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Long-term Follow-up with MRI Scans After Enucleation of Peripheral Nerve Schwannomas: Results from a Single-center
F Laura Ten Hove1, Isabeau A Ciggaar1, Emile G Coerkamp1
1Department of Radiology, Haaglanden Medical Centrum, The Hague, The Netherlands.
Background:
Enucleation is a surgical technique to resect peripheral nerve schwannomas. The procedure has a low risk for postoperative deficit, but a small chance for recurrence, because tumor cells may remain inside the pseudocapsule that is left after resection. Magnetic resonance imaging (MRI) scans are frequently performed after surgery to investigate potential residual tumor, but currently there is little information in the literature on the value of follow-up with MRI.
Material And Methods:
All patients who underwent enucleation of a peripheral nerve schwannoma between October 2013 and June 2022 were included. Postoperative MRI scans (gadolinium-enhanced) made at different time points after the surgery were re-examined for residual enhancement. Patients with residual enhancement were contacted to inform whether symptoms had recurred.
Results:
A total of 75 schwannoma enucleations in 74 patients were included. The first postoperative MRI scan, performed 3 months after the surgery, showed no residual enhancement in 50 patients. In the remaining 24 patients, another MRI scan was made 1 year after the surgery, which still showed a possible remnant in 11 patients. On the third MRI scan, performed 2 years after enucleation, there were 7 suspected cases (9%). None of these patients had clinical symptoms at a mean postoperative follow-up of 5 years.
Conclusions:
Our data show that the value of postoperative MRI scans after enucleation of peripheral nerve schwannomas is limited, because residual enhancement in the beginning can be non-specific and the small percentage of patients, that persistently had a potential remnant, were all asymptomatic.
Insights
Postoperative MRI scans after peripheral nerve schwannoma enucleation have limited value. Most residual enhancements are non-specific, and asymptomatic patients with potential remnants do not require intervention.
Area of Science:
- Neurosurgery
- Oncology
- Radiology
Background:
- Enucleation is a surgical method for peripheral nerve schwannomas.
- Postoperative deficits are rare, but tumor recurrence is possible due to residual cells.
- The utility of follow-up Magnetic Resonance Imaging (MRI) for detecting residual tumors remains unclear.
Purpose of the Study:
- To evaluate the diagnostic value of postoperative MRI scans in detecting residual peripheral nerve schwannomas after enucleation.
- To assess the clinical significance of residual tumor enhancement on MRI scans.
Main Methods:
- Retrospective analysis of 75 enucleations for peripheral nerve schwannoma (2013-2022).
- Review of serial gadolinium-enhanced postoperative MRI scans at 3 months, 1 year, and 2 years.
- Correlation of imaging findings with clinical follow-up and patient symptoms.
Main Results:
- No residual enhancement was observed in 50 patients on the initial 3-month postoperative MRI.
- Possible remnants were detected in 11 patients at 1 year and 7 patients (9%) at 2 years.
- None of the patients with suspected residual tumor enhancement exhibited clinical symptoms at a 5-year follow-up.
Conclusions:
- Postoperative MRI has limited value in assessing residual peripheral nerve schwannomas after enucleation.
- Early residual enhancement is often non-specific.
- Asymptomatic patients with persistent imaging remnants do not necessitate further intervention.
