Microsurgical management of non-neurofibromatosis spinal schwannoma

INTRODUCTION

The aim of this study is to assess the clinical properties and surgical results of patients diagnosed with spinal schwannomas without neurofibromatosis (NF) properties.

PATIENTS AND METHODS

The data obtained from 35 patients who underwent resection of spinal schwannomas were analyzed. All cases with neurofibromas and those with a known diagnosis of NF Type 1 or 2 were excluded. 35 patients underwent surgery for spinal schwannoma at our institution between January 1997 and 2010. The data were gathered retrospectively from medical records and included clinical presentation, tumor location and post-operative complications. All cases were surgically excised, and they were confirmed to be schwannomas by pathologists with histopathological sections in paraffin stained with hematoxylin-eosin.

RESULT

We treated 35 (20 males and 15 females) patients with spinal schwannomas. The mean age of the patients was 47.2 (between 13 and 76) years. Of the cases, six schwannomas were located in the cervical spine, four in the thoracic spine, two in cervico-thoracic area, 10 in the thoraco-lumbar area and 13 in the lumbar spine. Two patients had malignant schwannomas that were recurrent. Of the 35 cases, the schwannomas were intradural-extramedullary in 30 cases (86%), intradural-intramedullar in 2 cases (6%), and extradural in 3 cases (9%).

CONCLUSION

Spinal schwannomas may occur at any level of the spinal axis and are most frequently intradural-extramedullary. The most common clinical presentation is pain. Most of the spinal schwannomas in non-NF patients can be resected completely without or with minor post-operative deficits. This knowledge may help us to create a strategy for total resection of a spinal schwannomas.

Cerebral alveolar echinococcosis. A case report with MRI and review of the literature

Alveolar echinococcosis is an important zoonotic infection caused by the larval stage of the Echinococcus multilocularis. It is endemic to North America, Central Europa, Russia, China and Turkey. The liver and the lung are the organs most commonly involved. Cerebral alveolar echinococcosis is rare accounting for only 1% of cases. We present a 55-year-old patient with a right frontal mass. T2-weighted MRI series revealed a grape like multilobular, heterogeneous mass with low density. A diagnosis of glial tumor was made. The mass was totally removed. The histopathological examination showed a diffuse growth composed of compartments that are filled with a gelatinous matrix and many brood capsules and protoscolices filled with necrotic tissue. Histopathological findings were consistent with the diagnosis of alveolar echinococcosis. No postoperative complications were observed. There were no lesions in the liver and lungs. The patient was started on albendazole (ABZ) at a daily dosage of 800 mg for 3 months. The patient has remained free of any mass lesion for 5 years. Hypointense grape-like mass with calcification and surrounding white matter edema in T2-weighted MRI should suggest cerebral alveolar echinococcosis. Radical surgery and an adjuvant therapy with ABZ provides useful prolongation of life.

Spinal meningiomas: evaluation of 41 patients

AIM

Spinal meningiomas are relatively frequent intraspinal tumors. They constitute 25-46% of all primary spinal neoplasms.

METHODS

Forty-one patients with spinal meningiomas surgically treated between 1986 and 2001 are reviewed in this report. There were 32 females and 9 males, aged 16 to 73 years old. Tumor location was cervical in 7 cases and thoracic in 34 cases. All tumors were intradural. All of the patients were operated by laminectomy in prone position.

RESULTS

Total excision was achieved in 40 (98%) patients and subtotal excision in 1(2%). The majority of the tumors were meningothelial (42%) or psammomatous (25%). There was no surgical mortality. Four patients (10%) suffered from morbidity: One patient with CSF fistula, 1 deep venous thrombosis, 1 case with paraparesis and 1 wound infection was seen. Neither multiple meningiomas nor malign meningiomas were seen in our series.

CONCLUSIONS

Spinal meningiomas are benign tumors and should be excised totally. If the preoperative neurological status is not complicated, fairly good outcome can be achieved.

Tentorial meningiomas

We report our experience with and long-term results of 37 patients with tentorial meningiomas who underwent surgery between 1972 and 1993. The average age was 43 years, and the mean duration of symptoms was 36 months. Headache (83.8%) and extremity or gait ataxia (35.1%) were the most common complaints. On neurological examination, signs of elevated intracranial pressure and cerebellar deficits (51.4%) were the most common findings, followed by third nerve involvement (35.1%). Computed tomography, angiography, and, in recent years, magnetic resonance imaging were used as diagnostic tools and for planning the surgical procedure. According to the primary site of attachment, the tentorial meningiomas were divided into three subgroups: medial, lateral, and falcotentorial. The lateral and medial tumors, with mainly supratentorial development, were approached from above by using a temporal, temporooccipital, or parietooccipital craniotomy. For tumors developing mainly in the posterior cranial fossa, suboccipital craniectomy was performed. In six patients who showed medial tentorial and petrous apex attachment, a combined subtemporal transpetrosal and retromastoid approach was performed. In 31 patients, the tumors were totally removed, and, in 6 patients, only subtotal excision could be done. Seven patients had postoperative complications, but only one of them died of severe brain edema. Our mortality rate was 2.7%. In this article, appropriate preoperative studies, surgical techniques, and surgical results are discussed.