Differences between Cervical Schwannomas of the Anterior and Posterior Nerve Roots in Relation to the Incidence of Postoperative Radicular Dysfunction

Yu-Ichiro Ohnishi, Koichi Iwatsuki, Toshika Ohkawa, Koshi Ninomiya, Takashi Moriwaki, Toshiki Yoshimine, Yu-Ichiro Ohnishi, Koichi Iwatsuki, Toshika Ohkawa, Koshi Ninomiya, Takashi Moriwaki, Toshiki Yoshimine

Abstract

Study design: A retrospective study.

Purpose: To assess the case files of patients who underwent surgery for cervical dumbbell schwannoma for determining the differences between schwannomas of the anterior and posterior nerve roots with respect to the incidence of postoperative radicular dysfunction.

Overview of literature: The spinal roots giving origin to schwannoma are frequently nonfunctional, but there is a risk of postoperative neurological deficit once these roots are resected during surgery.

Methods: Fifteen patients with cervical dumbbell schwannomas were treated surgically. Ten men and 5 women, who were 35-79 years old (mean age, 61.5 years), presented with neck pain (n=6), radiculopathy (n=10), and myelopathy (n=11).

Results: Fourteen patients underwent gross total resection and exhibited no recurrence. Follow-ups were performed for a period of 6-66 months (mean, 28 months). Preoperative symptoms resolved in 11 patients (73.3%) but they persisted partially in 4 patients (26.7%). Six patients had tumors of anterior nerve root origin, and 9 patients had tumors of posterior nerve root origin. Two patients who underwent total resection of anterior nerve root tumors (33.3%) displayed minor postoperative motor weakness. One patient who underwent total resection of a posterior nerve root tumor (11.1%) showed postoperative numbness.

Conclusions: Appropriate tumor removal improved the neurological symptoms. In this study, the incidence of radicular dysfunction was higher in patients who underwent resection of anterior nerve root tumors than in patients who underwent resection of posterior nerve root tumors.

Keywords: Cervical; Dumbbell; Nerve root; Radicular dysfunction; Schwannoma.

Conflict of interest statement

Conflict of Interest: No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1. Contrast-enhanced axial (A) and coronal…
Fig. 1. Contrast-enhanced axial (A) and coronal (B) magnetic resonance (MR) images of patient no. 7 show a C5-C6 dumbbell tumor. The VA is displaced anteromedially. Postoperative contrast-enhanced axial (C) and coronal (D) MR images show complete tumor removal. Postoperative lateral roentgenogram (E) shows lateral mass screw placement. VA, vertebral arteries.
Fig. 2. Contrast-enhanced axial (A, B) and…
Fig. 2. Contrast-enhanced axial (A, B) and coronal (C) magnetic resonance (MR) images of patient no. 11 show a C3 dumbbell tumor. The VA is displaced anteromedially (yellow arrowhead). Contact of the tumor with the internal carotid artery can be seen (as indicated by the red arrow). Postoperative contrast-enhanced axial (D) and coronal (E) MR images show complete tumor removal. Postoperative lateral roentgenogram (F) shows anterior fixation of the iliac bone with a plate. VA, vertebral arteries.
Fig. 3. Contrast-enhanced axial (A, B) and…
Fig. 3. Contrast-enhanced axial (A, B) and coronal (C) magnetic resonance (MR) images of patient no. 13 show a C2 dumbbell tumor. Postoperative T1WI axial (D, E) and coronal (F) MR images show complete tumor removal.

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Source: PubMed

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