Treatment of large thoracic and lumbar paraspinal schwannoma

Paraspinal neurogenic tumors usually expand into the mediastinum and retroperitoneum and can reach a considerable size before they become symptomatic. Such large tumors are rare. We describe 14 cases of large schwannomas (>2.5 cm ø) with mild and late onset of symptoms, which were treated with total surgical resection through a single-approach surgery.

In 2013 14 patients with paraspinal large schwannomas were treated in our institutions. Data were analyzed retrospectively. Magnetic resonance imaging (MRI) showed lesions suspicious for a paraspinal schwannoma with partial intraforaminal growth. In case of ambiguity regarding tumor dignity, a needle biopsy was performed before final treatment. Three different approaches and their indications were discussed.

Fourteen patients (7 female and 7 male, ages 18-58 years, mean: 39.8 years) requiring surgical exploration because of a thoracic (6) or lumbar/lumbosacral (8) lesion were treated in our institutions. Two patients received CT-guided needle biopsy preoperatively. Complete resection of the schwannoma was possible through a mini-thoracotomy in 1 case (7 %), a retroperitoneal approach in 2 cases (14 %), and dorsal interlaminar and intercostal fenestration in 11 cases (79 %). Histological examination revealed the diagnosis of schwannoma (WHO grade I) in all cases except one with neurofibroma (WHO grade I). There were no major complications in any case.

Large benign schwannomas are rare. They need a tailored treatment, which in most cases works through one surgical approach. Usually it is possible to perform a complete resection with a good postoperative prognosis.