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Park H, Kim S, Kim YR, Park SH, Rhee JM, Chung CK, Kim JH, Lee CH, Kim KT, Kim CH. Surgical Strategy for Dumbbell-Shaped Cervical Schwannoma at the Vicinity of the Vertebral Artery: The Utilization of Anatomic Layer. Oper Neurosurg (Hagerstown) 2024:01787389-990000000-01209. [PMID: 38953646 DOI: 10.1227/ons.0000000000001245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 04/19/2024] [Indexed: 07/04/2024] Open
Abstract
BACKGROUND AND OBJECTIVES In cases where dumbbell-shaped cervical schwannoma encases the vertebral artery (VA), there is a risk of VA injury during surgery. The objective of this study is to propose a strategy for preserving the VA during the surgical excision of tumors adjacent to the VA through the utilization of anatomic layers. METHODS A retrospective analysis was conducted on 37 patients who underwent surgery for dumbbell-shaped cervical schwannoma with contacting VA from January 2004 to July 2023. The VA encasement group consisted of 12 patients, and the VA nonencasement group included 25 patients. RESULTS The perineurium acted as a protective barrier from direct VA exposure or injury during surgery. However, in the VA encasement group, 1 patient was unable to preserve the perineurium while removing a tumor adjacent to the VA, resulting in VA injury. The patient had the intact dominant VA on the opposite side, and there were no new neurological deficits or infarctions after the surgery. Gross total resection was achieved in 25 patients (67.6%), while residual tumor was confirmed in 12 patients (32.4%). Four patients (33.3% of 12 patients) underwent reoperation because of the regrowth of the residual tumor within the neural foramen. In the case of the 8 patients (66.7% of 12 patients) whose residual tumor was located outside the neural foramen, no regrowth was observed, and there was no recurrence of the tumor within the remaining perineurium after total resection. CONCLUSION In conclusion, when resecting a dumbbell-shaped cervical schwannoma contacting VA, subperineurium dissection prevents VA injury because the perineurium acts as a protective barrier.
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Affiliation(s)
- Hangeul Park
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sum Kim
- Department of Neurosurgery, Kangdong Sacred Heart Hospital, Seoul, Republic of Korea
| | - Young-Rak Kim
- Department of Neurosurgery, Armed Forces Yangju Hospital, Yangu, Republic of Korea
| | - Sung-Hye Park
- Department of Pathology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - John M Rhee
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Chun Kee Chung
- Department of Brain and Cognitive Sciences, Seoul National University, Seoul, Republic of Korea
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jun-Hoe Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Chang-Hyun Lee
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kyoung-Tae Kim
- Department of Neurosurgery, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
| | - Chi Heon Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Medical Device Development, Seoul National University College of Medicine, Seoul, Republic of Korea
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Hussain O, DeGroot A, Treffy R, Bakhaidar M, Zenga J, Shabani S. Large Cervical Spinal Schwannoma Requiring Anterior and Posterior Decompression and Fusion with Careful Dissection of the Vertebral Artery. World Neurosurg 2024; 187:68. [PMID: 38599373 DOI: 10.1016/j.wneu.2024.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 03/31/2024] [Accepted: 04/01/2024] [Indexed: 04/12/2024]
Affiliation(s)
- Omar Hussain
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
| | - Andrew DeGroot
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Randall Treffy
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Mohamad Bakhaidar
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Joseph Zenga
- Department of Otolaryngology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Saman Shabani
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Yang M, Zhong N, Lou Y, Jiang D, Liu Y, Dai Z, Wan W, Jiao J, Yang X, Xiao J. A Novel and Reproducible Classification of Cervical Dumbbell Tumors to Inform Surgical Approach and Reconstruction Techniques. Spine (Phila Pa 1976) 2024; 49:715-725. [PMID: 38239008 DOI: 10.1097/brs.0000000000004927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 01/03/2024] [Indexed: 04/25/2024]
Abstract
