Surgical Principles for Spinal and Paraspinal Neurofibromas

Neurofibromas are the most prevalent seen tumor in the neurofibromatosis type 1 (NF1) disease. Spinal neurofibromas, which are the major diagnostic criteria of disease, are seen in approximately 60% of the patients with NF1. They constitute 23% of all of the spinal tumors. While the spinal neurofibromas most frequently show a location in thoracic region, it is followed by their predilection in cervical and lumbar regions, respectively. The spinal neurofibromas located in the sacral region are quite rarely observed and show an asymptomatic course until reaching to the big sizes. Of these spinal neurofibromas, 72% were with intradural extramedullary, 14% with extradural, and 13% with intradural and extradural “dumbbell formation.” Only 1% of the spinal neurofibromas are intramedullary located. The total taking of the single solitary neurofibroma surgically is relatively easier. But, the difficulties can be encountered in taking these tumors surgically since they are characterized by the multiple tumors in the plexiform neurofibromas, especially accompanying to the NF1. In this chapter, the surgical difficulties encountered in the region in which the tumor is localized and different surgical approaches are developed in the course of time in order to exceed these difficulties are described.