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Is laminectomy necessary for C1-C2 epidural schwannomas?

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Abstract

Purpose

Spinal schwannomas often require laminectomy for gross total resection. However, laminectomy may not be necessary due to the unique anatomy of epidural schwannomas at the C1-2 level, even with the intradural part. This study aimed to determine the need for laminectomy by comparing factors between patients who underwent laminectomy and those who did not and to identify the benefits of not performing laminectomy.

Methods

Fifty patients with spinal epidural schwannoma confined to C1-C2 level were retrospectively collected and divided into groups based on whether laminectomy was intended and performed. In all cases where laminectomy was conducted, patients underwent laminoplasty using microplate-and-screws, which deviates from the conventional laminectomy approach. Tumor characteristics were compared, and a cut-off value for laminectomy was determined. Outcomes were compared between groups, and factors influencing laminectomy were identified. Postoperative changes in cervical curves were measured.

Results

The diameter of the intradural part of the tumor was significantly longer in the laminectomy performed group, with a 14.86 mm cut-off diameter requiring laminectomy. Recurrence rates did not differ significantly between groups. Surgery time was substantially longer for the laminectomy performed group. No significant changes were observed in Cobb's angles of Oc-C2, C1-C2, and Oc-C1 before and after surgery.

Conclusion

The study showed that the diameter of the intradural part of the tumor influenced the decision to perform laminectomy for removing epidural schwannomas at C1-C2. The cut-off value of the diameter of the intradural part of the tumor for the laminectomy was 14.86 mm. Not performing laminectomy can be a viable option with no significant differences in removal and complication rates.

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Data Availability

The datasets used and/or analysed during the current study available from the corresponding author on reasonable request.

Abbreviations

MRI :

Magnetic Resonance Imaging

M :

Male

F :

Female

BMI :

Body Mass Index

ROC :

Receiver Operating Characteristic

F/U :

Follow-up

OP :

Operative

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Funding

This study did not receive any funding or financial support.

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Authors and Affiliations

  1. Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea

    Tae-Shin Kim, Woon Tak Yuh, Junghoon Han, Junhoe Kim, Chang-Hyun Lee, Chi Heon Kim & Chun Kee Chung

  2. Department of Neurosurgery, Hallym University Dongtan Sacred Heart Hospital, Hwaseong-Si, Republic of Korea

    Woon Tak Yuh

  3. Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Republic of Korea

    Chi Heon Kim & Chun Kee Chung

  4. Department of Brain and Cognitive Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea

    Chun Kee Chung

Authors
  1. Tae-Shin Kim
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  2. Woon Tak Yuh
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  4. Junhoe Kim
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  5. Chang-Hyun Lee
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Correspondence to Chun Kee Chung.

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Ethics approval

The Institutional Review Board approved the study (IRB Number: H-2303–144-1416). The study adhered to the guidelines specified in the Declaration of Helsinki, and the manuscript followed the STROBE checklist.

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Kim, TS., Yuh, W.T., Han, J. et al. Is laminectomy necessary for C1-C2 epidural schwannomas?. Acta Neurochir 165, 3065–3076 (2023). https://doi.org/10.1007/s00701-023-05707-2

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  • DOI: https://doi.org/10.1007/s00701-023-05707-2

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