Neurological outcomes and surgical complications in 221 spinal nerve sheath tumors

Michael M. Safaee, Russ Lyon, Nicholas Barbaro, Dean Chou, Praveen V. Mummaneni, Philip R. Weinstein, Cynthia T. Chin, Tarik Tihan, Christopher P. Ames

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

OBJECTIVE Among all primary spinal neoplasms, approximately two-thirds are intradural extramedullary lesions; nerve sheath tumors, mainly neurofibromas and schwannomas, comprise approximately half of them. Given the rarity of these lesions, reports of surgical complications are limited. The aim of this study was to identify the rates of new or worsening neurological deficits and surgical complications associated with the resection of spinal nerve sheath tumors and the potential factors related to these outcomes. METHODS Patients were identified through a search of an institutional neuropathology database and a separate review of current procedural terminology (CPT) codes. Age, sex, clinical presentation, presence of neurofibromatosis (NF), tumor type, tumor location, extent of resection characterized as gross total or subtotal, use of intraoperative neuromonitoring, surgical complications, presence of neurological deficit, and clinical follow-up were recorded. RESULTS Two hundred twenty-one tumors in 199 patients with a mean age of 45 years were identified. Fifty-three tumors were neurofibromas; 163, schwannomas; and 5, malignant peripheral nerve sheath tumors (MPNSTs). There were 70 complications in 221 cases, a rate of 32%, which included 34 new or worsening sensory symptoms (15%), 12 new or worsening motor deficits (5%), 10 CSF leaks or pseudomeningoceles (4%), 11 wound infections (5%), 5 cases of spinal deformity (2%), and 6 others (2 spinal epidural hematomas, 1 nonoperative cranial subdural hematoma, 1 deep venous thrombosis, 1 case of urinary retention, and 1 recurrent laryngeal nerve injury). Complications were more common in cervical (36%) and lumbosacral (38%) tumors than in thoracic (18%) lesions (p = 0.021). Intradural and dumbbell lesions were associated with higher rates of CSF leakage, pseudomeningocele, and wound infection. Complications were present in 18 neurofibromas (34%), 50 schwannomas (31%), and 2 MPNSTs (40%); the differences in frequency were not significant (p = 0.834). Higher complication rates were observed in patients with NF than in patients without (38% vs 30%, p = 0.189), although rates were higher in NF Type 2 than in Type 1 (64% vs 31%). There was no difference in the use of intraoperative neuromonitoring when comparing cases with surgical complications and those without (67% vs 69%, p = 0.797). However, the use of neuromonitoring was associated with a significantly higher rate of gross-total resection (79% vs 66%, p = 0.022). CONCLUSIONS Resection is a safe and effective treatment for spinal nerve sheath tumors. Approximately 30% of patients developed a postoperative complication, most commonly new or worsening sensory deficits. This rate probably represents an inevitable complication of nerve sheath tumor surgery given the intimacy of these lesions with functional neural elements.

Original languageEnglish (US)
Pages (from-to)103-111
Number of pages9
JournalJournal of neurosurgery. Spine
Volume26
Issue number1
DOIs
StatePublished - Jan 1 2017

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Nerve Sheath Neoplasms
Spinal Nerves
Neurilemmoma
Neurofibroma
Neurofibromatoses
Wound Infection
Neoplasms
Spinal Neoplasms
Intracranial Subdural Hematoma
Recurrent Laryngeal Nerve Injuries
Spinal Epidural Hematoma
Current Procedural Terminology
Neurofibromatosis 2
Urinary Retention
Venous Thrombosis
Thorax
Databases

Keywords

  • DVT = deep venous thrombosis
  • EMG = electromyography
  • GTR = gross-total resection
  • MEP = motor evoked potential
  • MPNST = malignant PNST
  • nerve sheath tumor
  • neurofibroma
  • NF1, NF2 = neurofibromatosis Type 1, Type 2
  • oncology
  • PNST = peripheral nerve sheath tumor
  • schwannoma
  • spine
  • SSEP = somatosensory evoked potential
  • STR = subtotal resection

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Safaee, M. M., Lyon, R., Barbaro, N., Chou, D., Mummaneni, P. V., Weinstein, P. R., ... Ames, C. P. (2017). Neurological outcomes and surgical complications in 221 spinal nerve sheath tumors. Journal of neurosurgery. Spine, 26(1), 103-111. https://doi.org/10.3171/2016.5.SPINE15974

Neurological outcomes and surgical complications in 221 spinal nerve sheath tumors. / Safaee, Michael M.; Lyon, Russ; Barbaro, Nicholas; Chou, Dean; Mummaneni, Praveen V.; Weinstein, Philip R.; Chin, Cynthia T.; Tihan, Tarik; Ames, Christopher P.

In: Journal of neurosurgery. Spine, Vol. 26, No. 1, 01.01.2017, p. 103-111.

