Neurospine.  2023 Sep;20(3):747-755. 10.14245/ns.2346376.188.

Intramedullary Schwannoma of the Spinal Cord: A Nationwide Analysis by the Neurospinal Society of Japan

Affiliations
  • 1Spine and Spinal Cord center, Juntendo University, Tokyo, Japan
  • 2Department of Neurosurgery, Juntendo University, Tokyo, Japan
  • 3Department of Minimum-Invasive Neurospinal Surgery, Mie University, Mie, Japan
  • 4Sapporo Azabu Neurosurgical Hospital, Sapporo, Japan
  • 5Department of Neurosurgery, Kawasaki Medical School, Okayama, Japan
  • 6Uchikado Neuro-Spine Clinic, Fukuoka, Japan
  • 7Department of Neurosurgery, The Jikei University, Tokyo, Japan
  • 8Department of Spinal Surgery, Akita Cerebrospinal and Cardiovascular Center, Akita, Japan
  • 9Department of Neurosurgery, Nara Medical University, Nara, Japan
  • 10Division of Neurosurgery, Tohoku Medical and Pharmaceutical University, Sendai, Japan

Abstract


Objective
This study was aimed to report the clinical characteristics of intramedullary schwannomas and discuss imaging findings and treatment strategies.
Methods
The inclusion criterion was consecutive patients with intramedullary schwannomas who were surgically treated at 8 centers between 2009 and 2020. Clinical characteristics included age, sex, clinical presentation, disease duration, and follow-up period. The modified McCormick scale was used to compare the preoperative and postoperative conditions. Pre- and postoperative magnetic resonance images (MRI) of each case were analyzed.
Results
The mean age of the total 11 patients at the operation was 50.2 years. The mean duration of the symptoms was 23 months, with limb paresthesia being the most common clinical presentation. The cervical spine was the most common localization level of the tumor in 6 cases. The mean follow-up duration was 49.4 months. Gross total resection (GTR) and subtotal resection (STR) was achieved in 9 and 2 cases, respectively. According to the modified McCormick scale at 6 months postoperatively, 7 cases (63.6%) had improved and 4 cases (36.3%) had unchanged grades. Typical MRI findings of the intramedullary schwannoma included ring-like enhancement, syringomyelia, cystic formation, intramedullary edema, and hemosiderin deposition. Gadolinium enhancement was homogenous in 8 cases (72.7%). The tumor margins were well demarcated in all cases.
Conclusion
Intramedullary schwannoma should be considered when sharp margins and well-enhanced tumors are present at the cervical spine level and the initial symptoms are relatively mild, such as dysesthesia. When GTR cannot be achieved, STR for tumor decompression is recommended.

Keyword

Intramedullary schwannoma; Magnetic resonance imaging; Gross total resection; Subtotal resection; Preoperative diagnosis
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