gms | German Medical Science

Objective: Spinal neurinomas are relatively rare benign neoplastic lesions that occur with an incidence of approx. 0.5/100, 000 patients (pt) per year. Accordingly, only a few case series exist comprising of small case numbers.

Method: All pt treated surgically upon spinal neurinomas between 04/2006 and 09/2012 in our clinic were evaluated. This consecutive retrospective series includes 61 pt. The clinical status before and after surgery was evaluated. Diagnostic imaging using MRI was performed preoperatively and 3 months after surgery, respectively, as well as every year in follow-up (FU). The median FU was 11 months (range 2-60 months) and is available for 36 Pt. (59%).

Results: The median age was 53 yrs. There were 36 male (59%) and 25 (41%) female pt. The tumor location was: cervical/cervikothoracic n= 8 (13%), thoracic/thoracolumbar n= 26 (43%), lumbar/lumbosacral n= 27 (44%). Forty-five neurinomas (74%) were located within the spinal canal, 13 (21%) were intraforaminal, 3 (5%) were extraspinal paravertebral tumors. All 61 neurinomas were WHO grade I tumors. In 60 (98%) of cases gross total resection (GTR) was achieved. In 1 (2%) Pt. a subtotal resection was performed. Surgical approaches were: hemilaminectomy n= 40 (66%), interlaminar fenestration n= 7 (13%), laminectomy n= 6 (10%), thoracotomy n= 3 (5%), laminoplasty n= 1 (2%), costotransversectomy n = 1 (2%), anterior corpectomy n= 1 (2%). By discharge 29 pt. (48%) improved from preop. symptoms, 29pt. (48%) were neurologically unchanged, 3 pt. (5%) exhibited a postop. deterioration. In FU, neurological improvement was observed in 43 cases (70%), unchanged symptoms in 18 pt. (30%), no new permanent deficits were observed in our series. Surgical complications were: postop. hemorrhage n= 2, CSF fistula n= 2, wound healing disorder n= 3. In FU, 1 local recurrence (2%) was observed in a pt who underwent a GTR 42 months before. The recurrence was resected again without complications.

Conclusions: Spinal neurinomas are benign lesions with a low recurrence rate after GTR. Surgical therapy is associated with a very low risk of a new permanent deficit (0% in our series), whereas the probability of postoperative improvement of symptoms is very high (70% in our series). Hence, the GTR is recommended as the gold standard for the treatment of spinal neurinomas.