Image-Guided Thoracoscopic Resection of Thoracic Dumbbell Nerve Sheath Tumors

Neurosurgery ◽  
2011 ◽  
Vol 70 (2) ◽  
pp. 461-468 ◽  
Author(s):  
Samer Ghostine ◽  
Shoshanna Vaynman ◽  
James Scott Schoeb ◽  
Helen Cambron ◽  
Wesley A. King ◽  
...  
Keyword(s):  
Thoracoscopic Surgery ◽  
Guidance System ◽  
Gross Total Resection ◽  
Total Resection ◽  
Thoracoscopic Resection ◽  
Thoracoscopic Approach ◽  
Nerve Sheath Tumors ◽  
Image Guided ◽  
Spinal Reconstruction ◽  
Nerve Sheath

Abstract BACKGROUND: Surgical removal of dumbbell nerve sheath tumors (NSTs) remains challenging because these neoplasms occupy ≥ 2 spinal and extraspinal spaces. The presence of intraspinal extension, tumor dimension, and/or its location within the thoracic cavity have previously made the resection of these types of neoplasms difficult. OBJECTIVE: To describe the feasibility of performing minimally invasive thoracoscopic surgery, as facilitated by an image guidance system (IGS), to achieve gross total resection of select dumbbell NSTs located in the thoracic spine. METHODS: The 3 cases presented here contained small intraspinal or foraminal components. Preoperative symptoms included Horner syndrome and back and chest wall pain. We used IGS to help guide the complete thoracoscopic resection of select dumbbell NSTs, consisting of extradural, intraforaminal, and paravertebral tumor components, which previously would have been challenging with only a thoracoscopic approach. RESULTS: IGS provided continuous intraoperative anatomic orientation to achieve gross total resection in all 3 cases. All surgical and postsurgical outcomes were satisfactory; preoperative symptoms improved or resolved; and no adverse events were observed. CONCLUSION: Thoracic dumbbell NSTs that have small intraspinal or foraminal components could be resected thoracoscopically when facilitated by IGS. Image-guided thoracoscopic resection of such dumbbell tumors may not only improve the precision of resection, reduce recurrence, and avoid the need for spinal reconstruction but also obviate the need for more invasive or simultaneous posterior procedures. The IGS enhances the accuracy and safety of 2-dimensional thoracoscopic surgery and may reduce its learning curve.

The Long-term Outcome After Resection of Intraspinal Nerve Sheath Tumors

Neurosurgery ◽  
2015 ◽  
Vol 77 (4) ◽  
pp. 585-593 ◽  
Author(s):  
Charlotte Marie Halvorsen ◽  
Pål Rønning ◽  
John Hald ◽  
Tom Børge Johannesen ◽  
Frode Kolstad ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Progression Free Survival ◽  
Gross Total Resection ◽  
Subtotal Resection ◽  
Total Resection ◽  
Free Survival ◽  
Nerve Sheath Tumors ◽  
Nerve Sheath

Abstract BACKGROUND: The existing literature on recurrence rates and long-term clinical outcome after resection of intraspinal nerve sheath tumors is limited. OBJECTIVE: To evaluate progression-free survival, overall survival, and long-term clinical outcome in a consecutive series of 131 patients with symptomatic intraspinal nerve sheath tumors. METHODS: Medical charts were retrospectively reviewed. Surviving patients voluntarily participated in a clinical history and physical examination that focused on neurological function and current tumor status. RESULTS: Follow-up data are 100% complete; median follow-up time was 6.1 years. All patients (100%) had surgery as the first line of treatment; gross total resection was performed in 112 patients (85.5%) and subtotal resection in 19 patients (14.5%). Five-year progression-free survival was 89%. The following risk factors for recurrence were identified: neurofibroma, malignant peripheral nerve sheath tumor, subtotal resection, neurofibromatoses/schwannomatosis, and advancing age at diagnosis. More than 95% of patients had neurological function compatible with an independent life at follow-up. The rate of tumor recurrence in nonneurofibromatosis patients undergoing total resection of a single schwannoma was 3% (3/93), in comparison with a recurrence rate of 32% (12/38) in the remaining patients. CONCLUSION: Gross total resection is the gold standard treatment for patients with intraspinal nerve sheath tumors. In a time of limited health care resources, we recommend that follow-up be focused on the subgroup of patients with a high risk of recurrence. The benefit of long-term, yearly magnetic resonance imaging follow-up with respect to recurrence in nonneurofibromatosis patients undergoing gross total resection of a single schwannoma is, in our opinion, questionable.

