Surgical Strategies in the Management of Spinal Nerve Sheath Tumors

Objectives: Spinal nerve sheath tumors (SNSTs) are the most common lesions in the extramedullary intradural compartment. Complex and large lesions may pose technical difficulties for the operating surgeons. We discuss the management of SNSTs and technical issues including surgical approaches, spinal fixation, and dural handling with the goal of achieving good clinical outcomes while minimizing the risk of complications. We also propose a new classification for SNSTs to guide surgical treatment of these tumors. Methods: A retrospective analysis was performed of 61 patients who underwent surgery for SNSTs during the period 1995-2012. The posterior approach was used for removal of most tumors (n = 53). Lesions having a substantial extraforaminal component were accessed from the anterior or lateral approach or a combined approach. Concomitant spinal fixation and fusion was performed in 7 patients. Results: Most of the patients (n = 53) had clinical improvement; clinical status was the same in 4 patients and worse in the remaining 4 patients. One or more complications developed in 18 patients (29.5%). Recurrence was the most common complication (n = 7). Death occurred in 2 patients with malignant peripheral nerve sheath tumors 12 and 8 months, respectively, after surgical resection. Conclusions: Lesions with large extraforaminal extension pose technical difficulty. Spinal fixation with fusion should be supplemented whenever necessary. Complications related to dura mater may be associated with significant morbidity, and all possible efforts should be made to prevent them.