SCHWANNOMA TUMORS

What are the Typical Symptoms of Schwannoma Tumors?

Typically, schwannomas don’t show symptoms until they are large enough to push on the nearby nerves. The region that the damaged nerve controls may occasionally cause you discomfort. Other typical symptoms include:

• A skin-deep bump is visible.
• Piercing, throbbing, or searing pain.
• A tingling, pins, and needles feeling.
• Muscular tremor.
• Numbness.
• Nighttime neck or backache.

These symptoms might affect your face, arms, legs, or torso, depending on where the schwannoma is located. As the tumor grows, your symptoms might alter.

When it comes to spinal schwannomas, symptoms often remain absent until the tumor reaches a significant size, exerting pressure on nearby nerves or the spinal cord. This pressure can result in:

• Pain, numbness, or weakness in the affected limbs.
• Difficulty with balance.
• Lack of coordination, particularly noticeable in the hands.
• Back or neck pain that can wake you at night, is often referred to as night pain.

The nerve that connects your inner ear to your brain has several schwannomas. A vestibular schwannoma, also called an acoustic neuroma, is what this is. Acoustic neuromas can also result in the following symptoms in addition to those mentioned above:

• Either one or both ears ringing.
• Lack of balance and coordination.

Understanding the specific symptoms associated with different types of schwannomas, especially spinal schwannomas, can help in early detection and management, ensuring that any changes in symptoms are promptly addressed by healthcare professionals.

What Causes a Schwannoma?

In most cases, the cause of schwannoma is unknown. About 90% of cases are sporadic (incidental). Inherited disorders such as the Carney complex, neurofibromatosis 2 (NF2), and schwannomatosis can lead to schwannoma. Genetic studies indicate that the NF2 gene on chromosome 22 plays an important role in the development of schwannoma. People inherit a tendency to develop schwannoma from their parents and can pass the genetic condition on to their children.

Risk Factors of Schwannoma Tumors

Schwannoma has no recognized risk factors:

• Tumors can develop in people of any age or gender.
• Due to neurofibromatosis 2, women may occasionally develop Schwannoma Tumors more than males.
• The likelihood that a parent will pass on schwannoma to their offspring continues to as a factor. Genetic risk factors are still being investigated.

Genetic Influences and Sporadic Cases

Schwannomas can be linked to inherited conditions such as neurofibromatosis II (NF2) and schwannomatosis. These genetic disorders are significant factors that can predispose individuals to develop schwannomas, including those affecting the spine.

• Neurofibromatosis II (NF2): Known to cause multiple schwannomas, especially affecting the cranial and spinal nerves.
• Schwannomatosis: A rarer genetic condition, also associated with the development of these tumors.

For those without NF2 or schwannomatosis, schwannomas are termed “sporadic,” meaning they arise without any identifiable risk factors. These tumors are the most common type of nerve sheath tumors and typically occur as solitary tumors, implying that having one does not generally lead to the development of another.

Demographic Considerations

• Gender and Age: Both men and women are equally susceptible, with most cases occurring in middle-aged individuals. However, schwannomas can also present in children and older adults, albeit less frequently.

Understanding these factors provides a clearer picture of the risk landscape for schwannoma tumors, aiding in earlier recognition and treatment.

Diagnosis of Schwannoma Tumors

Due to the symptoms of schwannomas being similar to those of many other illnesses, diagnosis is challenging. They also have a very sluggish rate of growth, so whatever symptoms they do have are typically hardly perceptible. Your doctor may inquire about your signs and symptoms, go over your medical history, and do a routine physical examination, as well as a neurological assessment to determine whether you have a schwannoma. Your doctor could offer one or more of these diagnostic tests if symptoms point to the possibility that you have a schwannoma or another kind of nerve tumor:

Magnetic Resonance Imaging (MRI)

This scan creates a thorough, 3-D image of your nerves and surrounding tissue using a magnet and radio waves. MRI scans are particularly useful in diagnosing spinal schwannomas, as they can identify tumors as small as a few millimeters. A contrast-enhancing agent is often used to enhance the clarity of the images. This agent, administered intravenously, helps the schwannomas light up brightly on the scan, differentiating them from other intradural tumors like meningiomas and myxopapillary ependymomas.

Computerized Tomography (CT)

To take many pictures of your body, a CT scanner revolves around it. For your doctor to assess how your tumor’s growth could harm you, a computer utilizes the photos to create a comprehensive depiction of it.

Electromyogram (EMG)

In this test, a doctor inserts a small needle into a muscle so that an electromyograph records the muscle’s electrical activity when it tries to move it. Examination of nerve conduction. You may have this test taken with your EMG. It measures how quickly nerves transmit electrical signals to muscles.