scholarly journals A Case Report of Complete Excision of Brachial Plexus Schwannoma: A Rare Entity

2016 ◽  
Vol 13 (2) ◽  
pp. 92-93
Author(s):  
Anish M Singh ◽  
Janith L Singh ◽  
Bellu Kayastha ◽  
Prabin Shrestha
Keyword(s):  
Case Report ◽  
Brachial Plexus ◽  
Gross Total Resection ◽  
Anatomical Location ◽  
Rare Entity ◽  
Rare Occurrence ◽  
Total Resection ◽  
Complete Excision ◽  
Nerve Sheath Tumors ◽  
Nerve Sheath

Brachial plexus schwannomas are rare benign nerve sheath tumors and only about 5% of schwannoma arise from the brachial plexus. They create a great challenge to surgeons due to their rare occurrence and complex anatomical location. We present a case of 37 yrs female presented with a right supraclavicular mass with severe radiating pain in right hand. Further investigation was done with MRI and FNAC which turns out to be huge right brachial plexus schwannoma. Gross total resection was done without any neurological motor defi cits. Nepal Journal of Neuroscience. Vol. 13, No. 2, 2016, Page: 92-93

Fluorescein-guided removal of peripheral nerve sheath tumors: a preliminary analysis of 20 cases

2019 ◽  
pp. 1-10 ◽  
Author(s):  
Ignazio G. Vetrano ◽  
Francesco Acerbi ◽  
Jacopo Falco ◽  
Grazia Devigili ◽  
Sara Rinaldo ◽  
...  
Keyword(s):  
Peripheral Nerve ◽  
Tumor Resection ◽  
Gross Total Resection ◽  
Light Illumination ◽  
Total Resection ◽  
Follicular Hyperplasia ◽  
Nerve Sheath Tumors ◽  
Peripheral Nerve Sheath Tumors ◽  
Nerve Sheath ◽  
Yellow 560

OBJECTIVEBenign peripheral nerve sheath tumors (PNSTs) include mainly schwannomas—the most common tumors arising from peripheral nerves—and neurofibromas. Due to their origin, distinguishing between functional intact nerve and the fibers from whence the PNST arose may not always be easy to perform. The introduction of intraoperative tools to better visualize these tumors could be helpful in achieving a gross-total resection. In this study, the authors present a series of patients harboring PNST in which the surgery was performed under fluorescein guidance.METHODSBetween September 2018 and February 2019, 20 consecutive patients with a total of 25 suspected PNSTs underwent fluorescein-guided surgery performed under microscopic view with a dedicated filter integrated into the surgical microscope (YELLOW 560) and with intraoperative monitoring. All patients presented with a different degree of contrast enhancement at preoperative MRI. Fluorescein was intravenously injected after intubation at a dose of 1 mg/kg. Preoperative clinical and radiological data, intraoperative fluorescein characteristics, and postoperative neurological and radiological outcomes were collected and analyzed.RESULTSSix patients were affected by neurofibromatosis or schwannomatosis. There were 14 schwannomas, 8 neurofibromas, 1 myxoma, 1 reactive follicular hyperplasia, and 1 giant cell tumor of tendon sheath. No patient experienced worsening of neurological status after surgery. No side effects related to fluorescein injection were found in this series. Fluorescein allowed an optimal intraoperative distinction between tumor and surrounding nerves in 13 of 14 schwannomas and in all neurofibromas. In 6 neurofibromas and in 1 schwannoma, the final YELLOW 560 visualization showed the presence of small tumor remnants that were not visible under white-light illumination and that could be removed, obtaining a gross-total resection.CONCLUSIONSFluorescein was demonstrated to be a feasible, safe, and helpful intraoperative adjunct to better identify and distinguish PNSTs from intact functional nerves, with a possible impact on tumor resection, particularly in diffuse neurofibromas.

