Surgical outcomes and factors related to postoperative motor and sensory deficits in resection for 244 cases of spinal schwannoma. (November 2020)

• Record Type: Journal Article
• Authors: Ando, Kei; Kobayashi, Kazuyoshi; Nakashima, Hiroaki; Machino, Masaaki; Ito, Sadayuki; Kanbara, Shunsuke; Inoue, Taro; Segi, Naoki; Koshimizu, Hiroyuki; Imagama, Shiro
• Is Part Of: Journal of clinical neuroscience. Volume 81(2020)
• Page Start: 6
• Page End: 11
• Publication Date: 2020-11
• Subjects: Spinal schwannoma -- Surgical outcomes -- Risk factors for postoperative motor and sensory deficits -- Transcranial motor-evoked potential -- Preoperative motor weakness -- Preoperative gait disturbance -- Dumbbell Eden type II -- Subtotal resection -- Operative time; Brain -- Surgery -- Periodicals; Neurosciences -- Periodicals; Nervous system -- Surgery -- Periodicals; Brain -- surgery -- Periodicals; Neurosurgical Procedures -- Periodicals; Neurosciences -- Periodicals; Electronic journals; 616.8
• DOI: 10.1016/j.jocn.2020.09.025
• Languages: English
• ISSNs: 0967-5868

Abstract

Highlights: In 244 patients treated surgically for spinal schwannoma, postoperative motor deterioration occurred at a rate of 13.1%. The associated risk factors were motor weakness, gait disturbance, dumbbell type, STR, and operative time. The rate of postoperative sensory deficit was 20.5%, and the risk factors for this event were preoperative gait disturbance and subtotal resection. TcMEP monitoring was unable to detect roots vulnerable to injury during surgery, but its use is still valuable. Abstract: In a large cohort the clinical presentation, management and outcomes of spinal schwannoma and factors related to postoperative motor and sensory deficits were invesgtigated. In 244 patients (males: 126, females: 118, average age 51.8 y) at one center, significant factors related to postoperative motor and sensory deficits were identified. Tumors were in the cervical (n = 79, 32.4%), lumbar (n = 66), thoracolumbar (T11-L1) (n = 55), and thoracic (n = 39) regions, and 5 patients had sacrum tumors. The rates of postoperative motor and sensory deterioration were 13.1% and 20.5%, respectively. The risk factors for motor deterioration were preoperative motor weakness, preoperative gait disturbance, dumbbell Eden type II, subtotal resection, and operative time, and those for postoperative sensory deficit were preoperative gait disturbance and subtotal resection. Of 12 patients with significant TcMEP changes, 11 had a new motor deficit after surgery; and of 216 patients with stable TcMEP data, 196 were neurologically intact after surgery (true negative) and 20 (11.0%) had deficits in the immediate postoperative stage (false negative). These deficits resolved during hospitalization for most patients. Of 15 patients with TcMEP deterioration and recovery, 11 (93.3%) had no motor deficits after surgery (p < 0.01).