Surgical treatment strategies for intraspinal and extraspinal communicating schwannomas

Zhang Fengjiang; Ding Daling; Yu Bin; Li En; Chen Yu; Qiu Kai

doi:10.11850/j.issn.1009-122X.2023.12.008

Abstract：Objective To investigate the clinical characteristics and surgical treatment strategies for intraspinal and extraspinal communicating schwannomas.Methods A retrospective analysis was conducted on the clinical data of 56 patients with intraspinal and extraspinal communicating schwannomas who underwent microsurgical resection.The surgical approach was selected based on the characteristics of tumor growth.A total of 29 patients underwent posterior midline laminectomy,11 patients underwent lateral cervical approach,2 patients underwent combined anterior-posterior approach,6 patients underwent hemilaminectomy,and 8 patients underwent intermuscular ligamentous space approach.Results Total tumor resection was achieved in 53 cases,and partial resection in 3 cases,including 1 case of subtotal resection due to tumor wrapping around the ipsilateral vertebral artery in the combined anterior-posterior approach.Internal fixation procedures such as lateral mass screw implantation and subtotal vertebrectomy were performed in 8 patients after tumor resection.Postoperative pathological examinations confirmed schwannomas in all cases.Postoperative neurological symptoms improved to varying degrees.Complications occurred in 3 cases.All patients were followed up for 5 to 66 months,with 1 case of tumor recurrence,no worsening of motor dysfunction,and no secondary spinal deformities.Conclusions Individualized surgical approaches should be developed based on the characteristics of intraspinal and extraspinal communicating schwannomas.Accurate preoperative and intraoperative assessment of spinal stability,combined with microsurgical techniques,should aim for complete tumor resection whenever possible.Rational selection of spinal internal fixation can reduce the incidence of postoperative spinal deformities.