Spinal Nerve Sheath Tumours: A 10 Year Review of Outcomes and Complications in a National Neurosurgical Centre

Introduction: Spinal nerve sheath tumours (SNST) are most commonly benign tumours that present with pain. The aim of the study was to assess the presentation and outcomes, in particular new neurological deficits in surgically treated SNSTs.

Methods: All surgically treated SNSTs in a single institution from 2014 to 2023 were identified by searching the institution’s histopathological database and neuro-oncology multi-disciplinary team conference. Patient charts, electronic records and imaging were examined. Information on patient demographics, presenting symptoms, tumour characteristics, surgical procedures, use of intra-operative monitoring (IOM), neurological outcomes and complications were recorded.

Results: 169 tumours were operated on in 164 patients. 66% (109) of patients were male, and 34% (55) females, with an average age of 48 years (range 11 – 88). Pain was the most common presenting symptom in 71.6% (121). 26.0% (44) patients presented with a motor weakness.
Tumours were most commonly found in the lumbar spine (38.3%). 63.3% of tumours were located intradural extramedullary. The mean maximal diameter of tumours was 3.2cm (0.6 – 21cm). Schwannoma was the most common diagnosis (80%), followed by neurofibroma (13%) and malignant peripheral nerve sheath tumours (4%). Gross total resection (GTR) was achieved in 65.9% patients, and IOM was used in 21.9% cases. An overall complication rate of 24.9% (42) was observed. New motor deficits and new sensory deficits occurred in 6.1% (10) and 3.7% (6) cases respectively. Post-operative cerebrospinal fluid (CSF) leak and infection rates requiring re-operation rates were 5.5% (9) and 1.2% (2) respectively. Complications were not associated with GTR (24% vs 25% , p = 0.83) or the use of IOM (27% vs 23%, p = 0.73). Complications were associated with larger tumours (maximal diameter of 3cm and greater) (p = 0.04).

Conclusion : Gross total resection of spinal nerve sheath tumours is a safe procedure with a low risk of new neurological deficits.