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Razzouk J, Case T, Vyhmeister E, Nguyen K, Carter D, Carter M, Sajdak G, Kricfalusi M, Taylor R, Bedward D, Shin D, Wycliffe N, Ramos O, Lipa SA, Bono CM, Cheng W, Danisa O. Morphometric analysis of cervical neuroforaminal dimensions from C2-T1 using computed tomography of 1,000 patients. Spine J 2024:S1529-9430(24)00219-5. [PMID: 38705281 DOI: 10.1016/j.spinee.2024.05.001] [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] [Received: 12/11/2023] [Revised: 04/22/2024] [Accepted: 05/01/2024] [Indexed: 05/07/2024]
Abstract
BACKGROUND Race and sex differences are not consistently reported in the literature. Fundamentally, anatomical differences of cervical neuroforaminal dimensions (CNFD) amongst these groups would be important to know. PURPOSE To establish normative radiographic morphometric measurements of CNFD and uncover the influence of patient sex, race, and ethnicity while also considering anthropometric characteristics. STUDY DESIGN Retrospective radiographic morphometric study. PATIENT SAMPLE A total of 1,000 patients between 18 and 35 years of age who were free of spinal pathology. OUTCOME MEASURES Foraminal height, axial width, and area of cervical neural foramen. METHODS Cervical CTs were reviewed to measure CNFD, defined as follows: foraminal height, axial width, and area. Statistical analyses were performed to assess associations between CNFD, and patient height, weight, sex, race, and ethnicity. RESULTS CNFD measurements followed a bimodal distribution pattern moving caudally from C2-T1. Irrespective of disc level, cervical CNFD were as follows: left and right widths of 6.6±1.5 and 6.6±1.5 mm, heights of 9.4±2.4 and 9.4±3.2 mm, and areas of 60.0±19.5 and 60.6±20.7 mm2. Left and right foraminal width were highest at C2-C3 and lowest at C3-C4. Left and right foraminal height were highest at C7-T1 and C6-C7, respectively and lowest at C3-C4. Left and right foraminal areas were highest at C2-C3 and lowest at C3-C4. Significant differences were observed for all CNFD measurements across disc levels. CNFD did not vary based on laterality. Significant CNFD differences were observed with respect to patient sex, race, and ethnicity. Male height and area were larger compared to females. In contrast, female foraminal width was larger compared to males. The Asian cohort demonstrated the largest foraminal widths. White and Hispanic patients demonstrated the largest foraminal heights and areas. Black patients demonstrated the smallest foraminal widths, heights, and areas. Patient height and weight were only weakly correlated with CNFD measurements across all levels from C2-T1. CONCLUSIONS This study describes 36,000 normative measurements of 12,000 foramina from C2-T1. CNFD measurements vary based on disc level, but not laterality. Contrasting left- versus right-sided neuroforamina of the same level may aid in determining the presence of unilateral stenosis. Patient sex, race, and ethnicity are associated with CNFD, while patient anthropometric factors are weakly correlated with CNFD.
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Affiliation(s)
- Jacob Razzouk
- Loma Linda University School of Medicine, 11175 Campus St, Loma Linda, CA, 92350, USA
| | - Trevor Case
- California University of Science and Medicine, 1501 Violet St, Colton, CA, 92324, USA
| | - Ethan Vyhmeister
- Loma Linda University School of Medicine, 11175 Campus St, Loma Linda, CA, 92350, USA
| | - Kai Nguyen
- Loma Linda University School of Medicine, 11175 Campus St, Loma Linda, CA, 92350, USA
| | - Davis Carter
- Loma Linda University School of Medicine, 11175 Campus St, Loma Linda, CA, 92350, USA
| | - Mei Carter
- Loma Linda University School of Medicine, 11175 Campus St, Loma Linda, CA, 92350, USA
| | - Grant Sajdak
- Loma Linda University School of Medicine, 11175 Campus St, Loma Linda, CA, 92350, USA
| | - Mikayla Kricfalusi
- California University of Science and Medicine, 1501 Violet St, Colton, CA, 92324, USA
| | - Rachel Taylor
- Loma Linda University School of Medicine, 11175 Campus St, Loma Linda, CA, 92350, USA
| | - Derran Bedward
- Loma Linda University School of Medicine, 11175 Campus St, Loma Linda, CA, 92350, USA
| | - David Shin
- Loma Linda University School of Medicine, 11175 Campus St, Loma Linda, CA, 92350, USA
| | - Nathaniel Wycliffe
- Department of Radiology, Loma Linda University Medical Center, 11234 Anderson St, Loma Linda, CA, 92354, USA
| | - Omar Ramos
- Twin Cities Spine Center, 913 E 26th St, Minneapolis, MN, 55404 USA
| | - Shaina A Lipa
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA
| | - Christopher M Bono
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA, 02114, USA
| | - Wayne Cheng
- Division of Orthopaedic Surgery, Jerry L. Pettis Memorial Veterans Hospital, 11201 Benton St, Loma Linda, CA, 92357, USA
| | - Olumide Danisa
- Departments of Orthopaedic Surgery and Neurologic Surgery, Loma Linda University Medical Center, 11234 Anderson St, Loma Linda, CA, 92354, USA.
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Muramatsu K, Tani Y, Seto T, Iwanaga R, Mihara A, Ihara K, Sakai T. Schwannoma in the extremity: clinical features and microscopic intra-capsular enucleation. J Rural Med 2021; 16:184-190. [PMID: 34707726 PMCID: PMC8527622 DOI: 10.2185/jrm.2021-020] [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: 04/16/2021] [Accepted: 05/31/2021] [Indexed: 11/27/2022] Open
Abstract
Objective: Schwannomas are the most common type of neoplasm of the
peripheral nerves. Enucleation is a standard surgical procedure; however, it occasionally
results in iatrogenic nerve injury, even with atraumatic procedures. Herein, we present
the clinical characteristics of schwannoma arising in the extremities and discuss the
clinical outcomes of extra- and intra-capsular
enucleation. Patients and Methods: We reviewed 122 schwannomas treated at our institute.
