The expression of glutamate metabolism modulators in the intracranial tumors and glioblastoma cell line.

BACKGROUND: The accumulation of excess glutamate in the synapse leads to excitotoxicity, which is the underlying reason of neuronal death in intracranial tumors. METHODS AND RESULTS: We identified the expression levels of glutamate dehydrogenase, glutamine synthetase and sirtuin 4 in U87 cell line and various intracranial tumors. mRNA expressions of glutamate dehydrogenase (GDH), glutamine synthetase (GS) and sirtuin 4 (SIRT4) were analyzed in various intracranial tumors using qPCR. GDH, GS and SIRT4 protein expressions were analyzed in glioblastoma (U87) and glial (IHA-immortalized human astrocytes) cell lines via western blotting. The protein expressions of SIRT4 and GS were shown to be elevated and GDH protein expression was reduced in U87 cells in comparison to IHA cells. All types of intracranial tumors displayed lower GS mRNA expressions compared to controls. SIRT4 mRNA expressions were also shown to be lower in all the tumors and grades, although not significantly. GDH mRNA expression was found to be similar in all groups. CONCLUSION: The molecular mechanisms of glutamate metabolism and excitotoxicity should be discovered to develop therapies against intracranial tumors.

Microsurgical endoscopy-assisted presigmoid retrolabyrinthine approach with mastoid bone drilling: an anatomical laboratory investigation.

PURPOSE: This study aims to evaluate the applicability of the endoscopy-assisted presigmoid retrolabyrinthine approach, advantages, disadvantages, and the applicability of surgery with pre-op radiological parameters; identify important landmarks; and to reveal their relationships with important structures in the surgical field with objective data. Also, we aim to improve the surgical technique for increasing reachable anatomic structure. METHODS: Mastoid drilling and endoscopy-assisted presigmoid retrolabyrinthine approach were performed and endoscopic instruments were used to obtain the three-dimensional pictures. Computed tomography images were evaluated to correlate to the anatomic data. RESULTS: In terms of pre-operative radiological evaluation of the applicability of the presigmoid approach were investigated with selected radiological parameters. The endoscopy-assisted presigmoid retrolabyrinthine approach applied to cadavers the relationship, distances between important anatomical landmarks, and anatomical structures in the surgical field recorded. The anatomical structures that could reach with the application of the procedure were recorded. The relationship between pre-operative measured radiological parameters and surgical results was evaluated with objective data. Additional combinations to improve this surgical method discussed and the results of our combination were recorded with photographs. CONCLUSION: Although the presigmoid retrolabyrinthine approach has facilitated with the assistance of endoscope, it has observed that there are still some difficulties, and it has been concluded that the radiological parameters are useful in evaluating the applicability of this surgery. It observed that this surgery can be performed more effectively with combinations.

The benefits of inferolateral transtubercular route on intradural surgical exposure using the endoscopic endonasal transclival approach.

BACKGROUND: Surgical access to the ventral pontomedullary junction (PMJ) can be achieved through various corridors depending on the location and extension of the lesion. The jugular tubercle (JT), a surgically challenging obstacle to access the PMJ, typically needs to be addressed in transcranial exposures. We describe the endoscopic endonasal transclival approach (EETCA) and its inferolateral transtubercular extension to assess the intradural surgical field gained through JT removal. We also complement the dissections with an illustrative case. METHODS: EETCA was surgically simulated, and the anatomical landmarks were assessed in eight cadaveric heads. Microsurgical dissections were additionally performed along the endoscopic surgical path. Lastly, we present an intraoperative video of the trans-JT approach in a patient with lower clival chordoma. RESULTS: The EETCA allowed adequate extracranial visualization and removal of the JT. The surgical bony window-obtained along the clivus and centered at the JT via the EETCA-measured 11 × 9 × 7 mm. Removal of the JT provided an improved intradural field within the lower third of the cerebellopontine cistern to expose an area bordered by the cranial nerves VII/VIII and flocculus superior and anterior margin of the lateral recess of the fourth ventricle and cranial nerves IX-XI inferiorly, centered on the foramen of Luschka. CONCLUSIONS: Removal of the JT via EETCA improves exposure along the lower third of the cerebellopontine and upper cerebellomedullary cisterns. The inferolateral transtubercular extension of the EETCA provides access to the lateral recess of the fourth ventricle, in combination with the ventral midline pontomedullary region.

