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Asymptomatic spinal schwannomas may not need surgical treatment
Researchers of this retrospective study found patients with isointensive/high and high/rim spinal schwannomas as evidenced on T2-weighted gadolinium-enhanced MRI were small and had minimal growth, but those with a heterogeneous/heterogeneous classification increased in growth and often needed surgical treatment.
Researchers retrospectively reviewed data from 23 patients with schwannomas (SCH) detected by MRI. Patients had a mean follow-up of 5 years. In all, researchers found the average tumor size was 1,495 mm³ at the initial visit and 2,224 mm³ at the final follow-up. The absolute and relative growth rates of the tumors were calculated and found to be 139 mm³ per year and 5.3% per year, respectively.
Eleven cases were classified as isointensive/hypertensive (iso/high), five cases were identified as rim enhancement when enhancement was peripheral (high/rim) and seven cases were categorized as heterogeneous/heterogeneous (hetero/hetero). Researchers based the tumor classifications on gadolinium-enhanced T2-weighted (T2W) MRI scans.
“The majority of asymptomatic SCHs have only minimal growth and do not need surgical intervention. Physicians should monitor clinical symptoms and perform repeated imaging studies when patients have large-volume tumors that are heterogeneously intense on their T2W images, indicating an Antoni type A pattern of high cell-density lesions and an Antoni type B pattern of low cell-density lesions on pathological examination. Radiological features, such as heterogeneously intense on T2W images, may provide useful information to predict the growth potential of spinal SCHs,” researchers wrote in the study.
If tumor growth and symptoms continue, and the tumor causes significant compression of the spinal cord and cauda equine, then researchers recommend surgical removal. – by Robert Linnehan
Disclosure: The researchers report no relevant financial disclosures.
Perspective
Back to TopLittle is known of the progression pattern of spinal schwannomas. This article presented us with a promising opinion about this topic. The authors show us that initial radiology may serve as a predictor of progression. This article strives to show there are at least three different growth patterns as determined by MRI characteristics. These data may help surgeons to decide for a certain treatment or change the treatment modality during follow-up.
However, this study had a small number of patients and the retrospective method of the investigational analysis means that further studies are required with sufficient size patient population to achieve a higher level of evidence. Furthermore, to determine the natural history of spinal schwannomas, a longer period of standard follow-up may be required.