scholarly journals The utility of high-resolution intraoperative MRI in endoscopic transsphenoidal surgery for pituitary macroadenomas: early experience in the Advanced Multimodality Image Guided Operating suite

2016 ◽  
Vol 40 (3) ◽  
pp. E18 ◽  
Author(s):  
Hasan A. Zaidi ◽  
Kenneth De Los Reyes ◽  
Garni Barkhoudarian ◽  
Zachary N. Litvack ◽  
Wenya Linda Bi ◽  
...  
Keyword(s):  
Skull Base ◽  
Residual Disease ◽  
Skull Base Surgery ◽  
Intraoperative Mri ◽  
Gross Total Resection ◽  
Inclusion Criteria ◽  
Total Resection ◽  
Image Guided ◽  
Multimodality Image ◽  
Pituitary Macroadenomas

OBJECTIVE Endoscopic skull base surgery has become increasingly popular among the skull base surgery community, with improved illumination and angled visualization potentially improving tumor resection rates. Intraoperative MRI (iMRI) is used to detect residual disease during the course of the resection. This study is an investigation of the utility of 3-T iMRI in combination with transnasal endoscopy with regard to gross-total resection (GTR) of pituitary macroadenomas. METHODS The authors retrospectively reviewed all endoscopic transsphenoidal operations performed in the Advanced Multimodality Image Guided Operating (AMIGO) suite from November 2011 to December 2014. Inclusion criteria were patients harboring presumed pituitary macroadenomas with optic nerve or chiasmal compression and visual loss, operated on by a single surgeon. RESULTS Of the 27 patients who underwent transsphenoidal resection in the AMIGO suite, 20 patients met the inclusion criteria. The endoscope alone, without the use of iMRI, would have correctly predicted extent of resection in 13 (65%) of 20 cases. Gross-total resection was achieved in 12 patients (60%) prior to MRI. Intraoperative MRI helped convert 1 STR and 4 NTRs to GTRs, increasing the number of GTRs from 12 (60%) to 16 (80%). CONCLUSIONS Despite advances in visualization provided by the endoscope, the incidence of residual disease can potentially place the patient at risk for additional surgery. The authors found that iMRI can be useful in detecting unexpected residual tumor. The cost-effectiveness of this tool is yet to be determined.

Initial clinical experience with image-guided linear accelerator-based spinal radiosurgery for treatment of benign nerve sheath tumors

2009 ◽  
Vol 72 (6) ◽  
pp. 668-674 ◽  
Author(s):  
Michael T. Selch ◽  
Kevin Lin ◽  
Nzhde Agazaryan ◽  
Steve Tenn ◽  
Alessandra Gorgulho ◽  
...  
Keyword(s):  
Clinical Experience ◽  
Linear Accelerator ◽  
Nerve Sheath Tumors ◽  
Image Guided ◽  
Nerve Sheath ◽  
Spinal Radiosurgery ◽  
Initial Clinical Experience

Image-guided Craniotomy for Cerebral Metastases: Techniques and Outcomes

Neurosurgery ◽  
2003 ◽  
Vol 53 (1) ◽  
pp. 82-90 ◽  
Author(s):  
Tze-Ching Tan ◽  
Peter McL. Black
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Brain Metastases ◽  
Class I ◽  
Gross Total Resection ◽  
Intravenous Sedation ◽  
Resonance Imaging ◽  
Total Resection ◽  
Image Guided ◽  
Primary Disease

