Surgical resection is the treatment of choice 1) 2).
Gross total resection (GTR) of the tumor with as much preservation of neurovascular structures as possible 3).
Preoperative planning remains crucial for successful Spinal Schwannoma treatment and relies to a great extent on proper tumor spinal schwannoma classification.
They need a tailored treatment, which in most cases works through one surgical approach. Usually it is possible to perform a complete resection with a good postoperative prognosis 4).
Unlike neurofibromas, schwannomas do not arise from the nerve fibers and so the tumor is easily separated from nerve fibers without neurologic compromise. In the rare case that this is impossible, the remnant tumor may be followed up radiographically if it is histologically benign. Malignant schwannomas are treated with adjuvant radiation therapy.
In the series of Asazuma et al., a posterior approach was used in 35 patients; 7 others underwent a combined anterior and posterior approach. A posterior approach was used for all type IIa and IIIa tumors, and for some type IIIb (upper cervical), IV, and VI tumors; a combined posterior and anterior approach was used for type IIb and the remainder of type IV and VI. Reconstruction was performed using spinal instrumentation in 4 patients (9.5%). Resection was subtotal in 6 patients (14.3%) and total in 36 (85.7%). 5).