A Case of Pseudoaneurysm of the Internal Carotid Artery Following Endoscopic Endonasal Pituitary Surgery: Endovascular Treatment with Flow-Diverting Stent Implantation.

Internal carotid artery (ICA) pseudoaneurysm is a rare complication of endoscopic endonasal surgery occurring in 0.4-1.1% of cases. Pseudoaneurysms can subsequently result in other complications, such as subarachnoid hemorrhage, epistaxis, and caroticocavernous fistula with resultant death or permanent neurologic deficit. In this case, we illustrate endovascular treatment with a flow-diverting stent for an ICA pseudoaneurysm after endoscopic endonasal surgery for a pituitary adenoma in a 56-year-old male. Surgery was complicated by excessive intraoperative bleeding and emergent CT angiography confirmed an iatrogenic pseudoaneurysm on the anteromedial surface of the ICA. The pseudoaneurysm was treated endovascularly with flow-diverting stent implantation only. Follow-up CT angiography after three months demonstrated occlusion of the pseudoaneurysm.

A Rare History: an Intracranial Nail Present for Over a Half-Century.

We present a rare case of a patient with a persistent headache for many years found to have an intracranial nail present for nearly 65 years. The nail was found entering approximately 1 cm from the midline on the left side, passing below the superior sagittal sinus, with the tip 1.5 mm right of the frontal horn of the lateral ventricle. Treatment strategies designed to optimize outcome for intracranial foreign bodies and possible complications are discussed in this report. We also discuss the decision for surgical intervention for foreign bodies and the relevance of position of the foreign body.

Cerebral venous sinus thrombosis associated with spontaneous intermittent cerebrospinal fluid rhinorrhea: a case report.

OBJECTIVES: To present a rare case of cerebral venous sinus thrombosis (CVST). CLINICAL PRESENTATION AND INTERVENTION: A 43-year-old woman presented with coma and was diagnosed as a case of CVST. She recovered in a few days with heparin treatment. Many possible risk factors for CSVT were negative in the patient but intermittent cerebrospinal fluid (CSF) rhinorrhea was accidentally noticed. Cerebral computed tomography and magnetic resonance imaging were done. The patient was diagnosed as having spontaneous intermittent CSF rhinorrhea due to a defect in the base of the skull. CONCLUSIONS: This case showed the importance of being aware that a defect in the base of the skull may lead to intermittent CSF rhinorrhea in patients with CVST.

Management Strategy for a Patient with Coexistence of Meningioma and Paraophthalmic Aneurysm.

The coexistence of intracerebral aneurysm and meningioma is a rare occurrence. There is no consensus about the treatment options. We aim to present a case of a 61-year female admitted to this clinic with persistent headache and loss of vision in both eyes, especially on the left. Radiological images demonstrated a para-ophthalmic saccular aneurysm coexisting with an extra-axial homogenously enhancing mass in the right cavernous sinus, which was possibly a meningioma. A flow diverting stent, following the coil embolisation of the aneurysm, was placed. Then the patient underwent stereotactic radiosurgery for the cavernous sinus meningioma. Diagnosis and treatment of such pathologies are easily achieved with the technological advancements of imaging techniques. The hypothesis of increased hemodynamic pressures, due to meningioma causing intracranial aneurysms, may explain this coexistence. Endovascular surgery, followed by stereotactic radiosurgery, may be a reliable approach for a patient with coexistent meningioma and aneurysm. Key Words: Meningioma, Aneurysm, Cavernous sinus.

Nonvestibular schwannomas: an evaluation of functional outcome after radiosurgical and microsurgical management.