Abstract OBJECTIVE The purpose of the present study was to analyze the outcomes after craniotomies for brain metastases in a modern series using image-guided technologies either in the regular operating room or in the intraoperative magnetic resonance imaging unit. METHODS Neurosurgical outcomes were analyzed for 49 patients who underwent 55 image-guided craniotomies for excision of brain metastases during a 5-year period. Tumors were located in critical and noncritical function regions of the brain. A total of 23 craniotomies for tumors in critical brain were performed using intravenous sedation anesthesia; craniotomies for noncritical function brain regions were completed under general anesthesia. The patients were also divided into Radiation Therapy Oncology Group recursive partitioning analysis (RPA) classes on the basis of age, Karnofsky Performance Scale scores, state of primary disease, and presence or absence of extracranial metastases. RESULTS There was no perioperative mortality. Gross total resection, as verified by postoperative contrast-enhanced computed tomography or magnetic resonance imaging, was achieved in 96% of patients. The median anesthesia time was 4.25 hours, and the median length of hospital stay was 3 days. In 51 symptomatic cases, there was complete resolution of symptoms in 70% (n = 36), improvement in 14% (n = 7), and no change in 12% (n = 6) postoperatively. No patient who was neurologically intact preoperatively deteriorated after surgery, and 93% of patients maintained or improved their functional status. Only two patients (3.6%) with significant preoperative deficits had increased long-term deficits postoperatively. The mean follow-up was 1 year, and the local recurrence rate was 16%. The median survival of the entire group was 16.23 months (17.5 mo in RPA Class I, 22.9 mo in RPA Class II, and 9.8 mo in RPA Class III). CONCLUSION Gross total resection of brain metastases, including those involving critical function areas, can be safely achieved with a low morbidity rate using contemporary image-guided systems. RPA Class I and II patients with controlled primary disease benefit from aggressive treatment by surgery and radiation.

scholarly journals Malignant Intracerebral Nerve Sheath Tumors: A Case Report with Review of the Literature

2013 ◽  
Vol 2013 ◽  
pp. 1-9
Author(s):  
Faris Shweikeh ◽  
Doniel Drazin ◽  
Sergei I. Bannykh
Keyword(s):  
Differential Diagnosis ◽  
Treatment Strategies ◽  
Mass Effect ◽  
Brain Parenchyma ◽  
Site Infection ◽  
Review Of The Literature ◽  
Total Resection ◽  
Nerve Sheath Tumors ◽  
Nerve Sheath ◽  
Associated Mass

The occurrence of benign nerve sheath tumors within the neuroaxis is uncommon. Even rarer is the finding within brain parenchyma, termed malignant intracerebral nerve sheath tumors (MINST). We present a case of MINST which occurred in the frontal lobe of an 18-year-old male that recurred almost 4 years later. Imaging demonstrated a 4.0 cm lesion with an associated mass effect. He underwent a right fronto-parietal craniotomy for gross total resection. Pathology was inconclusive with a Glioblastoma Multiforme (GBM) as the most likely diagnosis, though gliosarcoma and MINST were also highly considered. Postoperatively, he was treated with chemotherapy and radiation and followed for almost 4 years, when an MRI indicated a recurrence. Resection of the recurrence was highly suggestive of MINST. Surgery was followed by radiation and chemotherapy, but, less than 7 months later, he was readmitted for a surgical-site infection, and, after multiple surgeries, and his family terminated care. Recognizing this unusual tumor in the differential diagnosis of a heterogeneously enhancing intracerebral mass can help surgeons diagnose and treat it. This report also exhaustively reviews the literature and presents diagnostic and treatment strategies.

Analysis of the effect of intraoperative neuromonitoring during resection of benign nerve sheath tumors on gross-total resection and neurological complications

2021 ◽  
pp. 1-10
Author(s):  
Thomas J. Wilson ◽  
Forrest Hamrick ◽  
Saud Alzahrani ◽  
Christopher F. Dibble ◽  
Sravanthi Koduri ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Propensity Score ◽  
Neurological Complication ◽  
Neurological Complications ◽  
Intraoperative Neuromonitoring ◽  
Total Resection ◽  
Nerve Sheath Tumors ◽  
Nerve Sheath ◽  
Negative Predictor ◽  
Mixed Nerve