STUDY DESIGN A retrospective case series. OBJECTIVE This study developed a novel classification system based on imaging and anatomy to select optimal surgical approaches and reconstruction strategies to achieve total resection of cervical dumbbell tumors and restore spinal stability. SUMMARY OF BACKGROUND DATA Total resection is necessary to decrease the recurrence rate of cervical dumbbell tumors. Previous cervical dumbbell tumor classifications are insufficient for determining surgical strategies; therefore, a practical classification is needed. MATERIALS AND METHODS This study included 295 consecutive patients with cervical dumbbell tumors who underwent total surgical resection. A novel classification of cervical dumbbell tumors was developed based on magnetic resonance imaging and computed tomography. Continuous variables were expressed as mean±SD and were compared using an unpaired two-tailed Student t test. The χ 2 test or the Fisher exact test was used for categorical variables. Kendall's W test assessed three independent raters' inter-rater and intrarater reliabilities on 140 cervical dumbbell tumors. RESULTS The inter-rater and intrarater consistency coefficient was 0.969 (χ 2 =404.3, P <0.001) and 0.984 (χ 2 =273.7, P <0.001). All patients with type I and II tumors underwent single-posterior surgeries to achieve total resection. Of the patients in this study, 86.1%, 25.9%, 75.9%, and 76.9% underwent posterior surgeries for types IIIa, IIIb, IVa, and V tumors, respectively. All patients with type IVb tumors underwent a combined anterior and posterior approach. Posterior internal fixation was used for all patients in posterior surgery. Anterior reconstruction was applied for patients with type IVb tumors (20/20, 100%) and some with type V tumors (3/13, 23.1%). The mean follow-up duration was 93.6±2.6 months. A recurrence was observed in 19 (6.4%) patients. CONCLUSION The authors describe a novel classification system that is of practical use for planning the complete resection of cervical dumbbell tumors.
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Affiliation(s)
- Minglei Yang
- Department of Orthopedic Oncology, Spine Tumor Center, The Second Affiliated Hospital of Naval Medical University, Shanghai, China
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Peeters JB, Dessesard Olijnyk L, Janelle F, Shedid D, Bojanowski MW, Labidi M. Surgical management of tumors of the cervical spine and craniovertebral junction involving the vertebral artery: A narrative review. Neurochirurgie 2024; 70:101550. [PMID: 38552591 DOI: 10.1016/j.neuchi.2024.101550] [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: 02/28/2024] [Accepted: 03/12/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND The vertebral artery (VA) is in close proximity to bony structures, nerves and nerve sheaths of the cervical spine and craniovertebral junction (CVJ). These structures can be sources of tumors that are responsible for displacement, encasement and sometimes invasion of the VA. Removing these tumors while minimizing the risk of vascular injury requires thorough knowledge of the vascular anatomy, risk factors of vascular injury, the relationships of each tumor type with the VA, and the different surgical approaches and techniques that result in the best outcomes in terms of vascular control, tumoral exposure and resection. OBJECTIVE To present an overview of preoperative and anatomical considerations, differential diagnoses and various approaches to consider in cases of tumors in close relationship with the VA. METHOD A review of recent literature was conducted to examine the anatomy of the VA, the tumors most frequently affecting it, surgical approaches, and the necessary pre-operative preparations for ensuring safe and maximal tumor resection. This review aims to underscore the principles of treatment. CONCLUSION Tumors located at the CVJ and the cervical spine intimately involved with the VA, pose a surgical challenge and increase the risk of incomplete removal of the lesion. Detailed knowledge of the patient-specific anatomy and a targeted pre-operative work-up enable optimal planning of surgical approach and management of the VA, thereby reducing surgical risks and improving extent of resection.
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Affiliation(s)
- Jean-Baptiste Peeters
- Division of Neurosurgery, Department of Surgery, Centre Hospitalier de l'Universite de Montreal (CHUM), 1000 rue St-Denis, Montréal H2X 0C1, QC, Canada
| | - Leonardo Dessesard Olijnyk
- Division of Neurosurgery, Department of Surgery, Centre Hospitalier de l'Universite de Montreal (CHUM), 1000 rue St-Denis, Montréal H2X 0C1, QC, Canada
| | - Felix Janelle
- Division of Neurosurgery, Department of Surgery, Centre Hospitalier de l'Universite de Montreal (CHUM), 1000 rue St-Denis, Montréal H2X 0C1, QC, Canada
| | - Daniel Shedid
- Division of Neurosurgery, Department of Surgery, Centre Hospitalier de l'Universite de Montreal (CHUM), 1000 rue St-Denis, Montréal H2X 0C1, QC, Canada
| | - Michel W Bojanowski
- Division of Neurosurgery, Department of Surgery, Centre Hospitalier de l'Universite de Montreal (CHUM), 1000 rue St-Denis, Montréal H2X 0C1, QC, Canada
| | - Moujahed Labidi
- Division of Neurosurgery, Department of Surgery, Centre Hospitalier de l'Universite de Montreal (CHUM), 1000 rue St-Denis, Montréal H2X 0C1, QC, Canada.
