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K. Sridhar, Ravi Ramamurthi, M.C. Vasudevan and B. Ramamurthi

, however, other categories of tumors, that, due to their size and extent, justify the designator giant schwannoma. The authors propose a classification system of spinal schwannomas, in which a giant tumor is defined and discuss the surgical management of patients with giant invasive spinal schwannomas. Clinical Material and Methods The case records of patients with spinal schwannomas surgically treated at our center between 1990 and 1999 were analyzed retrospectively. The lesions were diagnosed by radiography, myelography, and/or MR imaging. Classification of

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Madeleine Sowash, Ori Barzilai, Sweena Kahn, Lily McLaughlin, Patrick Boland, Mark H. Bilsky and Ilya Laufer

and women. 14 Giant schwannomas of the spine are classified as an intraspinal tumor of at least 2 vertebral bodies in length or with an extraspinal extension of at least 2.5 cm. 17 Here, we have also included giant paraspinal schwannomas of at least 2.5 cm. Giant schwannomas most commonly present in the lumbar or sacral regions but are also found in the cervical and thoracic regions. 1 , 10 , 11 , 13 , 21 , 24 The most common symptoms are back pain, radiculopathy, muscle weakness, sensory deficit, difficulty with ambulation, and bladder/bowel dysfunction, which

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Alex Alfieri, Mauro Campello, Maximilian Broger, Mario Vitale and Andreas Schwarz

giant of the giant schwannomas . J Urol 162 : 791 – 792 , 1999 18 Lackman RD , Khoury LD , Esmail A , Donthineni-Rao R : The treatment of sacral giant-cell tumours by serial arterial embolisation . J Bone Joint Surg Br 84 : 873 – 877 , 2002 19 Laforga JB : Cellular schwannoma: report of a case diagnosed intraoperatively with the aid of cytologic imprints . Diagn Cytopathol 29 : 95 – 100 , 2003 20 Leggon RE , Zlotecki R , Reith J , Scarborough MT : Giant cell tumor of the pelvis and sacrum: 17 cases and analysis of the

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Surgical management of giant presacral schwannoma: systematic review of published cases and meta-analysis

Presented at the 2019 AANS/CNS Joint Section on Disorders of the Spine and Peripheral Nerves

Zach Pennington, Erick M. Westbroek, A. Karim Ahmed, Ethan Cottrill, Daniel Lubelski, Matthew L. Goodwin and Daniel M. Sciubba

, consistent with what we observed in our analysis. Interestingly, they reported that patients may have extremely long prodromal periods, with 1 patient reporting symptom duration of 23 years at the time of consultation. The next landmark paper in the treatment of presacral schwannoma was that of Sridhar et al., who described a series of 10 giant invasive spinal schwannomas. 76 Sridhar and colleagues were the first to propose a definition of giant schwannoma, describing them as tumors that involve two or more continuous vertebral bodies or which have an extraspinal

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Sung Mo Ryu, Sun-Ho Lee, Kyung Min Lee, Whan Eoh and Eun-Sang Kim

obliteration of the fat between the VA and tumor with VA deformation. We adopted the criterion of > 180° circumferential involvement of the VA as a positive sign for encasement. 18 Preoperative tumor size was measured as the longest diameter of the tumor on axial T1-weighted enhancement or T2-weighted MR images. 23 A giant schwannoma of the spine was defined as an intraspinal schwannoma of at least 2 vertebral bodies in length or as an extraspinal extension of at least 2.5 cm. 24 , 25 Surgical Approaches and Neurological Evaluations Surgical approaches were classified as

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Chih-Chuan Yang, Hung-Chang Chen and Chien-Min Chen

of giant presacral schwannomas: a report of four cases . Eur Radiol 12 : 2365 – 2369 , 2002 12 Schindler OS , Dixon JH , Case P : Retroperitoneal giant schwannomas: report on two cases and review of the literature . J Orthop Surg (Hong Kong) 10 : 77 – 84 , 2002

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Nicola Montano, Quintino Giorgio D'Alessandris, Manuela D'Ercole, Liverana Lauretti, Roberto Pallini, Rina Di Bonaventura, Giuseppe La Rocca, Federico Bianchi and Eduardo Fernandez

), extremities (35) 47 (15–198) GTR↑, NF↓ (for local recurrence) NA Çağlı et al., 2012 13 Giant schwannoma (100) Sacrum 97.2 (12–180) NA NA Canavese & Krajbich, 2011 14 (20 tumors) Plexiform neurofibroma in NF (100) Extremities (75), trunk (25) 65.5 (24–145) Tumor size >15 cm↓, GTR↑ (for recurrence) tumor size, age <10 yrs↓ (for wound healing problems) U Casanova et al., 2000 24 MPNST (100) Head/neck (25), trunk (42), extremities (33) 230 (114–150) GTR↑, tumor size >5 cm↓, RT↑ (for OS) NA Chong et al., 2000 5

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Mohammed Adeeb Sebai, Panagiotis Kerezoudis, Mohammed Ali Alvi, Jang Won Yoon, Robert J. Spinner and Mohamad Bydon

with a posterolateral transpedicular approach . Acta Neurochir (Wien) 158 : 1563 – 1569 , 2016 10.1007/s00701-016-2864-7 27290663 12 Iwasaki M , Nakamura K , Takeshita K , Kawaguchi H , Akune T , Hoshino Y : Surgical management of giant schwannoma in the lumbosacral region . J Spinal Disord 11 : 444 – 447 , 1998 10.1097/00002517-199810000-00012 9811106 13 Jiang H , He J , Zhan X , He M , Zong S , Xiao Z : Occipito-cervical fusion following gross total resection for the treatment of spinal extramedullary tumors in