Oncological and neurological outcomes after parent rootlet resection in functionally critical spinal schwannomas: a retrospective multicenter comparative study

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OBJECTIVE: Resection of spinal schwannomas remains a clinical and technical challenge, particularly in cases involving functionally critical spinal segments where management of the parent nerve rootlet is critical. Although sacrificing the involved rootlet may enable gross-total resection (GTR), it carries a significant risk of postoperative neurological deficits. This study aimed to evaluate the extent of tumor resection and the incidence of new deficits associated with rootlet resection in the cervical and lumbosacral spine. METHODS: In this European multicenter cohort study, the authors retrospectively analyzed patients diagnosed with spinal schwannomas located between segments C3-T1 (cervical) and L1-S2 (lumbosacral). Patients were stratified into 2 cohorts based on intraoperative management of the parent rootlet: rootlet resection versus rootlet preservation. Primary outcomes were GTR and the incidence of new neurological deficits. RESULTS: Of the 232 spinal schwannomas in the database, 190 (81.9%) were classified as arising in functionally critical segments. The parent rootlet was resected in 94 cases (49.5%) and preserved in 96 (50.5%). The rate of GTR was significantly higher in the rootlet resection cohort (n = 88, 93.6%) than in the rootlet preservation cohort (n = 72, 75.0%; p = 0.008). The OR for incomplete resection in the rootlet resection group was 0.205 (95% CI 0.09-0.56, p < 0.001), with a number needed to treat of 5.4 (95% CI 3.5-12.1) to achieve 1 additional GTR. New neurological deficits occurred in 5 patients (5.3%) after rootlet resection and in 7 patients (7.3%) after preservation (p = 0.767). Perioperative parameters, complications, and functional recovery at 3 months were comparable between the groups, with both cohorts showing significant improvement over baseline. With a mean follow-up of 33.1 ± 28.2 months (± SD), the mean progression-free survival was 121.4 months in the GTR cohort and 89.1 months in the non-GTR cohort (p < 0.001). CONCLUSIONS: Parent rootlet resection was associated with higher rates of GTR without an increased risk of new postoperative deficits. These findings require confirmation in prospective studies.

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