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Corrivetti F, Roperto R, Sufianov R, Cacciotti G, Musin A, Sufianov A, Mastronardi L. Surgical management of spinal schwannomas arising from the first and second cervical roots: Results of a cumulative case series. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2023; 14:426-432. [PMID: 38268693 PMCID: PMC10805161 DOI: 10.4103/jcvjs.jcvjs_75_23] [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: 07/14/2023] [Accepted: 10/16/2023] [Indexed: 01/26/2024] Open
Abstract
Objective Schwannomas of the first and second nerve roots are rare neurosurgical entities, harboring specific surgical features that make surgical resection particularly challenging and deserve specifics dissertations. This study is a retrospectively analysis of 14 patients operated in two different neurosurgical centers: the San Filippo Neri Hospital of Rome and the Federal Centre of Neurosurgery of Tjumen. Materials and Methods In the last 6 years, 14 patients underwent neurosurgical resection of high cervical (C1-C2) schwannomas, in two different neurosurgical centers. Patients data regarding clinical presentation, radiological findings, and surgical results were retrospectively analyzed. Results The mean age was 50 years (range 13-74), the follow-up mean duration was 30 ± 8.5 (range 24-72 months), and there was no significant differences among different tumor locations (intradural, extradural, and dumbbell). Surgical results were excellent: gross total resection was achieved in all cases and there were no intraoperative complications or postoperative mortality. All patients presented postoperative clinical improvement except one who remained stable. Karnofsky performance status, at the last follow-up, confirmed a global clinical improvement. No vertebral artery (VA) injury neither spinal instability occurred; nerve root sacrifice was reported in one case. Conclusions Neurosurgical treatment of C1-C2 schwannomas is associated with good outcomes in terms of extent of resection and neurological function. In particular, dumbbell shape and VA involvement do not represent limitations to achieve complete tumor resection and good clinical outcome. In conclusion, microsurgery represents the treatment of choice for C1-C2 schwannomas.
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Affiliation(s)
- Francesco Corrivetti
- Department of Neurosurgery, San Filippo Neri Hospital, ASL Roma 1, Rome, Italy
- Laboratory of Neuroanatomy, EBRIS Foundation, Salerno, Italy
| | - Raffaelino Roperto
- Department of Neurosurgery, San Filippo Neri Hospital, ASL Roma 1, Rome, Italy
| | - Rinat Sufianov
- Federal Centre of Neurosurgery, Tyumen, Russia
- Department of Neurosurgery, The State Education Institution of Higher Professional Training, The First Sechenov Moscow State Medical University Under Ministry of Health, Moscow, Russia
| | - Guglielmo Cacciotti
- Department of Neurosurgery, San Filippo Neri Hospital, ASL Roma 1, Rome, Italy
| | | | - Albert Sufianov
- Federal Centre of Neurosurgery, Tyumen, Russia
- Department of Neurosurgery, The State Education Institution of Higher Professional Training, The First Sechenov Moscow State Medical University Under Ministry of Health, Moscow, Russia
| | - Luciano Mastronardi
- Department of Neurosurgery, San Filippo Neri Hospital, ASL Roma 1, Rome, Italy
- Department of Neurosurgery, The State Education Institution of Higher Professional Training, The First Sechenov Moscow State Medical University Under Ministry of Health, Moscow, Russia
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Yagi R, Fukumura M, Omura N, Hiramatsu R, Kameda M, Nonoguchi N, Furuse M, Kawabata S, Takami T, Wanibuchi M. Vertebral artery is an anatomical landmark in the posterior unilateral resection of cervical benign nerve sheath tumors with dumbbell extension of Eden type 2 or 3. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2023; 14:388-392. [PMID: 38268689 PMCID: PMC10805166 DOI: 10.4103/jcvjs.jcvjs_84_23] [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: 07/31/2023] [Accepted: 09/19/2023] [Indexed: 01/26/2024] Open
Abstract