Research output: Contribution to journalArticle

Safaee, MM, Lyon, R, Barbaro, N, Chou, D, Mummaneni, PV, Weinstein, PR, Chin, CT, Tihan, T & Ames, CP 2017, 'Neurological outcomes and surgical complications in 221 spinal nerve sheath tumors', Journal of neurosurgery. Spine, vol. 26, no. 1, pp. 103-111. https://doi.org/10.3171/2016.5.SPINE15974
Safaee MM, Lyon R, Barbaro N, Chou D, Mummaneni PV, Weinstein PR et al. Neurological outcomes and surgical complications in 221 spinal nerve sheath tumors. Journal of neurosurgery. Spine. 2017 Jan 1;26(1):103-111. https://doi.org/10.3171/2016.5.SPINE15974
Safaee, Michael M. ; Lyon, Russ ; Barbaro, Nicholas ; Chou, Dean ; Mummaneni, Praveen V. ; Weinstein, Philip R. ; Chin, Cynthia T. ; Tihan, Tarik ; Ames, Christopher P. / Neurological outcomes and surgical complications in 221 spinal nerve sheath tumors. In: Journal of neurosurgery. Spine. 2017 ; Vol. 26, No. 1. pp. 103-111.
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abstract = "OBJECTIVE Among all primary spinal neoplasms, approximately two-thirds are intradural extramedullary lesions; nerve sheath tumors, mainly neurofibromas and schwannomas, comprise approximately half of them. Given the rarity of these lesions, reports of surgical complications are limited. The aim of this study was to identify the rates of new or worsening neurological deficits and surgical complications associated with the resection of spinal nerve sheath tumors and the potential factors related to these outcomes. METHODS Patients were identified through a search of an institutional neuropathology database and a separate review of current procedural terminology (CPT) codes. Age, sex, clinical presentation, presence of neurofibromatosis (NF), tumor type, tumor location, extent of resection characterized as gross total or subtotal, use of intraoperative neuromonitoring, surgical complications, presence of neurological deficit, and clinical follow-up were recorded. RESULTS Two hundred twenty-one tumors in 199 patients with a mean age of 45 years were identified. Fifty-three tumors were neurofibromas; 163, schwannomas; and 5, malignant peripheral nerve sheath tumors (MPNSTs). There were 70 complications in 221 cases, a rate of 32{\%}, which included 34 new or worsening sensory symptoms (15{\%}), 12 new or worsening motor deficits (5{\%}), 10 CSF leaks or pseudomeningoceles (4{\%}), 11 wound infections (5{\%}), 5 cases of spinal deformity (2{\%}), and 6 others (2 spinal epidural hematomas, 1 nonoperative cranial subdural hematoma, 1 deep venous thrombosis, 1 case of urinary retention, and 1 recurrent laryngeal nerve injury). Complications were more common in cervical (36{\%}) and lumbosacral (38{\%}) tumors than in thoracic (18{\%}) lesions (p = 0.021). Intradural and dumbbell lesions were associated with higher rates of CSF leakage, pseudomeningocele, and wound infection. Complications were present in 18 neurofibromas (34{\%}), 50 schwannomas (31{\%}), and 2 MPNSTs (40{\%}); the differences in frequency were not significant (p = 0.834). Higher complication rates were observed in patients with NF than in patients without (38{\%} vs 30{\%}, p = 0.189), although rates were higher in NF Type 2 than in Type 1 (64{\%} vs 31{\%}). There was no difference in the use of intraoperative neuromonitoring when comparing cases with surgical complications and those without (67{\%} vs 69{\%}, p = 0.797). However, the use of neuromonitoring was associated with a significantly higher rate of gross-total resection (79{\%} vs 66{\%}, p = 0.022). CONCLUSIONS Resection is a safe and effective treatment for spinal nerve sheath tumors. Approximately 30{\%} of patients developed a postoperative complication, most commonly new or worsening sensory deficits. This rate probably represents an inevitable complication of nerve sheath tumor surgery given the intimacy of these lesions with functional neural elements.",
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T1 - Neurological outcomes and surgical complications in 221 spinal nerve sheath tumors

AU - Safaee, Michael M.

AU - Lyon, Russ

AU - Barbaro, Nicholas

AU - Chou, Dean

AU - Mummaneni, Praveen V.

AU - Weinstein, Philip R.

AU - Chin, Cynthia T.

AU - Tihan, Tarik

AU - Ames, Christopher P.

