Surgical strategies for managing foraminal nerve sheath tumors: the emerging role of CyberKnife ablation.
Sixteen Stanford University Medical Center (SUMC) patients with foraminal nerve sheath tumors had charts reviewed. CyberKnife radiosurgery was innovative in management. Parameters were evaluated for 16 foraminal nerve sheath tumors undergoing surgery, some with CyberKnife. Three neurofibromas had associated neurofibromatosis type 1 (NF1). Eleven patients had one resection; others had CyberKnife after one (two) and two (three) operations. The malignant peripheral nerve sheath tumor (MPNST) had prior field-radiation and adds another case. Approaches included laminotomy and laminectomies with partial (three) or total (two) facetectomies/fusions. Two cases each had supraclavicular, lateral extracavitary, retroperitoneal and Wiltze and costotransversectomy/thoracotomy procedures. Two underwent a laminectomy/partial facetectomy, then CyberKnife. Pre-CyberKnife, one of two others had a laminectomy/partial facetectomy, then total facetectomy/fusion and the other, two supraclavicular approaches. The MPNST had a hemi-laminotomy then laminectomy/total facetectomy/fusion, followed by CyberKnife. Roots were preserved, except in two. Of 11 single-operation-peripheral nerve sheath tumors, the asymptomatic case remained stable, nine (92%) improved and one (9%) worsened. Examinations remained intact in three (27%) and improved in seven (64%). Two having a single operation then CyberKnife had improvement after both. Of two undergoing two operations, one had symptom resolution post-operatively, worsened 4 years post-CyberKnife then has remained unchanged after re-operation. The other such patient improved post-operatively, had no change after re-operation and improved post-CyberKnife. The MPNST had presentation improvement after the first operation, worsened and after the second surgery \and CyberKnife, the patient expired from tumor spread. In conclusion, surgery is beneficial for pain relief and function preservation in foraminal nerve sheath tumors. Open surgery with CyberKnife is an innovation in these tumors' management.
Department of Neurosurgery, Stanford University Medical Center, Stanford, CA, USA. murovic@stanford.edu
Judith A
JA
Murovic
S
S
Charles Cho
Jon
J
Park
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004388:Dura Mater / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D007796:Laminectomy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D018317:Nerve Sheath Neoplasms / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D011183:Postoperative Complications; D011859:Radiography; D016634:Radiosurgery / Q000295:instrumentation / Q000379:methods*; D011878:Radiotherapy / Q000379:methods; D012189:Retrospective Studies; D013115:Spinal Canal / Q000473:pathology / Q000601:surgery; D013125:Spinal Neoplasms / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D013126:Spinal Nerve Roots / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D013131:Spine / Q000033:anatomy & histology / Q000473:pathology / Q000601:surgery*; D015996:Survival Rate; D013908:Thoracotomy / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult