Spinal extradural schwannoma

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Object. The authors endeavor to define the clinical and surgery-related profile of spinal nerve sheath tumors located in the extradural space outside both the dural sac and, apparently, the nerve roots' sleeve.

Methods. A series of 24 extradural schwannomas was retrospectively selected after reviewing the notes of spinal nerve sheath tumors surgically treated at La Sapienza University of Rome. Clinical data, tumor-related characteristics, and outcome were analyzed.

Women predominantly harbored these tumors. On admission sensory nerve root dysfunction was infrequently reported, whereas pyramidal tract deficits were often present. The tumor, generally large, was most frequently located in the intermediate thoracic segments and high cervical region; only one was reported in the lumbosacral region. Considerable erosion of vertebral bodies was reported in almost one third of the cases. In four patients eloquent nerve roots, that of C-5 in three and that of S-1 in one, were involved with the tumor. Radical tumor resection, with preservation of the nerve roots, was possible in several cases, whereas in two patients manipulation and resection of the C-5 root produced transient and permanent, respectively, root palsy. At follow-up examination patients for whom walking was impossible before surgery were now able to walk.

Conclusions. Extradural schwannomas can be distinguished from other nerve sheath tumors growing inside the spinal canal by their clinicoradiological features and unlikely nerve root origin. After surgery, recovery from pyramidal tract deficits, even severe, is noteworthy; in the authors' experience, however, resection of an involved appendicular root is more likely to result in a permanent and significant radicular deficit.

Article Information

Address reprint requests to: Paolo Celli, M.D., Divisione di Neurochirurgia, II° Facolta' di Medicina e Chirurgia, Ospedale S. Andrea, Via di Grottarossa 1035, 00189 Roma, Italy. email: Paolo.Celli@uniroma1.it.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Artist's drawings depicting the more typical configuration and extension of spinal extradural nerve sheath tumors in frontal (upper) and axial (lower) views. These tumors can grow in all directions (longitudinally in the epidural space, anteriorly in one or two excavated VBs, posteriorly eroding the laminae, and anterolaterally in the intervertebral foramen) and frequently extend in the paraspinal space through the enlarged intervertebral foramen or a bone defect. When they are large and extend extraspinally, their more typical configuration is characterized by lobulating contours and irregular margins; moderate to massive involvement of laminae and VBs is a constant finding and destruction of the spine segments on one side of the midline is sometimes striking.

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    Upper Left and Right: Lateral tomograms of thoracic spine demonstrating a round, well-demarcated, radiolucent defect, outlined with a regular margin and a thin sharply defined sclerotic border in the posterior part of the VB; these features are suggestive of benign growth. Lower Left and Right: Axial CT scans revealing the T4–5 extradural schwannoma filling the spinal canal, and, on the left side, destroying the VB, eroding the lamina, and extending extraspinally through the bone defect.

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    Anteroposterior plain cervical radiograph (upper left) and tomogram (upper right) revealing a large, striking bone defect involving the C-4 and C-5 VBs on the left side; destruction of the bone caused by C4–6 extradural schwannoma is also evident on axial (lower left) and coronal (lower right) bone window CT scans.

  • View in gallery

    Coronal (left) and axial (right) Gd-enhanced T1-weighted MR images demonstrating a large extradural, intraspinal—extraspinal schwannoma eroding the C-1 and C-2 arches on the right side.

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