Surgical Strategy for Type II Long Segment Giant Spinal Schwannomas – Case Series and Review of Literature

Abstract Background: Schwannomas have been classified according to their size, extent, and invasiveness. The type II giant intraspinal schwannomas (T2GSS) which extend for more than two vertebral bodies longitudinally are rare tumors. The challenge in surgery is the length of these lesions. Objective: The author critically reviewed literature with a view to decide on an ideal surgical strategy for these tumors. Material and Methods: A retrospective study was performed of the authors’ cases to identify those which qualified to be T2GSS. An online search was conducted to identify previously published cases in English literature. These were then analyzed especially for surgical approach and results. Results: Four cases from the author and 13 cases from the literature formed the basis of the study. The majority involved the cervical spine (15/17). In 4 patients, the lesion extended into the foramen magnum. The average length of the tumors was 6.5 (range 4–13), with 9 tumors located anteriorly. The approaches used included laminectomy – 5/17, laminoplasty – 4/17, hemilaminectomy – 2/17, and anterior corpectomy – 2/17. The author used a unilateral minimal laminotomy in 4 patients. There were no intraoperative complications recorded. Postoperative morbidity included pseudomeningocele, residual tumor, and swan neck deformity. Conclusions: The T2GSS is a rare tumor with this report being the first case series. The surgery for these tumors needs to take into account their longitudinal extent to avoid complications related to laminectomy. A unilateral posterior approach with minimal bone removal appears to be the appropriate strategy to be adopted along with good microsurgical techniques.