PY - 2017/1/1

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N2 - OBJECTIVE Among all primary spinal neoplasms, approximately two-thirds are intradural extramedullary lesions; nerve sheath tumors, mainly neurofibromas and schwannomas, comprise approximately half of them. Given the rarity of these lesions, reports of surgical complications are limited. The aim of this study was to identify the rates of new or worsening neurological deficits and surgical complications associated with the resection of spinal nerve sheath tumors and the potential factors related to these outcomes. METHODS Patients were identified through a search of an institutional neuropathology database and a separate review of current procedural terminology (CPT) codes. Age, sex, clinical presentation, presence of neurofibromatosis (NF), tumor type, tumor location, extent of resection characterized as gross total or subtotal, use of intraoperative neuromonitoring, surgical complications, presence of neurological deficit, and clinical follow-up were recorded. RESULTS Two hundred twenty-one tumors in 199 patients with a mean age of 45 years were identified. Fifty-three tumors were neurofibromas; 163, schwannomas; and 5, malignant peripheral nerve sheath tumors (MPNSTs). There were 70 complications in 221 cases, a rate of 32%, which included 34 new or worsening sensory symptoms (15%), 12 new or worsening motor deficits (5%), 10 CSF leaks or pseudomeningoceles (4%), 11 wound infections (5%), 5 cases of spinal deformity (2%), and 6 others (2 spinal epidural hematomas, 1 nonoperative cranial subdural hematoma, 1 deep venous thrombosis, 1 case of urinary retention, and 1 recurrent laryngeal nerve injury). Complications were more common in cervical (36%) and lumbosacral (38%) tumors than in thoracic (18%) lesions (p = 0.021). Intradural and dumbbell lesions were associated with higher rates of CSF leakage, pseudomeningocele, and wound infection. Complications were present in 18 neurofibromas (34%), 50 schwannomas (31%), and 2 MPNSTs (40%); the differences in frequency were not significant (p = 0.834). Higher complication rates were observed in patients with NF than in patients without (38% vs 30%, p = 0.189), although rates were higher in NF Type 2 than in Type 1 (64% vs 31%). There was no difference in the use of intraoperative neuromonitoring when comparing cases with surgical complications and those without (67% vs 69%, p = 0.797). However, the use of neuromonitoring was associated with a significantly higher rate of gross-total resection (79% vs 66%, p = 0.022). CONCLUSIONS Resection is a safe and effective treatment for spinal nerve sheath tumors. Approximately 30% of patients developed a postoperative complication, most commonly new or worsening sensory deficits. This rate probably represents an inevitable complication of nerve sheath tumor surgery given the intimacy of these lesions with functional neural elements.

AB - OBJECTIVE Among all primary spinal neoplasms, approximately two-thirds are intradural extramedullary lesions; nerve sheath tumors, mainly neurofibromas and schwannomas, comprise approximately half of them. Given the rarity of these lesions, reports of surgical complications are limited. The aim of this study was to identify the rates of new or worsening neurological deficits and surgical complications associated with the resection of spinal nerve sheath tumors and the potential factors related to these outcomes. METHODS Patients were identified through a search of an institutional neuropathology database and a separate review of current procedural terminology (CPT) codes. Age, sex, clinical presentation, presence of neurofibromatosis (NF), tumor type, tumor location, extent of resection characterized as gross total or subtotal, use of intraoperative neuromonitoring, surgical complications, presence of neurological deficit, and clinical follow-up were recorded. RESULTS Two hundred twenty-one tumors in 199 patients with a mean age of 45 years were identified. Fifty-three tumors were neurofibromas; 163, schwannomas; and 5, malignant peripheral nerve sheath tumors (MPNSTs). There were 70 complications in 221 cases, a rate of 32%, which included 34 new or worsening sensory symptoms (15%), 12 new or worsening motor deficits (5%), 10 CSF leaks or pseudomeningoceles (4%), 11 wound infections (5%), 5 cases of spinal deformity (2%), and 6 others (2 spinal epidural hematomas, 1 nonoperative cranial subdural hematoma, 1 deep venous thrombosis, 1 case of urinary retention, and 1 recurrent laryngeal nerve injury). Complications were more common in cervical (36%) and lumbosacral (38%) tumors than in thoracic (18%) lesions (p = 0.021). Intradural and dumbbell lesions were associated with higher rates of CSF leakage, pseudomeningocele, and wound infection. Complications were present in 18 neurofibromas (34%), 50 schwannomas (31%), and 2 MPNSTs (40%); the differences in frequency were not significant (p = 0.834). Higher complication rates were observed in patients with NF than in patients without (38% vs 30%, p = 0.189), although rates were higher in NF Type 2 than in Type 1 (64% vs 31%). There was no difference in the use of intraoperative neuromonitoring when comparing cases with surgical complications and those without (67% vs 69%, p = 0.797). However, the use of neuromonitoring was associated with a significantly higher rate of gross-total resection (79% vs 66%, p = 0.022). CONCLUSIONS Resection is a safe and effective treatment for spinal nerve sheath tumors. Approximately 30% of patients developed a postoperative complication, most commonly new or worsening sensory deficits. This rate probably represents an inevitable complication of nerve sheath tumor surgery given the intimacy of these lesions with functional neural elements.

KW - DVT = deep venous thrombosis

KW - EMG = electromyography

KW - GTR = gross-total resection

KW - MEP = motor evoked potential

KW - MPNST = malignant PNST

KW - nerve sheath tumor

KW - neurofibroma

KW - NF1, NF2 = neurofibromatosis Type 1, Type 2

KW - oncology

KW - PNST = peripheral nerve sheath tumor

KW - schwannoma

KW - spine

KW - SSEP = somatosensory evoked potential

KW - STR = subtotal resection

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