Background In the cervical nerve sheath tumor (NST) surgery with dumbbell extension of Eden type 2 or 3, selection of anterior, posterior, or combined approach remains controversial. Objectives This technical note aimed to propose possible advantages of the posterior unilateral approach (PUA). Methods: Six patients who underwent the surgical treatment of cervical NSTs with dumbbell extension of Eden type 2 or 3 were included. The critical surgical steps included (1) complete separation of extradural and intradural procedures, (2) careful peeling of the neural membranes (epineurium and perineurium) from the tumor surface in the extradural procedure, (3) complete removal of the extradural tumor within the neural membranes, (4) intradural disconnection of tumor origin, and (5) intentional tumor removal up to the vertebral artery (VA), i.e., the VA line. Results The tumor location of dumbbell extension was Eden types 2 and 3 in two and four patients. Gross total resection was achieved in two patients and intentional posterior removal of the tumor to the VA line was achieved in the remaining four patients. No vascular or neural injuries associated with surgical procedures occurred. Postoperative neurological assessment revealed no symptomatic aggravation in all patients. No secondary surgery was performed during the study period. Conclusion PUA was safe and less invasive for functional recovery and tumor resection, if the anatomical relationship between the tumor and VA is clearly understood. The VA line is an important anatomical landmark to limit the extent of tumor resection.
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Affiliation(s)
- Ryokichi Yagi
- Department of Neurosurgery and Neuroendovascular Therapy, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Masao Fukumura
- Department of Neurosurgery and Neuroendovascular Therapy, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Naoki Omura
- Department of Neurosurgery, Tesseikai Neurosurgical Hospital, Shijonawate, Osaka, Japan
| | - Ryo Hiramatsu
- Department of Neurosurgery and Neuroendovascular Therapy, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Masahiro Kameda
- Department of Neurosurgery and Neuroendovascular Therapy, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Naosuke Nonoguchi
- Department of Neurosurgery and Neuroendovascular Therapy, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Motomasa Furuse
- Department of Neurosurgery and Neuroendovascular Therapy, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Shinji Kawabata
- Department of Neurosurgery and Neuroendovascular Therapy, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Toshihiro Takami
- Department of Neurosurgery and Neuroendovascular Therapy, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Masahiko Wanibuchi
- Department of Neurosurgery and Neuroendovascular Therapy, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
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7
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Okubo T, Nagoshi N, Tsuji O, Suzuki S, Takahashi Y, Yagi M, Matsumoto M, Nakamura M, Watanabe K. Resection of Cervical Dumbbell-Shaped Schwannoma Using Posterior Unilateral Approach: Impact on Postoperative Cervical Function and Clinical Outcomes. Global Spine J 2023:21925682231178205. [PMID: 37210656 DOI: 10.1177/21925682231178205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/22/2023] Open
Abstract
STUDY DESIGN A retrospective comparative study. OBJECTIVES This study aimed to evaluate the radiographical changes in cervical sagittal alignment (CSA) and clinical outcomes after tumor resection using a posterior unilateral approach without spinal fixation for patients with cervical dumbbell-shaped schwannoma (DS). METHODS Seventy-three patients with DS who were followed up for at least 2 years were included. The Eden classification was used to designate the types of DS. The CSA and range of motion (ROM) were analyzed using radiographs. The clinical outcomes were assessed using the Japanese Orthopaedic Association (JOA) score and JOA cervical myelopathy questionnaire. RESULTS The CSA in the neutral, flexion, and extension position and cervical ROM were not significantly reduced in the follow-up period. The JOA scores showed significant improvement after surgery. The postoperative radiographic parameters and clinical outcomes of Eden type II or III DS, which needed facetectomy for the resection, did not show any statistically significant difference compared with those of Eden type I tumor, which was resected without facetectomy. Fifty-two cases (71.2%) achieved gross total resection, whereas 21 cases (28.8%) remained in partial resection (PR). One case underwent reoperation due to the regrowth of the remnant tumor whose margin was at the entrance of the intervertebral foramen. CONCLUSIONS Tumor resection using the posterior unilateral approach preserved CSA and resulted in favorable clinical outcomes in patients with DS. When the resection ends in PR, the proximal margin of the remnant tumor should be located distally away from the entrance of the foramen to prevent regrowth.
