Neurological Surgery No Shinkei Geka Volume 46, Issue 1 (January 2018)

Surgical Technique for Lumbar Spinal Extraforaminal Schwannoma Kiminori SAKURAI 1,2 , Shunji ASAMOTO 1,2 , Satoshi NAKAMURA 2 , Shinichi ISHIHARA 2 , Masayuki ISHIKAWA 2 , Makoto NISHIYAMA 2 , Kazuhiro SAMURA 1 , Fumitaka YOSHIOKA 1 , Masatou KAWASHIMA 1 , Yasuyuki FUKUI 2 1Department of Neurosurgery, International University of Health and Welfare, School of Medicine, Mita Hospital 2Spine and Spinal Cord Center, International University of Health and Welfare, School of Medicine, Mita Hospital Keyword: extraforaminal schwannoma , Wiltse paraspinal approach pp.5-9
Published Date 2018/1/10
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 INTRODUCTION:Spinal neurinomas are frequently observed in the cauda equina, particularly within the dura mater. However, extraforaminal schwannomas(EFS), which are neither intradural nor dumbbell type, are relatively rare;hence, different surgical procedures have been employed. Here, we report 12 cases of lumbar EFS with total resection that were safely performed.

 METHODS and SUBJECTS:This study was comprised of 12 patients with lumbar EFS(excluding those with neurofibromas)who were previously treated at our hospital. Using the Wiltse paraspinal approach, we inserted the microscope until it reached the tumor surface. After confirming the tumor surface, we inserted a scalpel to make an incision in a portion of the outer capsule. Then, we confirmed that the surfaces of the outer capsule and the tumor within the capsule could be dissected. Next, a thread was attached to the outer capsule and pulled upwards so that there was enough space to perform the required procedures within the capsule. Using a CUSA®, we removed the intracapsular tumor. After its removal, the outer capsule was treated carefully to ensure that the origin nerve was not damaged.

 RESULTS:In all cases, we successfully performed a total removal of the intracapsular tumor;in the mean postoperative observation period of 8 years, no recurrence was observed. Although temporary paralysis was observed in three patients, this improved over time.

 CONCLUSION:We report our experience with a surgical technique that ensured the safe removal of lumbar EFS. Satisfactory results were achieved, with no recurrences observed during the mean 8-year postoperative observation period.

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Neurological Surgery 脳神経外科
46巻1号 (2018年1月)
電子版ISSN 1882-1251 印刷版ISSN 0301-2603 医学書院