- Email: [email protected]
Severe Spinal Cord Compression by Pure Giant Intradural Schwannoma of Cervical Spine
Accepted Manuscript Severe Spinal Cord Compression By A Pure Giant Intradural Schwannoma Of The Cervical Spine Javier Quillo-Olvera, MD, Guang-Xun Lin, MD, MS, Jin-Sung Kim, MD, PhD PII:
S1878-8750(17)31834-X
DOI:
10.1016/j.wneu.2017.10.106
Reference:
WNEU 6759
To appear in:
World Neurosurgery
Received Date: 8 July 2017 Revised Date:
18 October 2017
Accepted Date: 20 October 2017
Please cite this article as: Quillo-Olvera J, Lin G-X, Kim J-S, Severe Spinal Cord Compression By A Pure Giant Intradural Schwannoma Of The Cervical Spine, World Neurosurgery (2017), doi: 10.1016/ j.wneu.2017.10.106. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT
SEVERE SPINAL CORD COMPRESSION BY A PURE GIANT INTRADURAL
Guang-Xun Lin MD, MS1 - [email protected] Jin-Sung Kim, MD, PhD1 - [email protected]
1
SC
Javier Quillo-Olvera, MD1 - [email protected]
RI PT
SCHWANNOMA OF THE CERVICAL SPINE
Seoul St. Mary’s Hospital, Spine Center, Department of Neurosurgery, College of Medicine.
Post-publication corresponding author Jin-Sung Kim MD, PhD
M AN U
The Catholic University of Korea, Seoul, South Korea.
TE D
Spine Center, Department of Neurosurgery, Seoul St. Mary´s Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo Daero, Seocho-gu, Seoul, 137-701, Seoul, South Korea.
AC C
EP
Phone: +82-2-2258-6128, Fax: +82-2-594-4248, email: [email protected]
1
ACCEPTED MANUSCRIPT
ABSTRACT A 73-year-old man with progressive quadriparesis, six months of evolution. Physical examination showed decreased strength at upper and lower limbs together with an increase in osteotendinous
RI PT
reflexes with Babinski sign. Upon radiological investigation, MRI revealed a tumor at C3-T2 with a severe ventrolateral displacement of the spinal cord (Figure 1). The patient underwent surgery for gross total resection of the lesion. Histopathologic findings reported a schwannoma.
SC
(Figure 2). Muscular strength of the limbs improved three months after surgery, and the patient was able to walk without assistance. Pure giant intradural schwannomas are those that extend
M AN U
over more than two vertebral bodies,1 incidence of these rare tumors is less than 5%.2 Only 8 cases including this one have been reported in the literature (Table 1). MRI findings are hypo- or isointense lesions relative to spinal cord on T1-weighted, hyperintense with heterogeneous characteristics on T2-weighted, and finally hyperintense on T1-weighted postcontrast imaging.3
TE D
This type of tumor usually causes severe spinal cord compression. No ideal surgical approach exists. Hussein et al, described a combined anteroposterior navigation-guided approach.4 Total
EP
tumor resection is associated with functional improvement and low recurrence rate.5
AC C
Keywords: Schwannoma; Intradural; Spinal tumor; Giant; Extramedullary.
Short title: Giant Intradural Schwannoma.
2
ACCEPTED MANUSCRIPT
FIGURES Figure 1. Spine MRI and Myelo-CT: (A) mid-sagittal T1-weighted image of cervical spine showing hypointense tumor from C3 to T2. (B) T2-weighted image in a mid-sagittal view,
RI PT
showing a hyperintense and heterogeneous tumor. (C) gadolinium-enhanced T1-weighted image of cervical spine in sagittal orientation showing a hyperintense and heterogeneous intradural, extramedullary tumor
at
C3-T2.
(D)
gadolinium-enhanced
T1-weighted
image.
(E)
SC
myelotomography in axial orientation of C4-C5 level showing severe spinal cord compression.
M AN U
Figure 2. Pathology and immunohistochemistry findings: (A) H&E stained microphotograph (x10) showing Antoni A (black arrow) areas and Antoni B (yellow arrow) areas. (B) Strong diffuse S-100 immunoreactivity. (C) Negative staining for epithelial membrane antigen (EMA).