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Affiliation(s)
- Toshiki Okubo
- Department of Orthopaedic Surgery, National Hospital Organization, Murayama Medical Center, Tokyo, Japan
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Narihito Nagoshi
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Osahiko Tsuji
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Satoshi Suzuki
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Yohei Takahashi
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Mitsuru Yagi
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
- Department of Orthopaedic Surgery, International University of Health and Welfare, School of Medicine, Chiba, Japan
| | - Morio Matsumoto
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Masaya Nakamura
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Kota Watanabe
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
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Melita NT, Bouchal SM, Haid RW, Hudson M, Kalani MA, McClendon J, Bendok BR. Commentary: Complete Resection of a Recurrent Cervical Dumbbell Schwannoma After Initial Subtotal Resection and Radiotherapy: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2023; 24:e236-e238. [PMID: 36701682 DOI: 10.1227/ons.0000000000000573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 10/18/2022] [Indexed: 01/27/2023] Open
Affiliation(s)
- Nicolae Teodor Melita
- Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA
- Precision Neuro-therapeutics Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona, USA
| | | | - Regis W Haid
- Department of Neurosurgery, Atlanta Brain and Spine Care, Atlanta, Georgia, USA
| | - Miles Hudson
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Maziyar A Kalani
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Jamal McClendon
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Bernard R Bendok
- Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA
- Precision Neuro-therapeutics Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona, USA
- Department of Radiology, Mayo Clinic, Phoenix, Arizona, USA
- Department of Otolaryngology-Head & Neck Surgery, Mayo Clinic, Phoenix, Arizona, USA
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9
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Maki Y, Abekura Y, Kawasaki T, Kobayashi T, Ioroi Y, Takayama M. Embolization of a vertebral artery encased in a regrowth cervical meningioma before resection. Surg Neurol Int 2022; 13:180. [PMID: 35509541 PMCID: PMC9063020 DOI: 10.25259/sni_300_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 04/14/2022] [Indexed: 11/04/2022] Open
Abstract
Background:
Managing intraoperative bleeding may be challenging when a cervical tumor encases the vertebral artery (VA). Here, a patient with a recurrent cervical meningioma between the C1/2 and C3/4 levels and encasement of the right VA injury developed intraoperative bleeding that was endovascularly embolized postoperatively.
Case Description:
A 30-year-old female presented with a progressive quadriparesis, most markedly involving the right upper extremity. Six years ago, she had a cervical meningioma resected at the C2/3 level. The new MR revealed regrowth of intraspinal tumor between the C1/2 to C4/5 levels accompanied by extradural encasement of the right VA within the C2/3 and C3/4 foramina. Before the first surgery, the right VA was embolized (i.e., after a balloon occlusion test proved negative). During the attempted resection of the intradural/extradural tumor, bleeding from the right VA was encountered; it was temporarily controlled. After complete occlusion of the right VA was angiographically confirmed, a second-stage procedure to fully resect the extradural remanent of the tumor was undertaken.
Conclusion:
Endovascular embolization of the right VA before the attempted resection of a recurrent intraspinal/extraspinal cervical meningioma failed to occlude the vessel entirely. The VA bleeding encountered intraoperatively was temporarily controlled. Delayed total VA occlusion was angiographically observed before full tumor resection could be completed.