Schwannomas arising from the minor nerve (n=30) or intramuscularly (n=15) were operated
using the extra-capsular technique. Of the 77 major nerve schwannomas, 62 schwannomas were
treated using the intra-capsular technique and 15 schwannomas using the extra-capsular
technique. Results: Neurological deficits following enucleation were significantly
lower using the intra-capsular technique than with the extra-capsular technique. The
patient age, duration of symptoms, maximum tumor diameter, and site of occurrence were not
associated with subsequent neurological deficits. With both techniques, no tumor
recurrence was observed at the final follow-up. Conclusion: These results support the use of intra-capsular
micro-enucleation as a safe and reliable treatment for every type of schwannoma. To
minimize the risk of nerve injury, en bloc resection should not be used because the main
purpose of schwannoma surgery is the relief of symptoms, not tumor resection.
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Affiliation(s)
- Keiichi Muramatsu
- Department of Hand and Microsurgery, Nagato General Hospital, Japan.,Department of Orthopedic Surgery, Yamaguchi University School of Medicine, Japan
| | - Yasuhiro Tani
- Department of Hand and Microsurgery, Nagato General Hospital, Japan
| | - Tetsuya Seto
- Department of Hand and Microsurgery, Nagato General Hospital, Japan
| | - Ryuta Iwanaga
- Department of Orthopedic Surgery, Yamaguchi University School of Medicine, Japan
| | - Atsushi Mihara
- Department of Orthopedic Surgery, Yamaguchi University School of Medicine, Japan
| | - Koichiro Ihara
- Department of Orthopedic Surgery, Kanmon Medical Center, Japan
| | - Takashi Sakai
- Department of Orthopedic Surgery, Yamaguchi University School of Medicine, Japan
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Tian J, Huang Q, Chen Z. Schwannoma of the long thoracic nerve in the left axilla: a case report. J Int Med Res 2019; 48:300060519890197. [PMID: 31801392 PMCID: PMC7607288 DOI: 10.1177/0300060519890197] [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] [Indexed: 11/17/2022] Open
Abstract
Schwannoma, which is also known as neurilemmoma, is a type of tumor that arises from the
peripheral nerve sheaths. Cases of schwannomas located in different regions have been
reported. Some schwannomas present as asymptomatic masses, while others cause discomfort,
such as pain and numbness. Magnetic resonance imaging (MRI) is a valuable diagnostic tool.
A 23-year-old woman presented to our hospital with a mass in the left axilla that was
misdiagnosed as mammae erraticae. The patient also considered the condition to be mammae
erraticae for approximately 14 months because of a lack of symptoms. MRI was recommended
by a surgeon from the galactophore department. A giant schwannoma was found. The mass was
surgically excised, while preserving the continuity of the long thoracic nerve. Routine
histopathological analysis confirmed the presence of a benign schwannoma. Schwannomas
located in the axilla are rare and may be easily misdiagnosed as mammae erraticae or
enlarged lymph nodes. Early investigation is necessary to make the diagnosis, and surgical
excision is usually curative.
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Affiliation(s)
- Jia Tian
- Department of Hand Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
| | - Qishun Huang
- Department of Hand Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
| | - Zhenbing Chen
- Department of Hand Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
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Date R, Muramatsu K, Ihara K, Taguchi T. Advantages of intra-capsular micro-enucleation of schwannoma arising from extremities. Acta Neurochir (Wien) 2012; 154:173-8; discussion 178. [PMID: 22072218 DOI: 10.1007/s00701-011-1213-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2011] [Accepted: 10/24/2011] [Indexed: 12/12/2022]
Abstract
BACKGROUND Schwannoma is the most common tumor of the peripheral nerves, with surgical enucleation being the established treatment modality. However, some schwannomas cannot be easily enucleated and this sometimes results in iatrogenic nerve injury even with atraumatic procedures. Here we present a retrospective review of the management of schwannoma in the extremities and compare clinical outcomes from the two techniques of extra-capsular and intra-capsular enucleation. METHODS We reviewed 36 schwannomas from 35 patients who underwent surgical excision of schwannomas arising from the extremities. Twenty had undergone extra-capsular resection and 16 had undergone enucleation using the intra-capsular technique. The post-operative neurological deficits were graded as minor, major, and transient. The duration of symptoms, maximum tumor diameter and site of occurrence were compared between patients with the three grades of deficit. RESULTS In total, 22 patients developed no sensory changes following enucleation of schwannoma or only temporary and minor changes that had fully resolved within 6 months. Ten patients developed new neurological deficits following surgery that took longer than 6 months to resolve. Four patients experienced new motor deficits or paresthesia following operation that had still not recovered at the final follow-up, all of whom underwent enucleation using the extra-capsular technique. Neurological deficit after enucleation was significantly lower using the intra-capsular compared with the extra-capsular technique. Patient age, duration of symptoms, maximum diameter of the tumor and site of occurrence did not influence the neurological deficit following enucleation of schwannoma. CONCLUSION These results support intra-capsular micro-enucleation as a safe and reliable treatment for every type of schwannoma. To minimize the risk of nerve injury, en bloc resection should not be used because the main purpose of schwannoma surgery is the relief of symptoms, not tumor resection. Thorough pre-operative counseling of patients to inform them of the potential occurrence of neurological deficit is important.
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