PURPOSE: Nonvestibular cranial nerve schwannomas (NVCNS) are relatively rare tumors. We evaluated our experience with radiosurgical and microsurgical treatment alone and in combination for the management of NVCNS. METHODS: The charts of 62 patients with NVCNS who were treated between 1993 and 2005 at our institution were reviewed. Patients diagnosed with neurofibromatosis type 2 were excluded. The patients underwent microsurgery and/or radiosurgery treatment. RESULTS: Trigeminal and jugular foramen schwannomas were the most common NVCNS tumors (n = 47), and the only two groups with sufficient numbers of patients to allow comparison of the three treatment approaches. In these two groups, the mean tumor volume was significantly higher in those who received combined therapy (8.59 +/- 2.29 cc), compared with radiosurgery (4.94 +/- 3.02 cc; p = 0.05) or microsurgery alone (5.38 +/- 3.23; p = 0.027). Patients who underwent radiosurgery alone were significantly older (67.7 +/- 13.3 years; p = 0.019) than those treated with microsurgery (55.3 +/- 13.7 years) or with both modalities (48.7 +/- 12.8 years). The Karnofsky Performance Scale scores were significantly higher (p < or = 0.05) at follow-up compared with baseline for all three treatment approaches. There was no significant change in the Glasgow Outcome scores before and after treatment. CONCLUSIONS: Microsurgery and radiosurgery can both be used to manage NVCNS tumors with excellent results. When treatment with either modality alone is not reasonable, tumors can be managed effectively with combined micro- and radiosurgery treatment.

Morphologic evaluation of cervical and lumbar facet joints: intra-articular facet block considerations.

STUDY DESIGN: Needle orientations for lumbar and cervical facet injection were measured in cadavers and compared with facet angles measured on magnetic resonance images (MRIs). OBJECTIVES: To establish facet orientation relative to clinical procedures of a facet joint block in the cervical and lumbar spine. METHODS: Needle orientation angles were measured from 20 unembalmed human cadaveric specimens (13 cervical and 7 lumbar). Spinal needles were inserted into the midpoints of the facet joint spaces from C3 to C7 and L1 to L5. Needle trajectories were measured with an optical tracking system. For comparison, facet angles from 100 clinical MRIs of lumbar spines were also measured. Facet orientations on MRIs were measured at their intersection with the transverse plane, and angles were quantified using image analysis software. RESULTS: Typical angles for insertion of the needle into the cervical facets were oriented closer to the coronal plane, whereas insertion angles for lumbar needles were oriented closer to the sagittal plane. Relative to the sagittal plane, the mean cervical angle was 72 degrees and the mean lumbar angle was 33 degrees. The insertion points of the cervical facets were a mean of 29 mm from the midsagittal plane compared with a mean of 22 mm for the lumbar facets. MRI-based facet joint angles correlated poorly with actual injection angles, which were overestimated 5 to 23 degrees, depending on the lumbar level. CONCLUSIONS: Knowledge of the quantitative anatomy of the facets may help improve clinical diagnosis and treatment. These data also may aid in constructing more realistic computer simulations.

Glutamate Transporter 1 expression in human glioblastomas.

PURPOSE: The purpose of our study was to investigate the mRNA expression profile of glutamate transporter 1 (GLT-1) in different types and grades of brain tumors, such as glioblastoma multiforme, astrocytomas (pilocytic, diffuse, anaplastic), oligodendrogliomas, ependydomas, medulloblastomas, and meningiomas using Real Time Quantitative PCR technique (qRT-PCR). METHODS: A total of 66 surgically removed primary brain tumors were collected retrospectively and the total RNA was isolated from each tumor sample. cDNA was generated and GLT-1 mRNA expression was evaluated with quantitative qRT-PCR. RESULTS: The mRNA expression of GLT-1 was significantly lower in primary brain tumors when compared to control brain tissues. GLT-1 expression was inversely correlated with the tumor grade, implicating its potential role in tumor progression. GLT-1 mRNA expression was lowest in grade 4 tumors, such as glioblastoma multiforme and medulloblastomas. The tumors with grade 3 and 4 combined displayed lower expression compared to tumors with grades 1 and 2. In grade 4 tumors, female patients displayed lower GLT-1 expression compared to male patients. In addition, glioblastoma multiforme patients older than 65 years of age showed lower GLT-1 expression when compared to the patients younger than 65. CONCLUSION: qRT-PCR was found to be a sensitive method in detecting GLT-1 expression in brain tumors. This study may lay the foundation for the future research about the excitotoxicity and brain tumors and GLT-1 might be a potential biomarker. Targeted therapies based on excitotoxic molecular pathways against gliomas should be designed to effectively combat these diseases.