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Affiliation(s)
- Yoshinori Maki
- Department of Neurosurgery, Hikone Chuo Hospital, Hikone,
| | - Yu Abekura
- Department of Neurosurgery, Otsu City Hospital, Otsu, Shiga, Japan
| | | | - Tamaki Kobayashi
- Department of Neurosurgery, Otsu City Hospital, Otsu, Shiga, Japan
| | - Yoshihiko Ioroi
- Department of Neurosurgery, Otsu City Hospital, Otsu, Shiga, Japan
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Takahashi T, Hirai T, Yoshii T, Inose H, Yuasa M, Matsukura Y, Morishita S, Kobayashi Y, Utagawa K, Kawabata A, Hashimoto J, Tanaka T, Motoyoshi T, Hashimoto M, Kawabata S, Okawa A. Risk factors for recurrence and regrowth of spinal schwannoma. J Orthop Sci 2022; 28:554-559. [PMID: 35382954 DOI: 10.1016/j.jos.2022.03.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 12/15/2021] [Accepted: 03/03/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Spinal schwannoma recurs after initial surgery at a rate of 4%-6%, with known risk factors including subtotal resection, multilevel involvement, large tumor size, and malignant histopathology. This study examined risk factors for schwannoma recurrence and residual tumor regrowth. METHODS Sixty-five patients who underwent resection of spinal schwannoma in our department between July 2010 and December 2018 and were followed up for more than 1 year were retrospectively analyzed for age, sex, follow-up duration, imaging and surgical data, recurrence, reoperation, and Japanese Orthopaedic Association scores before and 1 year after surgery. Patients with postoperative recurrence or residual tumor regrowth of >10% at the final visit (R+ group) were compared with patients without recurrence or regrowth (R- group). Multivariate logistic regression analysis was performed to analyze concurrent effects of risk factors on recurrence and regrowth. RESULTS The 65 patients (mean age 52.4 years at surgery) had schwannomas involving cervical (n = 14), thoracic (n = 25), and lumbar (n = 26) spinal levels. Mean follow-up duration was 58 months. Location was intradural in 65%, extradural in 17%, and both intradural and extradural in 18%. There were 4 recurrences (6.2%), and the mean interval between surgery and recurrence was 18.8 months. Seven patients (10.8%) experienced regrowth. Comparing group R+ (n = 11) and group R- (n = 54), univariate analysis showed significant differences in Sridhar tumor classification, giant tumor (Sridhar classification II, IVb, and V), left-right and cranial-caudal tumor size, largest diameter, operative time, blood loss, subtotal resection, reoperation, fusion surgery, and follow-up duration. Multivariate logistic regression analysis revealed giant tumor (Sridhar classification types II, IVb, and V) as an independent risk factor for recurrence and regrowth. CONCLUSIONS This retrospective review of 65 consecutive patients with spinal schwannoma in a single institution demonstrated that 16.9% had recurrence or regrowth, demonstrating that this potential risk should be kept in mind.
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Affiliation(s)
- Takuya Takahashi
- Department of Orthopaedics, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan
| | - Takashi Hirai
- Department of Orthopaedics, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan.
| | - Toshitaka Yoshii
- Department of Orthopaedics, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan
| | - Hiroyuki Inose
- Department of Orthopaedics, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan
| | - Masato Yuasa
- Department of Orthopaedics, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan
| | - Yu Matsukura
- Department of Orthopaedics, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan
| | - Shingo Morishita
- Department of Orthopaedics, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan
| | - Yutaka Kobayashi
- Department of Orthopaedics, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan
| | - Kurando Utagawa
- Department of Orthopaedics, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan
| | - Atsuyuki Kawabata
- Department of Orthopaedics, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan
| | - Jun Hashimoto
- Department of Orthopaedics, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan
| | - Tomoyuki Tanaka
- Department of Orthopaedics, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan
| | - Takayuki Motoyoshi
- Department of Orthopaedics, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan
| | - Motonori Hashimoto
- Department of Orthopaedics, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan
| | - Shigenori Kawabata
- Department of Orthopaedics, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan
| | - Atsushi Okawa
- Department of Orthopaedics, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan
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11
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Kitamura K, Nagoshi N, Tsuji O, Suzuki S, Nori S, Okada E, Yagi M, Matsumoto M, Nakamura M, Watanabe K. Remnant Tumor Margin as Predictive Factor for Its Growth After Incomplete Resection of Cervical Dumbbell-Shaped Schwannomas. Neurospine 2022; 19:32-40. [PMID: 35130425 PMCID: PMC8987553 DOI: 10.14245/ns.2142698.349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 10/30/2021] [Indexed: 11/30/2022] Open
Abstract
Objective The purpose of our study was to investigate the risk factors of remnant tumor growth after incomplete resection (IR) of cervical dumbbell-shaped schwannomas (DS).
