The Clinical Significance of Tumor Location in Surgical Management of Non-syndromic Spinal Schwannomas

Introduction: Spinal schwannomas are common benign tumors that can cause neurological deficits. The gold treatment is complete surgical resection. We aim to investigate the differences in the surgical variables and clinical outcomes by the tumor location.

Methods: We reviewed the medical records of patients who underwent surgical resection for non-syndromic spinal schwannomas at Johns Hopkins Medical Institutes from 2009 to 2023. The patients were categorized into two groups by tumor location: those with schwannomas at the Functional Nerve Roots of C5-T1 or L2-S1 (FNRT group), while the other group includes the patients with schwannomas at other spinal levels (Non-FNRT group).

Results: A total of 123 patients were included [Mean (SD) age, 51.87 (16.96); 50.4% women]. The FNRT group includes 60 (48.8%) patients. The presenting symptoms were pain (89.4%), sensory deficits (47.2%), and weakness (37.3%), with no significant differences between FNRT and non-FNRT groups. Most patients (85.4%) underwent gross total resection (GTR), with a lower GTR rate in the FNRT group (76.7%) compared to non-FNRT cases (93.4%) (p=0.016). The average blood loss during operation, surgery duration, and hospital stay length were higher in the FNRT group than in the non-FNRT group (p < 0.001). Postoperatively, the mean follow-up was 39.74 (171.65) months, with a longer duration among FNRT cases than non-FNRT (52.63 (244.40) vs. 27.69 (36.90), p=0.013). Pain relief was reported in 78 patients, with higher rate in the FNRT group (65.7%) than non-FNRT (59.0%) (p < 0.001). The recovery rates from motor and sensory deficits were 67.1% and 44.1%, respectively, with higher rates among the non-FNRT patients than FNRT patients. Tumor recurrence occurred in 16 (13.0%) patients, with no significant difference between the study groups.

Conclusion : Spinal schwannomas are surgically curable with favorable outcomes and acceptable risks. The tumor location is essential in terms of resection extent, estimated blood loss, surgery duration, hospital stay length, and clinical outcomes.