Endoscopic endonasal transclival approach to the ventral brainstem: Radiologic, anatomic feasibility and nuances, surgical limitations and future directions.

The endoscopic endonasal transclival approach (EETA) is less invasive than traditional open approaches; however, there is currently limited data on the pre-operative features that may predict success of the EETA. Surgical landmarks and exposure of the EETA and expanded EETA are assessed. We retrospectively measured multiple anatomic features in 154 adult dry skulls, 22 C1 and C2 dry bone vertebrae, and 500 paranasal sinus computed tomography (CT) scans. We also dissected 13 formalin-fixed, silicone-injected adult cadaveric heads. Relevant qualitative and quantitative data were obtained with CT (n = 10) and cadaveric dissection (n = 13). They are expressed as mean (SD), as appropriate and compared with unpaired t tests. Categorical variables were compared with χ2 tests. We determined the prevalence of clival and sphenoid sinus anatomic variations and assessed potential exposure of the craniovertebral region, based on the relative position of the nasal bone tip, posterior point of the hard palate, and their relation to the position of C1 and C2. Depending on anatomic features, EETA should allow visualization of the ventral brainstem. The mean (SD) dimensions of the surgical window for EETA were 43.2 (5.1) × 18.3 (1.1) mm, in the craniocaudad and horizontal dimensions, respectively. The craniocaudad dimension enlarged to 60.2 (4.7) mm with expanded EETA. The EETA allowed satisfactory exposure for odontoid and C1 anterior arch resection (expanded EETA) in all specimens, regardless of the orientation of the palate. The combination of preoperative radiographic assessment and intraoperative considerations allows safe and effective application and facilitate selection of the most appropriate approach.

Biomechanics of C-7 transfacet screw fixation.

OBJECT: The small diameter of the pedicle can make C-7 pedicle screw insertion dangerous. Although transfacet screws have been studied biomechanically when used in pinning joints, they have not been well studied when used as part of a C7-T1 screw/rod construct. The authors therefore compared C7-T1 fixation using a C-7 transfacet screw/T-1 pedicle screw construct with a construct composed of pedicle screws at both levels. METHODS: Each rigid posterior screw/rod construct was placed in 7 human cadaveric C6-T2 specimens (14 total). Specimens were tested in normal condition, after 2-column instability, and once fixated. Nondestructive, nonconstraining pure moments (maximum 1.5 Nm) were applied to induce flexion, extension, lateral bending, and axial rotation while recording 3D motion optoelectronically. The entire construct was then loaded to failure by dorsal linear force. RESULTS: There was no significant difference in angular range of motion between the 2 instrumented groups during any loading mode (p > 0.11, nonpaired t-tests). Both constructs reduced motion to < 2 degrees in any direction and allowed significantly less motion than in the normal condition. The C-7 facet screw/T-1 pedicle screw construct allowed a small but significantly greater lax zone than the pedicle screw/rod construct during lateral bending, and it failed under significantly less load than the pedicle screw/rod construct (p < 0.001). CONCLUSIONS: When C-7 transfacet screws are connected to T-1 pedicle screws, they provide equivalent stability of constructs formed by pedicle screws at both levels. Although less resistant to failure, the transfacet screw construct should be a viable alternative in patients with healthy bone.

C2 intralaminar screw placement: a quantitative anatomical and morphometric evaluation.