OBJECTIVEThe aim of this study was to examine the role of intraoperative neuromonitoring (IONM) during resection of benign peripheral nerve sheath tumors in achieving gross-total resection (GTR) and in reducing postoperative neurological complications.METHODSData from consecutive adult patients who underwent resection of a benign peripheral nerve sheath tumor at 7 participating institutions were combined. Propensity score matching was used to balance covariates. The primary outcomes of interest were the association between IONM and GTR and the association of IONM and the development of a permanent postoperative neurological complication. The secondary outcomes of interest were the association between IONM and GTR and the association between IONM and the development of a permanent postoperative neurological complication in the subgroup of patients with tumors involving a motor or mixed nerve. Univariate and multivariate logistic regression were then performed on the propensity score–matched samples to assess the ability of the independent variables to predict the outcomes of interest.RESULTSA total of 337 patients who underwent resection of benign nerve sheath tumors were included. In multivariate analysis, the use of IONM (OR 0.460, 95% CI 0.199–0.978; p = 0.047) was a significant negative predictor of GTR, whereas none of the variables, including IONM, were associated with the occurrence of a permanent postoperative neurological complication. Within the subgroup of motor/mixed nerve tumors, in the multivariate analysis, IONM (OR 0.263, 95% CI 0.096–0.723; p = 0.010) was a significant negative predictor of a GTR, whereas IONM (OR 3.800, 95% CI 1.925–7.502; p < 0.001) was a significant positive predictor of a permanent postoperative motor deficit.CONCLUSIONSOverall, 12% of the cohort had a permanent neurological complication, with new or worsened paresthesias most common, followed by pain and then weakness. The authors found that formal IONM was associated with a reduced likelihood of GTR and had no association with neurological complications. The authors believe that these data argue against IONM being considered standard of care but do not believe that these data should be used to universally argue against IONM during resection of benign nerve sheath tumors.

High-Definition 4K 3D Exoscope (ORBEYETM) in Peripheral Nerve Sheath Tumor Surgery: A Preliminary, Explorative, Pilot Study

2020 ◽  
Vol 19 (4) ◽  
pp. 480-488
Author(s):  
Ignazio G Vetrano ◽  
Francesco Acerbi ◽  
Jacopo Falco ◽  
Antonio D’Ammando ◽  
Grazia Devigili ◽  
...  
Keyword(s):  
Peripheral Nerve ◽  
Lower Limbs ◽  
Gross Total Resection ◽  
Nerve Sheath Tumor ◽  
Tumor Surgery ◽  
Total Resection ◽  
Peripheral Nerve Sheath Tumors ◽  
Advantages And Disadvantages ◽  
Nerve Sheath ◽  
Clinical Series

Abstract BACKGROUND Surgery for peripheral nerve sheath tumors aims to preserve functional fascicles achieving gross-total resection. Increasing the visualization of anatomic details helps to identify the different layers and the tumor-nerve interface. The traditional microscope can present some limitations in this type of surgery, such as its physical obstruction. OBJECTIVE To present a proof-of-concept study about exoscope-guided surgery for schwannomas of the lower limbs, to analyze the advantages and disadvantages of the 4K, high-quality, 3-dimensional (3D) imaging. METHODS We analyzed 2 consecutive surgical cases of suspected schwannomas of the lower limbs using the ORBEYE™ exoscope (Olympus). A standard operative microscope was also available in the operating room. All procedures were performed with neurophysiological monitoring, to identify functioning nerves and to localize the tumor capsule safest entry point. The cases are reported according to the PROCESS guidelines. RESULTS In both cases, we achieved a gross total resection of the schwannomas; the exoscope provided an excellent view of the anatomic details at tumor-nerve interface, as visible in intraoperative images and in the 3D-4K video supporting these findings. The surgeon's position was comfortable in both cases, although if the co-surgeon positioned himself in front of the first surgeon, the comfort was slightly reduced. The 4K monitor allowed a realistic, nontiring 3D vision for all the team. CONCLUSION The ORBEYETM, after an adequate learning curve, can represent a feasible and comfortable instrument for nerve tumor surgery, which is usually performed in a single horizontal plane. Further and wider clinical series are necessary to confirm this first impression.

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