Tumor Biopsy

If imaging tests reveal a nerve tumor, your doctor may take a tiny sample of cells (biopsy) from the tumor and examine them. You could require either local or general anesthesia for the biopsy, depending on the size and location of the tumor.

Nerve Biopsy

Your doctor could do a nerve biopsy if you have a disease like increasing peripheral neuropathy or swollen nerves that resemble nerve tumors. Depending on the magnitude of the tumor development, the course of therapy will start once the diagnosis has been made.

By leveraging these diagnostic tools, particularly the detailed imaging offered by MRIs, healthcare providers can effectively pinpoint the presence and specifics of spinal schwannomas, leading to informed decisions about treatment.

Classification of Spinal Schwannomas

Spinal schwannomas, a type of tumor affecting the protective membrane around nerves, are categorized primarily based on three factors: size, location, and their relationship with the dura. The dura is a delicate membrane that encloses essential components, including the spinal cord and parts of the spinal nerves.

Type I

These tumors lie entirely within the dura. This is the most common type of spinal schwannoma, remaining enclosed without extending beyond the membrane’s confines.

Type II

Initially arising within the dura, these tumors grow along a spinal nerve’s path and exit the spinal canal through the neural foramen—a channel allowing nerves to pass from the spine to the body. Due to their configuration, they feature a component inside and another outside the canal, forming what’s known as a dumbbell shape.

Type III

These are located entirely outside the spinal canal and are often referred to as paraspinal nerve sheath tumors. They do not breach the dura at any point.

Type IV

Originating outside the spinal canal, these tumors develop similarly to Type III but eventually infiltrate the spinal canal through the foramen. Like Type II, they take on a dumbbell shape, with sections inside and outside the spinal canal.

Understanding these classifications helps in assessing the nature and potential treatment approaches for schwannomas. Each type presents distinct challenges based on its position and growth pattern, directly influencing surgical and therapeutic strategies.

Treatment

To search for any indicators of Schwannoma, the oncologist, a cancer expert, will ask about the patient’s whole medical history and evaluate all outward skin irritation. Treatment for schwannomas is based on the location of the abnormal growth, as well as if it hurts or is enlarging fast. Options for treatment include:

• Your doctor might advise keeping an eye on your condition over time. Regular checks and an MRI or CT scan every few months to monitor the tumor’s growth will greatly help the doctor understand the patient’s condition.
• Because these are benign, slow-growing lesions, they are indicated for patients over the age of 70 with very small lesions and severe systemic or asymptomatic disease.

Surgery

If the tumor is hurting or expanding rapidly, a skilled peripheral nerve surgeon can remove it. Under general anesthesia, surgery on schwannomas is performed. Some patients can leave the hospital the day after surgery, depending on the location of the tumor. Some individuals may require a one- or two-day hospital stay. A tumor can come back even after it has been successfully removed after surgery. Surgery may often remove schwannomas with minimal possibility of them coming back until they are big enough to obstruct nerves or surrounding structures or to disfigure a person. Schwannomas tend to stay rather small, therefore standard surgery may completely remove the tumor.

The surgeon exposes the nerve, isolates the schwannoma from the healthy nerve tissue using precise microsurgical methods, and then eliminates it. It is crucial to seek the advice of a skilled surgeon like those at the Southwest Scoliosis and Spine Institute with experience in treating nerve tumors since some schwannoma surgical operations may need nerve restoration if the tumor’s removal will damage a nerve. The nerve function may improve quickly following successful surgery for treatments on peripheral nerve schwannomas, but if the schwannoma damages muscles, they could take longer to mend. Muscle dysfunction or weakness can occasionally last a lifetime. After surgery to remove a vestibular schwannoma, symptoms including facial paralysis, hearing loss, and headaches may last for weeks or even months before getting better.

Surgical Techniques for Removing Spinal Schwannomas

When it comes to the removal of spinal schwannomas, the approach largely depends on various factors such as the tumor’s size, location, and the symptoms presented by the patient.

Observation vs. Surgery

• Observation: If a spinal schwannoma is small, asymptomatic, and not exerting pressure on surrounding tissues, it might be manageable through regular monitoring with MRI scans.
• Surgery: For larger tumors, causing symptoms, or showing growth, surgical intervention is often necessary.

Microsurgical Techniques

The most effective approach for removing spinal schwannomas involves microsurgical techniques. These techniques allow for the precise removal of tumors:

• Surgical Microscopes: Surgeons employ high-powered microscopes to gain a clear and magnified view of the tumor and surrounding nerves, which facilitates meticulous dissection and removal.
• Fine Instruments: The use of very fine, specialized instruments ensures accuracy and minimizes damage to the surrounding healthy tissue.
• Microsurgical Techniques: An array of microsurgical techniques is utilized to carefully separate and excise the tumor from nerve fibers or spinal structures.