TE D
REFERENCES
1.- Sridhar K, Ramamurthi R, Vasudevan MC, Ramamurthi B. Giant invasive spinal schwannomas: definition and surgical management. J Neurosurg. 2001;94:210-5.
EP
2.-Das JM, Peethambaran A. Total excision of a giant ventral midline cervical spinal intradural schwannoma via posterior approach. Asian Spine J. 2016;10:153-7.
AC C
http://doi.org/10.4184/asj.2016.10.1.153. 3.-Albert AF, Kirkman MA, du Plessis D, Sacho R, Cowie R, Tzerakis NG. Giant solitary cystic schwannoma of the cervical spine: a case report. Clin Neurol Neurosurg. 2012;114:396-8. http://doi.org/10.1016/j.clineuro.2011.10.039. 4.- Hussain I, Navarro-Ramirez R, Lang G, Härtl R (2017). 3D Navigation-guided resection of giant ventral cervical intradural schwannoma with 360-degree stabilization. Clin Spine Surg, http://doi.org/10.1097/BSD.0000000000000511. 3
ACCEPTED MANUSCRIPT
5.- Yu NH, Lee SE, Jahng TA, Chung CK. Giant invasive spinal schwannoma: its clinical features and surgical management. Neurosurgery. 2012;71:58-66. http://doi.org/10.1227/NEU.0b013e31824f4f96.
Oncol 2006;17:86–7. http://doi.org/10.2298/AOO0904086S.
RI PT
6.- Stepanov S, Kozic D, Prvulovic N. An unusual MR finding of spinal schwannoma. Arch
7.- Vikram M, Pande A, Vasudevan MC, Ravi R. Cervical solitary long segment cystic
SC
schwannoma. Br J Neurosurg. 2010;24:208-10. http://doi.org/10.3109/02688690903301557. 8.- Mahore A, Chagla A, Goel A. Giant ventral midline schwannoma of cervical spine: agonies
AC C
EP
TE D
M AN U
and nuances. J Korean Neurosurg Soc. 2010;47:454-7. http://doi.org/10.3340/jkns.2010.47.6.454.
4
ACCEPTED MANUSCRIPT
Table 1.- Cases of ventrolateral intradural giant schwannomas reported in the literature. Location
1
25
F
C4-C7
Intradural/ extravertebral component
1
51
M
C3-C6
Intradural
1
40
M
C2-C7
Intradural
Mahore A, at al.8 2010
1
18
M
Albert AF, et al.3 2012
1
50
M
1
38
F
Hussain I, et al.4 2017
1
NR
M
QuilloOlvera J, et al. 2017
1
73
M
Cervicomed ullary junction – T3
Intradural
Intradural
Intradural
C5-C7
Intradural
C3-T2
Intradural
EP
Das JM, et al.2 2016
Cervicomed ullary junction – C7 C2/C3 disc space up to C5
GTR; gross total resection, NR; not reported.
AC C
Approach Combined approach (C4-C6 left side laminectomy + C4-C6 corpectomy + anterior stabilization) Posterior approach (C3-C6 laminectomy)
Resection
GTR
RI PT
Level
Posterior approach (right hemilaminectomy) Posterior approach (C1-C7 laminotomy)
SC
Sridhar K, et al.1 2001 Stepanov S, et al.6 2008 Vikram M, et al.7 2010
Age Sex
M AN U
Cases
TE D
Author
Posterior approach (C2-C5 laminectomy) Posterior approach (suboccipital craniectomy + excision of posterior arch of C1 + C2-C6 laminoplasty) Combined approach (2-level corpectomy + 360-degree stabilization). Posterior approach (laminectomy C3-T1)
NR
GTR
GTR
GTR
GTR
GTR
GTR
AC C
EP
TE D
M AN U
SC
RI PT
ACCEPTED MANUSCRIPT
AC C
EP
TE D
M AN U
SC
RI PT
ACCEPTED MANUSCRIPT
ACCEPTED MANUSCRIPT
Abbreviation list. EMA: Epithelial membrane antigen. H&E: Hematoxylin and eosin.
RI PT
MRI: Magnetic resonance imaging.
AC C
EP
TE D
M AN U
SC
Myelo-CT: Myelotomography.
ACCEPTED MANUSCRIPT
Statements All authors declare that no actual or potential conflict of interest exists. This manuscript has not been submitted elsewhere.
