title: Factors predicting clinical impairment after surgery for cervical spinal schwannoma.
abstract: Cervical spinal schwannoma is benign, and outcomes after surgical resection are generally excellent. A surgical dilemma sometimes arises as to whether to perform total tumor removal, which carries a risk of sacrificing the nerve root, or subtotal removal, where the risk can be tumor recurrence. The purpose of this study was to identify factors with the potential to predict clinical impairment after surgery for cervical spinal schwannomas. Thirty cases of cervical schwannomas treated surgically in our institute were retrospectively reviewed;initial symptoms, tumor location, Eden classification, surgical method, functional outcome, and tumor recurrence were investigated. All permanent motor deficits were the result of resecting functionally relevant nerve roots (i.e., C5-8). The rate of permanent sensory deficit was 11% after C1-4 nerve root resection, and 67% after C5-8 nerve root resection. Permanent neurological deficits occurred in 14% of patients younger than 40 years and 38% of those older than 40. Dumbbell tumors were associated with the need for total or ventral nerve root transection, as well as with a high incidence of tumor recurrence. The incidence of permanent neurological deficit was significantly higher in patients undergoing C5-8 nerve root resection, and tended to be higher in those over 40.
authors.affiliation: Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan.kentaro0311@do7.enjoy.ne.jp.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Yamane
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Takigawa
authors.forename: Masato
authors.initials: M
authors.lastname: Tanaka
authors.forename: Syuhei
authors.initials: S
authors.lastname: Osaki
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Sugimoto
authors.forename: Toshifumi
authors.initials: T
authors.lastname: Ozaki
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002574:Cervical Vertebrae / Q000294:innervation*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D009369:Neoplasms / Q000601:surgery*; D009422:Nervous System Diseases / Q000453:epidemiology; D009442:Neurilemmoma / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D013125:Spinal Neoplasms / Q000601:surgery*; D013126:Spinal Nerve Roots / Q000601:surgery; D055815:Young Adult