Subtotal Resection of Cervical Dumbbell Schwannomas: Radiographic Predictors for Surgical Considerations

Area of Science:

• Neurosurgery
• Radiology
• Oncology

Background:

• Cervical dumbbell schwannomas are rare tumors.
• Predicting their surgical resectability preoperatively is challenging.
• Current radiologic predictors for resectability are not well-established.

Purpose of the Study:

• To identify preoperative magnetic resonance imaging (MRI) features that predict the resectability of cervical dumbbell schwannomas.
• To correlate MRI findings with the extent of tumor removal (gross total resection vs. subtotal resection).

Main Methods:

• Retrospective review of 72 patients who underwent surgery for cervical dumbbell schwannomas.
• Analysis of preoperative MRI features: tumor size, level, Eden classification, vertebral artery (VA) involvement, and T2-weighted signal intensity (SI).
• Correlation of MRI findings with surgical outcomes (gross total resection [GTR] vs. subtotal resection [STR]).

Main Results:

• Gross total resection (GTR) was achieved in 51.4% of patients, and subtotal resection (STR) in 48.6%.
• Significant differences between GTR and STR groups were found in maximal tumor size, size of foraminal/extraforaminal portions, tumor level, VA involvement, and T2-weighted SI.
• Multivariate analysis identified high cervical level and encased vertebral artery as significant predictors for GTR.

Conclusions:

• Preoperative MRI features can predict the resectability of cervical dumbbell schwannomas.
• Tumor size, cervical level, and the degree of vertebral artery involvement are key predictive factors.
• These findings can aid in surgical planning and patient counseling.