Intradural Nerve Sheath Tumors: Neurofibromas and Schwannomas

130 Intradural Nerve Sheath Tumors: Neurofibromas and Schwannomas
Tanvir F. Choudhri and Paul C. McCormick

♦ Preoperative

Operative Planning

  • Review imaging: magnetic resonance imaging, computed tomography (CT), radiographs, or CT myelogram
  • Note location within the spinal canal: cervical location most common
  • Identify ventral-to-dorsal and rostral-to-caudal extents of the lesion
  • These lesions frequently extend laterally through the intervertebral foramen into the extraforaminal region to become dumb bell-shaped tumors
  • Consider preoperative fluoroscopic localization of level in thoracic lesions; otherwise, intraoperative radiographs are used to identify the correct level


  • Basic spine tray
  • High-speed drill (Midas Rex with AM-8 bit [Medtronic])
  • Operating microscope with bridge
  • Somatosensory evoked potential or direct motor evoked potential monitoring may be used in tumors causing severe spinal cord or cauda equina compression

Anesthetic Issues

  • Arterial line for blood pressure monitoring
  • Intravenous dexamethasone and antibiotic prophylaxis (cefazolin 1 to 2 g) administered preoperatively
  • In cases of severe cord compression make sure blood pressure does not fall below baseline during induction to prevent ischemic cord injury

♦ Intraoperative


  • For posterior approaches, patient prone with pressure points well padded
  • Mayfield head fixation in cervical lesions

Posterior Cervical Approach

  • For lesions of the cervical cord or cervicothoracic junction

Posterior Thoracic Approach

  • For lesions of the thoracic cord, cervicothoracic junction, or thoracolumbar junction

Retropleural Thoracotomy, Costotransversectomy, Lateral Extracavitary, and Transthoracic Approaches

  • For anteriorly and anterolaterally located thoracic tumors

Posterior Lumbar Approach

  • For lesions of the lumbar cord, thoracolumbar junction, or conus

Retroperitoneal Approach

  • For anteriorly and anterolaterally located thoracolumbar and lumbar tumors

Tumor Resection (Fig. 130.1)

  • Perform bone removal, using one of the described approaches to expose the dura surrounding the tumor


Fig. 130.1 Schematic of intradural nerve sheath tumor (A) exposure, and (B) resection.

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Jul 11, 2016 | Posted by in NEUROSURGERY | Comments Off on Intradural Nerve Sheath Tumors: Neurofibromas and Schwannomas

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