Sacrifice of Involved Nerve Root during Surgical Resection of Foraminal and/or Dumbbell Spinal Neurinomas
Even if usually needed to achieve the gross total resection (GTR) of spinal benign nerve sheath tumors (NSTs), nerve root sacrifice remains controversial regarding the risk of neurological deficit. For foraminal NSTs, we hypothesize that the involved root is poorly functional and thus can be safely...
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MDPI AG
2023-01-01
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| Series: | Brain Sciences |
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| Online Access: | https://www.mdpi.com/2076-3425/13/1/109 |
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| author | Alberto Vandenbulcke Ginevra Federica D’Onofrio Gabriele Capo Wassim Baassiri Cédric Y. Barrey |
| author_facet | Alberto Vandenbulcke Ginevra Federica D’Onofrio Gabriele Capo Wassim Baassiri Cédric Y. Barrey |
| author_sort | Alberto Vandenbulcke |
| collection | DOAJ |
| description | Even if usually needed to achieve the gross total resection (GTR) of spinal benign nerve sheath tumors (NSTs), nerve root sacrifice remains controversial regarding the risk of neurological deficit. For foraminal NSTs, we hypothesize that the involved root is poorly functional and thus can be safely sacrificed. All spinal benign NSTs with foraminal extension that underwent surgery from 2013 to 2021 were reviewed. The impacts of preoperative clinical status and patient and tumor characteristics on long-term outcomes were analyzed. Twenty-six patients were included, with a mean follow-up (FU) of 22.4 months. Functional motor roots (C5-T1, L3-S1) were involved in 14 cases. The involved nerve root was routinely sacrificed during surgery and GTR was obtained in 84.6% of cases. In the functional root subgroup, for patients with a pre-existing deficit (n = 5/14), neurological aggravation persisted in one case at last FU (n = 1/5), whereas for those with no preop deficit (n = 9/14), a postoperative deficit persisted in one patient only (n = 1/9). Preoperative radicular pain was the only characteristic significantly associated with an immediate postoperative motor deficit (<i>p</i> = 0.03). The sacrifice of an involved nerve root in foraminal NSTs seems to represent a reasonable and relevant option to resect these tumors, permitting one to achieve tumor resection in an oncologic fashion with a high rate of GTR. |
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| institution | Directory Open Access Journal |
| issn | 2076-3425 |
| language | English |
| last_indexed | 2024-03-09T13:22:20Z |
| publishDate | 2023-01-01 |
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| series | Brain Sciences |
| spelling | doaj.art-6a2ac49bc9b1425c97cdf454514b93a62023-11-30T21:27:46ZengMDPI AGBrain Sciences2076-34252023-01-0113110910.3390/brainsci13010109Sacrifice of Involved Nerve Root during Surgical Resection of Foraminal and/or Dumbbell Spinal NeurinomasAlberto Vandenbulcke0Ginevra Federica D’Onofrio1Gabriele Capo2Wassim Baassiri3Cédric Y. Barrey4Department of Spine and Spinal Cord Surgery, Hôpital Pierre Wertheimer, Hospices Civils de Lyon, Claude Bernard University of Lyon 1, 59 Boulevard Pinel, 696777 Lyon-Bron, FranceDepartment of Spine and Spinal Cord Surgery, Hôpital Pierre Wertheimer, Hospices Civils de Lyon, Claude Bernard University of Lyon 1, 59 Boulevard Pinel, 696777 Lyon-Bron, FranceDepartment of Spine and Spinal Cord Surgery, Hôpital Pierre Wertheimer, Hospices Civils de Lyon, Claude Bernard University of Lyon 1, 59 Boulevard Pinel, 696777 Lyon-Bron, FranceDepartment of Spine and Spinal Cord Surgery, Hôpital Pierre Wertheimer, Hospices Civils de Lyon, Claude Bernard University of Lyon 1, 59 Boulevard Pinel, 696777 Lyon-Bron, FranceDepartment of Spine and Spinal Cord Surgery, Hôpital Pierre Wertheimer, Hospices Civils de Lyon, Claude Bernard University of Lyon 1, 59 Boulevard Pinel, 696777 Lyon-Bron, FranceEven if usually needed to achieve the gross total resection (GTR) of spinal benign nerve sheath tumors (NSTs), nerve root sacrifice remains controversial regarding the risk of neurological deficit. For foraminal NSTs, we hypothesize that the involved root is poorly functional and thus can be safely sacrificed. All spinal benign NSTs with foraminal extension that underwent surgery from 2013 to 2021 were reviewed. The impacts of preoperative clinical status and patient and tumor characteristics on long-term outcomes were analyzed. Twenty-six patients were included, with a mean follow-up (FU) of 22.4 months. Functional motor roots (C5-T1, L3-S1) were involved in 14 cases. The involved nerve root was routinely sacrificed during surgery and GTR was obtained in 84.6% of cases. In the functional root subgroup, for patients with a pre-existing deficit (n = 5/14), neurological aggravation persisted in one case at last FU (n = 1/5), whereas for those with no preop deficit (n = 9/14), a postoperative deficit persisted in one patient only (n = 1/9). Preoperative radicular pain was the only characteristic significantly associated with an immediate postoperative motor deficit (<i>p</i> = 0.03). The sacrifice of an involved nerve root in foraminal NSTs seems to represent a reasonable and relevant option to resect these tumors, permitting one to achieve tumor resection in an oncologic fashion with a high rate of GTR.https://www.mdpi.com/2076-3425/13/1/109spinal nerve sheath tumorsforaminal schwannomaspinal cordspinal surgeryintradural lesionnerve root sacrifice |
| spellingShingle | Alberto Vandenbulcke Ginevra Federica D’Onofrio Gabriele Capo Wassim Baassiri Cédric Y. Barrey Sacrifice of Involved Nerve Root during Surgical Resection of Foraminal and/or Dumbbell Spinal Neurinomas Brain Sciences spinal nerve sheath tumors foraminal schwannoma spinal cord spinal surgery intradural lesion nerve root sacrifice |
| title | Sacrifice of Involved Nerve Root during Surgical Resection of Foraminal and/or Dumbbell Spinal Neurinomas |
| title_full | Sacrifice of Involved Nerve Root during Surgical Resection of Foraminal and/or Dumbbell Spinal Neurinomas |
| title_fullStr | Sacrifice of Involved Nerve Root during Surgical Resection of Foraminal and/or Dumbbell Spinal Neurinomas |
| title_full_unstemmed | Sacrifice of Involved Nerve Root during Surgical Resection of Foraminal and/or Dumbbell Spinal Neurinomas |
| title_short | Sacrifice of Involved Nerve Root during Surgical Resection of Foraminal and/or Dumbbell Spinal Neurinomas |
| title_sort | sacrifice of involved nerve root during surgical resection of foraminal and or dumbbell spinal neurinomas |
| topic | spinal nerve sheath tumors foraminal schwannoma spinal cord spinal surgery intradural lesion nerve root sacrifice |
| url | https://www.mdpi.com/2076-3425/13/1/109 |
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