PATIENT A 29-year-old woman with a 2-year history of an asymptomatic enlarging left infraauricular mass and normal FN function presented to a tertiary care referral center. Computed tomography and magnetic resonance imaging demonstrated a cystic lesion in the deep portion of the parotid gland extending into the stylomastoid foramen. INTERVENTION The patient underwent superficial parotidectomy, and a cystic parotid mass was found to be intrinsic to the intraparotid facial nerve. A portion of the mass was biopsied, and intraoperative frozen section pathology was consistent with a neurofibroma. A mastoidectomy with FN decompression was then performed until a normal-appearing segment was identified just proximal to the second genu. After biopsy, proximal facial nerve stimulation failed to elicit evoked motor potentials, and en bloc resection was performed. RESULTS Final pathology demonstrated a schwannoma involving the mastoid segment and a neurofibroma involving the proximal intraparotid facial nerve. CONCLUSION We report the first case of a facial nerve collision tumor involving an intraparotid neurofibroma and a mastoid segment facial nerve schwannoma. Benign FN sheath tumors of the parotid gland are rare but should be considered in the differential diagnosis of a parotid mass.
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Bhaskar S, Sobti S, Singh AK. Massive scalp hematoma due to diffuse neurofibroma in NF-1. Clin Neurol Neurosurg 2012; 115:477-80. [PMID: 22738734 DOI: 10.1016/j.clineuro.2012.05.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Revised: 02/20/2012] [Accepted: 05/28/2012] [Indexed: 10/28/2022]
Affiliation(s)
- S Bhaskar
- Department of Neurosurgery, 235, Academic Block, PGIMER & Dr. RML Hospital, New Delhi 110001, India.
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Mordant P, Bagan P, Le Pimpec Barthes F, Riquet M. Traitement chirurgical des tumeurs du médiastin. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/s1241-8226(12)39116-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Mordant P, Le Pimpec-Barthes F, Riquet M. [Neurogenic tumors of the mediastinum in adults]. REVUE DE PNEUMOLOGIE CLINIQUE 2010; 66:81-94. [PMID: 20207300 DOI: 10.1016/j.pneumo.2009.12.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2009] [Accepted: 12/17/2009] [Indexed: 05/28/2023]
Abstract
In adults, mediastinal neurogenic tumours constitute the third group of mediastinal tumours, after thymomas and lymphomas. If the group of neurogenic tumour is frequent, each type of tumour is relatively unusual in everyday's clinic. Among them, nerve sheath tumours are the more frequent, followed by tumour of the autonomic system. Askin tumour remains uncommon. Treatment of this tumour requires complete preoperative work-up, including standard radiography, CT-scan, MRI, and sometimes nuclear imaging. In most cases, the treatment is based on surgical resection, and may be associated with radiotherapy or chemotherapy in case of malignant tumour or incomplete resection. Better understanding of these tumours, including their molecular abnormalities, may lead to new changes in their classifications, and to their management.
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Affiliation(s)
- P Mordant
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, 20 rue Leblanc, 75015 Paris, France
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Schellingerhout D, Le Roux LG, Bredow S, Gelovani JG. Fluorescence Imaging of Fast Retrograde Axonal Transport in Living Animals. Mol Imaging 2009. [DOI: 10.2310/7290.2009.00029] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Dawid Schellingerhout
- From the Departments of Radiology and Experimental Diagnostic Imaging and the Department of Experimental Diagnostic Imaging, The University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - Lucia G. Le Roux
- From the Departments of Radiology and Experimental Diagnostic Imaging and the Department of Experimental Diagnostic Imaging, The University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - Sebastian Bredow
- From the Departments of Radiology and Experimental Diagnostic Imaging and the Department of Experimental Diagnostic Imaging, The University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - Juri G. Gelovani
- From the Departments of Radiology and Experimental Diagnostic Imaging and the Department of Experimental Diagnostic Imaging, The University of Texas M. D. Anderson Cancer Center, Houston, TX
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Santaolalla F, Sanchez J, Ereño C, Lecumberri G, Valdes C. Severe exophthalmos in trigeminal plexiform neurofibroma involving the orbit and the infratemporal fossa. J Clin Neurosci 2009; 16:970-2. [DOI: 10.1016/j.jocn.2008.09.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2008] [Revised: 09/19/2008] [Accepted: 09/21/2008] [Indexed: 10/20/2022]
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Murovic JA, Gibbs IC, Chang SD, Mobley BC, Park J, Adler JR. FORAMINAL NERVE SHEATH TUMORS. Neurosurgery 2009; 64:A33-43. [DOI: 10.1227/01.neu.0000341632.39692.9e] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
OBJECTIVE
To conduct a retrospective review of outcomes in 15 patients with 18 foraminal tumors, including 17 benign peripheral nerve sheath tumors and 1 malignant peripheral nerve sheath tumor, who underwent CyberKnife (Accuray, Inc., Sunnyvale, CA) radiosurgery at Stanford University Medical Center from 1999 to 2006.