These advanced techniques not only aim to completely remove the tumor but also prioritize preserving neurological function. Many patients experience improvements in their symptoms post-surgery, highlighting the effectiveness of these methods.

Radiation therapy

Radiation therapy is used to control tumor growth and improve symptoms. Along with surgery, radiation often will help the patient. Stereotactic radiosurgery (SRS) uses many precisely focused beams to destroy a tumor. If the tumor is near vital blood vessels or nerves, the doctor may recommend radiation therapy instead of surgery to avoid potential complications.

Stereotactic radiosurgery

A method known as stereotactic body radiation treatment may reduce harm to healthy tissue if the tumor appears close to important nerves or blood arteries. With this method, medical professionals may accurately apply radiation to a tumor without cutting the skin. Therefore, only microsurgery, which works for medium and large-sized tumors, can result in a full cure. A 12  to 24-hour stay in an intensive care unit is necessary after the treatment, along with continuous neurophysiological monitoring. It is possible to mix radiosurgery with microsurgery.

What is the Outlook for Schwannoma Tumors?

The prognosis for schwannoma relies on several variables, including:

• The location of the tumor.
• The tumor’s size.
• How much of the tumor was removed during surgery, if any?
• A benign or cancerous tumor.

The outlook for schwannoma is often favorable. When a tumor is eliminated, it often doesn’t return (recur). 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. This precise approach not only ensures the safe removal of the tumor but also significantly contributes to the improvement in neurological function that many patients experience post-surgery.

However, the majority of schwannoma problems usually develop following tumor removal surgery. The following situations considerably increase the likelihood of postoperative complications:

• If the tumor is significant.
• When the tumor is deep in the interior of the body.
• If your ulnar nerve is the site of the tumor (one of the three main nerves in your arm).

Despite these potential challenges, the advanced surgical techniques employed tend to minimize risks and enhance recovery, offering a hopeful prognosis for those undergoing treatment.

What Possible Side Effects Might Schwannoma Tumors Cause?

Finally, by sticking to the treatment plan that you and your healthcare provider specifically created for you, you can reduce your chance of experiencing major consequences. Schwannoma complications include:

• Adverse consequences of schwannoma treatment
• Loss of function, most often hearing loss, in the afflicted area
• In the afflicted region, numbness
• The afflicted region is in pain.
• In the afflicted region, paralysis
• Cancer returning

When a Patient is Diagnosed With a Schwannoma Tumor on their Spine, Who Should They See?

If a patient has been diagnosed with a schwannoma tumor on their spine, seeking care at the Southwest Scoliosis and Spine Institute, with offices in Dallas, Plano, and Frisco, Texas, can offer several benefits. Here are a few reasons why:

Expertise in Spine Conditions

The Southwest Scoliosis and Spine Institute specializes in treating various spine conditions, including schwannomas. They have a team of experienced spine specialists who are well-versed in diagnosing and treating these tumors. Their expertise ensures patients receive accurate evaluations, tailored treatment plans, and optimal care for their conditions.

Comprehensive Treatment Options

The institute offers a wide range of treatment options for schwannomas, including both non-surgical and surgical approaches. They can assess the tumor’s characteristics and location to determine the most suitable treatment strategy. This may involve monitoring the tumor’s growth, utilizing targeted therapies, or considering surgical removal when necessary.

Individualized Care and Support

The Southwest Scoliosis and Spine Institute prioritizes personalized care for each patient. They understand that schwannomas can have varying impacts and complexities, and they take the time to listen to patient’s concerns and provide compassionate support throughout the treatment journey. Their multidisciplinary team works together to address all aspects of the condition, from diagnosis to rehabilitation, ensuring the best possible outcome for the patient.

Collaboration and Advanced Technology

The institute emphasizes collaboration among specialists and utilizes advanced technology and diagnostic tools to provide precise evaluations and treatment planning. This enables them to offer the most effective and innovative treatment options available for schwannoma tumors.

Focus on Quality of Life

The Southwest Scoliosis and Spine Institute recognizes the importance of preserving and improving patients’ quality of life. They aim to alleviate symptoms, minimize the impact of the tumor on spinal function, and restore mobility and overall well-being. Their holistic approach takes into account the physical, emotional, and functional aspects of the patient’s condition, aiming for the best possible long-term outcomes.

It is important to consult with the Southwest Scoliosis and Spine Institute or a trusted healthcare professional for a thorough evaluation and to discuss personalized treatment options based on the specific characteristics of the schwannoma tumor and the individual patient’s needs. We have appointments within 24 hours.  Call us.

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WebMD: Neurofibrosarcoma and Schwannoma