AIM: To investigate the feasibility of placing a screw in the C2 lamina and evaluate the reliability of the surface of the dorsal arch of C2 as a landmark for determining the optimal site of screw entry. MATERIAL AND METHODS: 88 adult human C2 spines were used. Seven measurements were determined for screw entry points, trajectories, and lengths for placement of intralaminar screws. RESULTS: The average width of right C2 lamina (1/3 upper segment) was 2.6 mm (1.2 to 4.1 mm). The average width of left C2 lamina (1/3 upper segment) was 2.6 mm (1 to 4 mm). The average width of right C2 lamina (1/3 middle segment) was 4.9 mm (2.6 to 6.8 mm). The average width of left C2 lamina (1/3 middle segment) was 4.9 mm (2.3 to 7.6 mm). The average width of right C2 lamina (1/3 lower segment) was 5.7 mm (3.3 to 8.2 mm). The average width of left C2 lamina (1/3 lower segment) was 5.8 mm (2.2 to 9.6 mm). CONCLUSION: The width of the upper one-third of C2 lamina is not appropriate for the placement of intralaminar screws. On the other hand, the width of the middle and lower one-third of C2 lamina is more convenient for intralaminar screw delivery.

Combined anterior and posterior approach for sacral/retroperitoneal hydatid cyst disease: case report.

Achieving complete resolution of spinal hydatid cyst disease is quite challenging when bone is involved. Many authors reported the poor outcome of posterior decompression and laminectomy for intraosseous spinal hydatid disease. In an attempt to avoid a similar poor outcome, hydatid cysts were reached via both anterior and posterior surgical approaches in our patient. A 73-year-old man presented with complaints of low back and right leg pain. Symptoms or signs of systemic hydatid cyst disease were absent. MRI demonstrated a cystic lesion in the presacral/retroperitoneal region, involving the body of the sacrum and sacral canal. Computed tomography images showed enlargement of the sacral foraminae. The multiseptated cysts and their contents were isodense with cerebrospinal fluid. The cysts were removed via an anterior extraperitoneal approach, using a paramedian vertical incision, and then were also approached posteriorly via bilateral S1 hemilaminectomy. No neurological deficits occurred following surgery. The patient's symptoms completely disappeared after this combination of aggressive surgery and antihelminthic therapy. The application of both anterior and posterior approaches to intraosseous sacral hydatid cysts may be preferred when faced with hydatid disease in this location.

Anal Extrusion of a Ventriculoperitoneal Shunt.

Ventriculoperitoneal shunt (VPS) placement is an effective and most frequently used surgical method in the treatment of hydrocephalus, but the mechanical and infective complications are often seen after this surgical procedure. Bowel perforation after VPS surgery is rarely seen complication that is reported ranging between 0.1% and 0.7% in the literature. We report a case of 10-month baby who was shunted at day three of her life and has presented to us with protruding distal end of the ventricular catheter through anus. Mechanism of migration of VPS is unclarified yet; nevertheless, children with myelomeningocele have weakness of the bowel muscles, which probably makes it more sensitive for perforation. Additionally, sharp and stiff end of the VPS, use of trocar by some surgeons, chronic irritation by the shunt, previous surgery, infection and silicone allergy are other possible reasons of bowel perforation. Peritonitis and ventriculitis have a high morbidity and mortality that may occur after VPS-related bowel perforations; hence, it should be managed rapidly and aggressively to reduce morbidity and mortality.

Klippel-Trenaunay-Weber Syndrome with Atypical Presentation of Cerebral Cavernous Angioma: A Case Report and Literature Review.

BACKGROUND: Klippel-Trenaunay-Weber syndrome (KTWS) is a rare syndrome characterized by the triad of cutaneous hemangiomas, venous varicosities, and osseous-soft tissue hypertrophy of the affected limb. Clinical manifestations, genetic testing, and radiologic imaging are the key steps in diagnosing this syndrome. CASE DESCRIPTION: An 18-month-old boy was brought for follow-up brain magnetic resonance imaging (MRI) with a history of right lower limb hypertrophy, cutaneous varicosities, and hemangiomas diagnosed at birth. A baseline MRI at 12 months revealed multiple hemorrhagic lesions within the cerebrum, the largest in the right temporal lobe, which was treated surgically at the age of 18 months because of its rapid growth. This is the youngest patient with KTWS treated surgically for intracranial hemangiomas. CONCLUSION: KTWS is a rare disease with a wide range of manifestations. Multisystemic evaluation of this group of patients should be performed to identify cavernous hemangiomas at the early stage of life and adequately treat them in the future. Treatment of KTWS patients with cavernous hemangiomas should not be different from the treatment of patients with any other hemangiomas, and surgical intervention should be considered on a case-to-case bases.

