Spinal schwannoma

Definition

Spinal schwannomas are well-described slow growing benign spinal tumors of the peripheral nervous system, arising from Schwann cells.

Epidemiology

see Spinal schwannoma epidemiology.

Classification

see Spinal Schwannoma Classification.

Associations

The vast majority of spinal schwannomas are solitary and sporadic (95%) 10.

However, there is an association with neurofibromatosis type 2 (NF2). In patients with NF2, almost all spinal nerve root tumors are schwannomas or mixed tumors. In a young adult without the NF2 mutation, the finding of multiple schwannomas may meet the criteria for schwannomatosis.

Pathology

Antoni A and Antoni B tissue.

Clinical features

Patients with non-syndromic spinal schwannoma usually present to hospital with local pain and neurological deficit that exacerbate over time.

Early symptoms are often radicular.

Neurological deficits develop late.

Tumor may cause radiculopathy, myelopathy, radiculomyelopathy or cauda equina syndrome.

Diagnosis

The final diagnosis should be established by clinical findings and imaging methods and MRI is the best method for diagnosis and differential diagnosis.

The size and specific margins of the mass demonstrate the localization and invasion to the contiguous structures. The changes such as foramen enlargement and erosion in the pedicles detected in the direct graphs may be seen as masses with sharp margins and involve the peripheral contrast in the CT scans.

Paraspinal schwannomas are frequently asymptomatic and diagnosed incidentally on imaging of the spine ¹⁾.

Treatment

see Spinal schwannoma treatment.

Outcome

Recurrence is rare after total excision (except in neurofibromatosis).

The risk for motor deficit is higher for schwannomas than for neurofibromas, for cervical vs. lumbar tumors, and for cervical tumors wiyh extradural extension.

Case series

see Spinal Schwannoma Case Series.