Intracapsular Resection of Thoracic Extradural Schwannomas via the Isthmic Approach: Investigation of Clinical Feasibility With 41 Case Series

Objective

Thoracic spinal canal schwannomas can pose surgical challenges when extending into intra- and extra-foraminal regions and the thoracic cavity. This article aims to elucidate the technical nuances and clinical feasibility of the isthmic approach for treating thoracic extradural schwannomas via intracapsular resection.

Methods

The surgical technique was meticulously outlined, and a retrospective analysis of 41 patients who underwent thoracic schwannoma resection via the isthmic approach between January 2014 and August 2022 was conducted. Parameters including gross total resection (GTR) rate, operative duration, estimated blood loss (EBL), incision length, and postoperative hospital stay were evaluated. Preoperative and postoperative neurosurgical functions were assessed using the modified McCormick functional schema and Visual Analogue Scale (VAS).

Result

All patients achieved GTR, with an operative time of 125.37 ± 45.17 min, an average incision length of 6.56 ± 1.04 cm, and an estimated blood loss of 69.88 ± 86.54 mL. The average hospital stay was 6.76 ± 3.73 days. The VAS score significantly decreased postoperatively (preoperative vs. postoperative: 2.10 ± 0.85 vs. 1.32 ± 0.47, p < 0.001).

Conclusion

The isthmic approach via intracapsular resection is a promising method for treating extradural schwannomas extending into intra- and extra-foraminal regions. This approach enhances total tumor resection rates, preserves spinal stability, and significantly reduces operative duration, incision length, and blood loss.