ABSTRACT
Background: Schwannoma is a benign peripheral nerve sheath tumour derived from Schwann cells. Also known as Neurilemoma, it can affect any nerve in the body. They usually present as a painless swelling or paresthesia over the sensory distribution of the affected nerve. Although it is classically described that schwannomas are well encapsulated and can be completely enucleated during excision, many of them have fascicular involvement and could not be completely shelled out. The aim of this work is to present our experience in operative management of schwannomas located in extremities.Methods: Authors conducted a retrospective review for 18 adult patients with schwannoma, from June 2012 to June 2018. There were 10 men and 8 women, ranging from 20 to 68 years of age, with a mean age of 46 years old. All patients had excision done for the tumour and histopathological examination confirmed schwannoma. All patients were preoperatively evaluated both clinically and radiologically. FNAC was also done to confirm the origin of the swelling.Results: The mean follow up period has been 2 years. Complete excision with preservation of nerve was done in all cases except for one case in which nerve graft was used.Conclusions: Use of preoperative MRI, magnification and good surgical technique will help to enucleate the tumour completely without any collateral damage or recurrence. The possibility and option of nerve graft should be discussed with patients prior to schwannoma excision, so that nerve grafting could be directly proceeded with patient consent in case there is fascicular involvement of tumour found intraoperatively.
ABSTRACT
Background: The intradural extramedullary tumours of the spine are one of the commonest tumours of the spine. Early diagnosis and surgical removal helps in best outcome. The objective of the study was to analyze the clinical presentation, imageology, resectability, to know the incidence of different types of tumours in intradural extramedullary compartment and to study the surgical outcome. Methods: This was a prospective study of 32 cases of intradural extramedullary tumours. The clinical presentation, imageology, resectability, histopathology, surgical outcome were studied. The patients were investigated with plain spinal radiography and MRI. All cases were treated surgically by posterior or posterolateral approaches. Outcome and complications were evaluated. They were followed up regularly and the results were analyzed. Ambulatory status was classified on admission by using Nurick-grading scheme. Results: The incidence of intradural extramedullary spinal tumours was 57.14%. Most of the tumours presented in the third decade (37.5%). Mean age of Presentation for meningioma was 36 years and for nerve sheath tumours was 39.5 years. The nerve sheath tumours contributed 35% followed by meningioma 28%. Nerve sheath tumours were found to be most commonly located in thoracic region (56%). Total excision of tumour was achieved in 87.7% cases. Conclusions: Nerve Sheath tumours and Meningiomas were the most common in intradural extramedullary spinal lesions and complete excision was possible in almost all cases. Prognosis was usually good, in spite of poor neurological status at the time of presentation.