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MRI of Schwannoma of Spinal Protective Membrane (Dura)
Membrane (Dura)
The spinal cord and its associated structures are rare sites of tumor occurrence. The most common tumors developing from tissues within the spinal cord are known as astrocytomas or ependymomas. Tumors may also develop from supporting tissues of the spinal cord and nerves, such as schwannomas, neurofibromas, or meningiomas. The majority of these tumors are benign and spread beyond the spinal canal is extremely rare. Due to the compressive effect on the neural elements, however, these lesions can produce significant neurological deficit. Adjuvant therapy in the form of radiation or chemotherapy has little effect. Surgical resection is regarded as the treatment of choice.
Surgical Procedure
The procedure is performed under general anesthesia. Electro-physiological monitoring of spinal cord function is conducted prior to and during the operation. A midline incision is made overlying the tumor. The soft tissues are dissected to expose the back of the spine. The superficial spinal bones (the laminae) are removed to access the spinal canal. Within the spinal canal is a tissue-lined compartment that contains the spinal cord and nerves that are bathed in cerebrospinal fluid. The tissue lining of this compartment is known as the dura. The dura is opened parallel to the long axis of the spine to expose the spinal cord and nerves. Using microsurgical technique, the tumor is dissected free from the surrounding normal structures. A specimen is sent for pathological analysis during the surgical procedure in order to obtain a preliminary diagnosis. Once the tumor is removed the dura is sutured closed. A water-tight closure of the dura is essential in order to avoid leakage of the cerebrospinal fluid. The soft tissues overlying the spine are then closed in multiple layers and the skin closed with either staples or a nylon suture. If a water-tight closure of the dura cannot be achieved, the cerebrospinal fluid is diverted away from the operative site through an external drain. The incision is dressed with a gauze bandage.
Spinal Surgery (view from side)
Course of Treatment
Patients are typically admitted for several days following surgery. Initially the patient is required to remain in bed for several days following surgery to improve wound healing. Consultation with a physical therapist or rehabilitation specialist is obtained if necessary, depending on the degree of pre-operative neurological deficit. Pain management is controlled with oral analgesics. A period of intermittent catheterization may be required to assist with urinary function if the tumor has affected the nerves supplying the bladder. Following discharge, patients usually receive either in- or outpatient rehabilitation. Activity is increased as tolerated; however, strenuous activity is not recommended until cleared by the treating physician.
