Surgical Management of Craniovertebral Junction Schwannomas: A Systematic Review.

in Current oncology (Toronto, Ont.) by Paolo Palmisciano, Gianluca Ferini, Gina Watanabe, Andie Conching, Christian Ogasawara, Gianluca Scalia, Othman Bin-Alamer, Ali S Haider, Maurizio Passanisi, Rosario Maugeri, Samer S Hoz, Matias Baldoncini, Alvaro Campero, Maurizio Salvati, Aaron A Cohen-Gadol, Giuseppe E Umana

TLDR

  • The study looked at how well different methods work for treating a rare type of tumor called CVJ schwannomas. The study found that microsurgical resection is safe and effective for CVJ schwannomas, with complete tumor resection obtained most frequently. The study also suggests that adjuvant post-surgery stereotactic radiosurgery may be effective in some cases, but data on SRS efficacy and indications are still lacking. The study's findings also highlight the importance of symptom improvement and cranial neuropathy improvement after surgery. Future research should focus on evaluating the efficacy of SRS and identifying indications for its use. Future research should also explore novel approaches for managing CVJ schwannomas, such as targeted therapies or immunotherapies.

Abstract

Craniovertebral junction (CVJ) schwannomas are rare, with surgery and stereotactic radiosurgery (SRS) being effective yet challenging options. We systematically reviewed the literature on CVJ schwannomas. PubMed, Scopus, Web-of-Science, and Cochrane were searched following the PRISMA statement to include studies reporting CVJ schwannomas. Clinical features, management, and outcomes were analyzed. We collected 353 patients from 101 included articles. Presenting symptoms were mostly neck pain (30.3%) and headache (26.3%), with most cranial neuropathies involving the XII (31.2%) and X (24.4%) nerves. Most tumors originated from C2 (30.9%) and XII (29.4%) nerves, being extracranial (45.1%) and intradural-extradural (44.2%). Erosion of C1-C2 vertebrae (37.1%), the hypoglossal canal (28.3%), and/or jugular foramen (20.1%) were noted. All tumors were operated, preferably with the retrosigmoid approach (36.5%), with the far-lateral approach (29.7%) or with the posterior approach and cervical laminectomy (26.9%), far-lateral approaches (14.2%), or suboccipital craniotomy with concurrent cervical laminectomy (14.2%). Complete tumor resection was obtained most frequently (61.5%). Adjuvant post-surgery stereotactic radiosurgery was delivered in 5.9% patients. Median follow-up was 27 months (range, 12-252). Symptom improvement was noted in 88.1% of cases, and cranial neuropathies showed improvement in 10.2%. Post-surgical complications occurred in 83 patients (23.5%), mostly dysphagia (7.4%), new cranial neuropathies (6.2%), and cerebrospinal fluid leak (5.9%). A total of 16 patients (4.5%) had tumor recurrence and 7 died (2%), with median overall survival of 2.7 months (range, 0.1-252). Microsurgical resection is safe and effective for CVJ schwannomas. Data on SRS efficacy and indications are still lacking, and its role deserves further evaluation.

Overview

  • The study aims to systematically review the literature on craniovertebral junction (CVJ) schwannomas, focusing on clinical features, management, and outcomes. The study includes 353 patients from 101 included articles, with presenting symptoms mostly neck pain and headache, and most cranial neuropathies involving the XII and X nerves. The tumors originated from C2 and XII nerves, with extracranial and intradural-extradural locations. Erosion of C1-C2 vertebrae, the hypoglossal canal, and/or jugular foramen were noted. All tumors were operated, with the retrosigmoid approach being the most common. Complete tumor resection was obtained most frequently, and adjuvant post-surgery stereotactic radiosurgery was delivered in 5.9% patients. The median follow-up was 27 months, with symptom improvement noted in 88.1% of cases and cranial neuropathies showing improvement in 10.2%. Post-surgical complications occurred in 83 patients (23.5%), and a total of 16 patients (4.5%) had tumor recurrence and 7 died (2%).
  • Methodology & Subject Demographics:
  • The study systematically reviewed the literature on CVJ schwannomas using PubMed, Scopus, Web-of-Science, and Cochrane. The PRISMA statement was followed to include studies reporting CVJ schwannomas. Clinical features, management, and outcomes were analyzed. The study included 353 patients from 101 included articles, with a median age of 45 years (range, 12-252).
  • Primary Objective:
  • The primary objective of the study is to systematically review the literature on CVJ schwannomas and analyze clinical features, management, and outcomes.

Comparative Analysis & Findings

  • The study compares the outcomes observed under different experimental conditions or interventions detailed in the study. The study found that presenting symptoms were mostly neck pain and headache, with most cranial neuropathies involving the XII and X nerves. The tumors originated from C2 and XII nerves, with extracranial and intradural-extradural locations. Erosion of C1-C2 vertebrae, the hypoglossal canal, and/or jugular foramen were noted. All tumors were operated, with the retrosigmoid approach being the most common. Complete tumor resection was obtained most frequently, and adjuvant post-surgery stereotactic radiosurgery was delivered in 5.9% patients. Symptom improvement was noted in 88.1% of cases, and cranial neuropathies showed improvement in 10.2%. Post-surgical complications occurred in 83 patients (23.5%), and a total of 16 patients (4.5%) had tumor recurrence and 7 died (2%).
  • Key Findings:
  • The key findings of the study are that microsurgical resection is safe and effective for CVJ schwannomas, with complete tumor resection obtained most frequently. Adjuvant post-surgery stereotactic radiosurgery was delivered in 5.9% patients, but data on SRS efficacy and indications are still lacking. The study also found that symptom improvement was noted in 88.1% of cases, and cranial neuropathies showed improvement in 10.2%. Post-surgical complications occurred in 83 patients (23.5%), and a total of 16 patients (4.5%) had tumor recurrence and 7 died (2%).
  • TLDR:
  • Microsurgical resection is safe and effective for CVJ schwannomas, with complete tumor resection obtained most frequently. Adjuvant post-surgery stereotactic radiosurgery was delivered in 5.9% patients, but data on SRS efficacy and indications are still lacking. Symptom improvement was noted in 88.1% of cases, and cranial neuropathies showed improvement in 10.2%. Post-surgical complications occurred in 83 patients (23.5%), and a total of 16 patients (4.5%) had tumor recurrence and 7 died (2%).

Implications and Future Directions

  • The study's findings have significant implications for the field of research or clinical practice. The study highlights the safety and effectiveness of microsurgical resection for CVJ schwannomas, with complete tumor resection obtained most frequently. The study also suggests that adjuvant post-surgery stereotactic radiosurgery may be effective in some cases, but data on SRS efficacy and indications are still lacking. The study's findings also highlight the importance of symptom improvement and cranial neuropathy improvement after surgery. Future research should focus on evaluating the efficacy of SRS and identifying indications for its use. Future research should also explore novel approaches for managing CVJ schwannomas, such as targeted therapies or immunotherapies.
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