RI PT
All authors have contributed to the material and preparation of this manuscript.
No funding and financial support for this work from any organization was received.
AC C
EP
TE D
M AN U
SC
All authors have no affiliation with any industry involved in this work.
S1878-8750(17)31834-X
DOI:
10.1016/j.wneu.2017.10.106
Reference:
WNEU 6759
To appear in:
World Neurosurgery
Received Date: 8 July 2017 Revised Date:
18 October 2017
Accepted Date: 20 October 2017
Please cite this article as: Quillo-Olvera J, Lin G-X, Kim J-S, Severe Spinal Cord Compression By A Pure Giant Intradural Schwannoma Of The Cervical Spine, World Neurosurgery (2017), doi: 10.1016/ j.wneu.2017.10.106. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT
SEVERE SPINAL CORD COMPRESSION BY A PURE GIANT INTRADURAL
Guang-Xun Lin MD, MS1 - [email protected] Jin-Sung Kim, MD, PhD1 - [email protected]
1
SC
Javier Quillo-Olvera, MD1 - [email protected]
RI PT
SCHWANNOMA OF THE CERVICAL SPINE
Seoul St. Mary’s Hospital, Spine Center, Department of Neurosurgery, College of Medicine.
Post-publication corresponding author Jin-Sung Kim MD, PhD
M AN U
The Catholic University of Korea, Seoul, South Korea.
TE D
Spine Center, Department of Neurosurgery, Seoul St. Mary´s Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo Daero, Seocho-gu, Seoul, 137-701, Seoul, South Korea.
AC C
EP
Phone: +82-2-2258-6128, Fax: +82-2-594-4248, email: [email protected]
1
ACCEPTED MANUSCRIPT
ABSTRACT A 73-year-old man with progressive quadriparesis, six months of evolution. Physical examination showed decreased strength at upper and lower limbs together with an increase in osteotendinous
RI PT
reflexes with Babinski sign. Upon radiological investigation, MRI revealed a tumor at C3-T2 with a severe ventrolateral displacement of the spinal cord (Figure 1). The patient underwent surgery for gross total resection of the lesion. Histopathologic findings reported a schwannoma.
SC
(Figure 2). Muscular strength of the limbs improved three months after surgery, and the patient was able to walk without assistance. Pure giant intradural schwannomas are those that extend
M AN U
over more than two vertebral bodies,1 incidence of these rare tumors is less than 5%.2 Only 8 cases including this one have been reported in the literature (Table 1). MRI findings are hypo- or isointense lesions relative to spinal cord on T1-weighted, hyperintense with heterogeneous characteristics on T2-weighted, and finally hyperintense on T1-weighted postcontrast imaging.3
TE D
This type of tumor usually causes severe spinal cord compression. No ideal surgical approach exists. Hussein et al, described a combined anteroposterior navigation-guided approach.4 Total
EP
tumor resection is associated with functional improvement and low recurrence rate.5
AC C
Keywords: Schwannoma; Intradural; Spinal tumor; Giant; Extramedullary.
Short title: Giant Intradural Schwannoma.
2
ACCEPTED MANUSCRIPT
FIGURES Figure 1. Spine MRI and Myelo-CT: (A) mid-sagittal T1-weighted image of cervical spine showing hypointense tumor from C3 to T2. (B) T2-weighted image in a mid-sagittal view,
RI PT
showing a hyperintense and heterogeneous tumor. (C) gadolinium-enhanced T1-weighted image of cervical spine in sagittal orientation showing a hyperintense and heterogeneous intradural, extramedullary tumor
at
C3-T2.
(D)
gadolinium-enhanced
T1-weighted
image.
(E)
SC
myelotomography in axial orientation of C4-C5 level showing severe spinal cord compression.
M AN U
Figure 2. Pathology and immunohistochemistry findings: (A) H&E stained microphotograph (x10) showing Antoni A (black arrow) areas and Antoni B (yellow arrow) areas. (B) Strong diffuse S-100 immunoreactivity. (C) Negative staining for epithelial membrane antigen (EMA).
TE D
REFERENCES
1.- Sridhar K, Ramamurthi R, Vasudevan MC, Ramamurthi B. Giant invasive spinal schwannomas: definition and surgical management. J Neurosurg. 2001;94:210-5.