Methods Twenty-one patients with IR of cervical DS with at least 2 years of follow-up were included and were divided into 2 groups: the remnant tumor growth (G) (n = 10) and no growth (NG) (n = 11) groups. The tumor location in the axial plane according to Toyama classification, the location of the remnant tumor margin, and the tumor growth rate (MIB-1 index) index were compared.
Results No significant differences in Toyama classification and MIB-1 index were found. Age was significantly higher in the G group (61.4 years vs. 47.6 years; p=0.030), but univariate logistic regression analysis revealed little correlation to the growth (odds ratio [OR], 1.08; 95% confidence interval [CI], 1.001–1.166; p=0.047). Seventeen patients (9 in the G and 8 in the NG group) underwent the posterior one-way approach, and significant differences in the location of the remnant tumor margin were confirmed: within the spinal canal in 1 and 0 case, at the entrance of the intervertebral foramen in 7 and 1 cases, and in the foramen distal from the entrance in 1 and 7 cases, in the G and NG groups, respectively (p=0.007). The proximal margin was identified as a significant predictor of the growth (OR, 56.0; 95% CI, 2.93–1,072; p=0.008).
Conclusion Remnant tumors with margins distally away from the entrance of the foramen were less likely to grow after IR of cervical DS.
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Affiliation(s)
- Kazuya Kitamura
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
- Department of Orthopedic Surgery, National Defense Medical College, Saitama, Japan
| | - Narihito Nagoshi
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
- Corresponding Author Narihito Nagoshi https://orcid.org/0000-0001-8267-5789 Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Osahiko Tsuji
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Satoshi Suzuki
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Satoshi Nori
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Eijiro Okada
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Mitsuru Yagi
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Morio Matsumoto
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Masaya Nakamura
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Kota Watanabe
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
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12
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Nakajima T, Takeshima Y, Kim TK, Nakagawa I, Motoyama Y, Park YS, Nakase H. C2 extradural schwannoma compressing the dominant internal jugular vein: a case report. Acta Neurochir (Wien) 2020; 162:1181-1185. [PMID: 32198539 DOI: 10.1007/s00701-020-04294-w] [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: 01/29/2020] [Accepted: 03/13/2020] [Indexed: 11/28/2022]
Abstract
We describe a rare case of extradural schwannoma in the upper cervical spine compressing the dominant internal jugular vein (IJV) presenting with atypical headaches. A 50-year-old woman complained of a subcutaneous neck mass associated with atypical headaches. Radiological examinations revealed the right IJV was compressed anteriorly by C2 extradural mass and occluded with markedly dilated collateral cerebral venous drainage through deep cervical veins. Subtotal removal was performed via the posterolateral approach and the atypical headaches resolved immediately. This case demonstrates that extradural schwannoma in the upper cervical spine could compress the IJV and manifest as cerebral venous circulation disturbances.
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Affiliation(s)
- Tsukasa Nakajima
- Department of Neurosurgery, Nara Medical University School of Medicine, 840 Shijo-cho, Kashihara, Nara, 634-8521, Japan
| | - Yasuhiro Takeshima
- Department of Neurosurgery, Nara Medical University School of Medicine, 840 Shijo-cho, Kashihara, Nara, 634-8521, Japan.
| | - Tae-Kyun Kim
- Department of Neurosurgery, Nara Medical University School of Medicine, 840 Shijo-cho, Kashihara, Nara, 634-8521, Japan
| | - Ichiro Nakagawa
- Department of Neurosurgery, Nara Medical University School of Medicine, 840 Shijo-cho, Kashihara, Nara, 634-8521, Japan
| | - Yasushi Motoyama
- Department of Neurosurgery, Nara Medical University School of Medicine, 840 Shijo-cho, Kashihara, Nara, 634-8521, Japan
| | - Young-Su Park
- Department of Neurosurgery, Nara Medical University School of Medicine, 840 Shijo-cho, Kashihara, Nara, 634-8521, Japan
| | - Hiroyuki Nakase
- Department of Neurosurgery, Nara Medical University School of Medicine, 840 Shijo-cho, Kashihara, Nara, 634-8521, Japan
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