In his latest installment to the Total Spine series of instructional videos, Dr. Paul McCormick describes retropleural thoracotomy, a surgical technique used to treat complex spinal conditions of the thoracic and lumbar spine. “Retropleural thoracotomy is an important...
Schwannomas are nerve sheath tumors, or tumors that originate from the layer of insulation that surrounds nerve fibers. At The Spine Hospital at the Neurological Institute of New York, we specialize in treating spinal schwannomas.
Schwannomas arise from Schwann cells. These cells produce an insulating sheath surrounding the nerve fibers. The Schwann cells manufacture the nerve sheath out of myelin, a substance they produce for that purpose. Schwann cells don’t exist in the spinal cord. They produce their myelin sheath only for nerves outside the brain and spinal cord, called peripheral nerves.
Spinal schwannomas, then, do not arise in the spinal cord itself–there are no Schwann cells there. Instead, schwannomas arise on the spinal nerve roots. These are the nerves that branch out from the spinal cord to connect it with the rest of the body.
Spinal schwannomas are classified into four types by their size, location, and relationship to the dura (a thin membrane that encloses the spinal cord, parts of the spinal nerves, and the spinal fluid within the spinal canal).
Schwannomas are typically slow growing and usually benign–that is, they usually are not cancerous and will not spread. Malignant (cancerous) schwannomas are very rare.
Schwannomas are also called neuromas, neurilemomas, and neurinomas.
Small schwannomas often produce no symptoms. When present, symptoms of small schwannomas may include intermittent pain in the area supplied by the nerve that gives rise to the tumor.
|Causes and Risk Factors|
Inherited conditions called Neurofibromatosis II (NF2) and Schwannomatosis can cause schwannomas.
|Tests and Diagnosis|
Imaging studies usually provide the diagnosis of spinal schwannomas. Magnetic resonance (MR) scans, for example, use magnets, radio waves, and computer technology to produce images of organs and tissues like the brain and spinal cord. MR scans can identify spinal schwannomas as small as a few millimeters.
MR scans are sometimes performed using a contrast-enhancing agent–a material like a dye that makes some tumors light up brightly. The contrast-enhancing agent is delivered intravenously (through an IV) before the MR scan is performed. Most schwannomas enhance with contrast administration. Other intradural tumors, such as meningiomas and myxopapillary ependymomas, may have a similar appearance to schwannoma on MR imaging.
The treatment of spinal schwannomas depends on the size, location, and symptoms of the tumor. Small tumors producing no pressure on nearby tissues in patients with no symptoms can often be observed over time with intermittent MR scans.
For larger or symptomatic tumors, or tumors showing growth over time, microsurgical removal is usually recommended. In most patients, complete removal of these tumors can be safely achieved using a surgical microscope, very fine instruments, and an array of microsurgical techniques. In many cases, patients experience an improvement in neurological function.
See Dr. McCormick performing the procedures in the videos below.
In some patients with large dumbbell tumors, spinal stabilization and fusion may be performed following complete tumor removal.
Resection of a cervical dumbbell schwannoma with stabilization
|Preparing for Your Appointment|
Dr. Paul C. McCormick is an expert in treating schwannomas. They can also offer you a second opinion.
Helpful Surgery Overviews
Dr. McCormick will choose the treatment method specific to each patient and situation. Some of the condition’s treatment options may be listed below.
Columbia Neurosurgeons Named New York’s Super Doctor
Dr McCormick video on microsurgical resection of a synovial cyst causing severe lumbar spinal stenosis published in Operative Neurosurgery
Synovial Cysts are a benign and fairly common condition in adult patients. They can arise in most joints throughout the body. In most cases they are asymptomatic but in the spine they can enlarge to produce severe spinal stenosis and pressure on the spinal nerves...
Dr. McCormick invited speaker at 37th Annual Meeting of the Joint Section on Disorders of the Spine and Peripheral Nerves
Dr. McCormick was a featured speaker at the recent 37th Annual Joint Spine Section Annual Spine Summit meeting held in San Diego. He presented at the Innovative Technology Special Session: Operative Video Segments. His presentation was entitled “Intramedullary Tumor,...