EP
2.-Das JM, Peethambaran A. Total excision of a giant ventral midline cervical spinal intradural schwannoma via posterior approach. Asian Spine J. 2016;10:153-7.
AC C
http://doi.org/10.4184/asj.2016.10.1.153. 3.-Albert AF, Kirkman MA, du Plessis D, Sacho R, Cowie R, Tzerakis NG. Giant solitary cystic schwannoma of the cervical spine: a case report. Clin Neurol Neurosurg. 2012;114:396-8. http://doi.org/10.1016/j.clineuro.2011.10.039. 4.- Hussain I, Navarro-Ramirez R, Lang G, Härtl R (2017). 3D Navigation-guided resection of giant ventral cervical intradural schwannoma with 360-degree stabilization. Clin Spine Surg, http://doi.org/10.1097/BSD.0000000000000511. 3
ACCEPTED MANUSCRIPT
5.- Yu NH, Lee SE, Jahng TA, Chung CK. Giant invasive spinal schwannoma: its clinical features and surgical management. Neurosurgery. 2012;71:58-66. http://doi.org/10.1227/NEU.0b013e31824f4f96.
Oncol 2006;17:86–7. http://doi.org/10.2298/AOO0904086S.
RI PT
6.- Stepanov S, Kozic D, Prvulovic N. An unusual MR finding of spinal schwannoma. Arch
7.- Vikram M, Pande A, Vasudevan MC, Ravi R. Cervical solitary long segment cystic
SC
schwannoma. Br J Neurosurg. 2010;24:208-10. http://doi.org/10.3109/02688690903301557. 8.- Mahore A, Chagla A, Goel A. Giant ventral midline schwannoma of cervical spine: agonies
AC C
EP
TE D
M AN U
and nuances. J Korean Neurosurg Soc. 2010;47:454-7. http://doi.org/10.3340/jkns.2010.47.6.454.
4
ACCEPTED MANUSCRIPT
Table 1.- Cases of ventrolateral intradural giant schwannomas reported in the literature. Location
1
25
F
C4-C7
Intradural/ extravertebral component
1
51
M
C3-C6
Intradural
1
40
M
C2-C7
Intradural
Mahore A, at al.8 2010
1
18
M
Albert AF, et al.3 2012
1
50
M
1
38
F
Hussain I, et al.4 2017
1
NR
M
QuilloOlvera J, et al. 2017
1
73
M
Cervicomed ullary junction – T3
Intradural
Intradural
Intradural
C5-C7
Intradural
C3-T2
Intradural
EP
Das JM, et al.2 2016
Cervicomed ullary junction – C7 C2/C3 disc space up to C5
GTR; gross total resection, NR; not reported.
AC C
Approach Combined approach (C4-C6 left side laminectomy + C4-C6 corpectomy + anterior stabilization) Posterior approach (C3-C6 laminectomy)
Resection
GTR
RI PT
Level
Posterior approach (right hemilaminectomy) Posterior approach (C1-C7 laminotomy)
SC
Sridhar K, et al.1 2001 Stepanov S, et al.6 2008 Vikram M, et al.7 2010
Age Sex
M AN U
Cases
TE D
Author
Posterior approach (C2-C5 laminectomy) Posterior approach (suboccipital craniectomy + excision of posterior arch of C1 + C2-C6 laminoplasty) Combined approach (2-level corpectomy + 360-degree stabilization). Posterior approach (laminectomy C3-T1)
NR
GTR
GTR
GTR
GTR
GTR
GTR
AC C
EP
TE D
M AN U
SC
RI PT
ACCEPTED MANUSCRIPT
AC C
EP
TE D
M AN U
SC
RI PT
ACCEPTED MANUSCRIPT
ACCEPTED MANUSCRIPT
Abbreviation list. EMA: Epithelial membrane antigen. H&E: Hematoxylin and eosin.
RI PT
MRI: Magnetic resonance imaging.
AC C
EP
TE D
M AN U
SC
Myelo-CT: Myelotomography.
ACCEPTED MANUSCRIPT
Statements All authors declare that no actual or potential conflict of interest exists. This manuscript has not been submitted elsewhere.
RI PT
All authors have contributed to the material and preparation of this manuscript.
No funding and financial support for this work from any organization was received.
AC C
EP
TE D
M AN U
SC
All authors have no affiliation with any industry involved in this work.