METHODS
Symptoms and findings, neurofibromatosis (NF) association, previous radiation, imaging, dosimetry, tumor volume, central necrosis, and the relation of these factors to outcomes were evaluated.
RESULTS
Before treatment, 1 asymptomatic patient had radiculopathic findings, 3 patients experienced local pain with intact neurological examinations, and 7 patients had radiculopathic complaints with intact (1 patient), radiculopathic (4 patients), or radiculomyelopathic examinations (2 patients). Five patients had myelopathic complaints and findings. Three patients had NF1-associated neurofibromas, 1 patient with NF2 had a schwannoma, and 1 patient had a schwannomatosis-related lesion. Two likely radiation-induced lesions, a neurofibroma and a malignant peripheral nerve sheath tumor, were observed. Prescribed doses ranging from 16 to 24 Gy, delivered in 1 to 3 fractions of 6 to 20 Gy, resulted in maximum tumor doses ranging from 20.9 to 30 Gy. Target volumes ranged from 1.36 to 16.9 mL. After radiosurgery, the asymptomatic case remained asymptomatic, and neurological findings improved. Thirteen of 15 symptomatic patients with (12 patients) or without (3 patients) neurological findings improved (3 cases after resection) or remained stable, and 2 patients worsened. Symptoms and examinations remained stable or improved in 8 (80%) of 10 patients with schwannomas and 3 (60%) of 5 patients with neurofibromas. Tumor volumes decreased in 12 (67%) of 18 tumors and increased in 3 tumors. Tumor volumes decreased in 8 of 10 schwannomas and 3 of 7 neurofibromas. Central necrosis developed in 8 (44%) of 18 tumors.
CONCLUSION
CyberKnife radiosurgery resulted in pain relief and functional preservation in selected foraminal peripheral nerve sheath tumors and a malignant peripheral nerve sheath tumor. Symptomatic and neurological improvements were more noticeable with schwannomas. Myelopathic symptoms may necessitate surgical debulking before radiosurgery.
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Affiliation(s)
- Judith A. Murovic
- Department of Neurosurgery, Stanford University Medical Center, Stanford, California
| | - Iris C. Gibbs
- Department of Radiation Oncology, Stanford University Medical Center, Stanford, California
| | - Steven D. Chang
- Department of Neurosurgery, Stanford University Medical Center, Stanford, California
| | - Bret C. Mobley
- Department of Neuropathology, Stanford University Medical Center, Stanford, California
| | - Jon Park
- Department of Neurosurgery, Stanford University Medical Center, Stanford, California
| | - John R. Adler
- Department of Neurosurgery, Stanford University Medical Center, Stanford, California
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Wentworth S, Pinn M, Bourland JD, deGuzman AF, Ekstrand K, Ellis TL, Glazier SS, McMullen KP, Munley M, Stieber VW, Tatter SB, Shaw EG. Clinical Experience With Radiation Therapy in the Management of Neurofibromatosis-Associated Central Nervous System Tumors. Int J Radiat Oncol Biol Phys 2009; 73:208-13. [DOI: 10.1016/j.ijrobp.2008.03.073] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2008] [Revised: 03/25/2008] [Accepted: 03/27/2008] [Indexed: 10/21/2022]
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13
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Avanzo M, Romanelli P. Spinal radiosurgery: technology and clinical outcomes. Neurosurg Rev 2008; 32:1-12; discussion 12-3. [DOI: 10.1007/s10143-008-0167-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2007] [Revised: 05/23/2008] [Accepted: 07/26/2008] [Indexed: 12/25/2022]
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