Does Decompressive Duraplasty Have a Neuroprotective Effect on Spinal Trauma?: An Experimental Study.

BACKGROUND: Spinal cord injury (SCI) may result in neuromotor, sensory, and autonomic function damages. Edema because of spinal cord trauma can reach serious dimensions. The aim of this study was to histologically evaluate the effects of duraplasty on neural tissues. METHODS: Twenty-eight Wistar rats were randomly divided into 4 experimental groups: group 1 received laminectomy without SCI (sham); group 2 received laminectomy and SCI with the weight drop method; group 3 received laminectomy, SCI, and duraplasty within the first 6-8 hours of SCI; and group 4 received laminectomy, SCI, and duraplasty after 24 hours of SCI. The neurologic functions of the rats were tested periodically. All animals were euthanized 28 days after the surgery. Histopathologic and immunohistochemical evaluations were performed, and Kruskal-Wallis tests were used for statistical comparison of data between the groups. RESULTS: There was no significant difference in the Tarlov examination scores from different time points between the groups. The number of neurons stained with nuclear factor kappa beta was higher in group 3 than groups 1 and 4. The number of neurons stained with terminal deoxynucleotidyl transferase dUTP nick-end labeling was higher in group 2 than group 3. CONCLUSIONS: Decompressive laminectomy is a procedure frequently used in spinal trauma surgery. However, it is often unclear whether the decompression is fully adequate. Our results will aid the development of further studies regarding the reliability of duraplasty in the treatment of SCI.

Hypoxia-Inducible Factor 1α and AT-Rich Interactive Domain-Containing Protein 1A Expression in Pituitary Adenomas: Association with Pathological, Clinical, and Radiological Features.

BACKGROUND: Hypoxia-inducible factor (HIF) plays a major role in tumorigenesis and cancer progression. In hypoxic conditions, HIF is upregulated and has been shown to activate multiple genes required for cells to adapt to hypoxia. AT-rich interactive domain-containing protein 1A (ARID1A), a SWI/SNF (switch/sucrose nonfermentable) chromatin remodeling gene has context-dependent tumor-suppressive and oncogenic roles in cancer. We assessed the correlations between the expression and mutations of HIF1A and ARID1A in histopathologically confirmed pituitary adenomas. METHODS: We performed a retrospective analysis of 71 patients who had undergone surgery for pituitary adenoma. Patient demographic, radiological, and histopathological features were correlated with HIF1A and ARID1A expression. RESULTS: Most cases were HIF1A positive (62%). No significant correlation was found between HIF1A expression and age, gender, tumor size, bone erosion, hemorrhage, or Ki-67 index. An inverse correlation was demonstrated between HIF1A and cavernous sinus invasion (P = 0.035). ARID1A loss was found in 28.2% of pituitary adenomas. No significant correlation was found between ARID1A and any of the assessed variables. CONCLUSIONS: In our patient cohort, we found that most pituitary adenomas expressed HIF1A. To the best of our knowledge, we are the first to assess the presence of ARID1A loss in pituitary adenomas, which occurred in 28.2% of cases. No individual demographic, imaging, or histopathological feature was predictive of ARID1A. Likewise, with the exception of an increased incidence of cavernous sinus invasion, no correlation was found with HIF1A. Given the prognostic value of these markers in other malignancies, their frequency in pituitary adenomas warrants further exploration of their potential role in pituitary adenoma treatment and outcome.

Nontraumatic scalp arteriovenous fistula in an adult: technical report on an illustrative case.

BACKGROUND: The treatment of sAVF is difficult, and many therapeutic approaches have been proposed. General approaches for the treatment of sAVF include ligation of the feeding arteries, surgical removal, electrothrombosis, embolization, and a combination of these approaches. CASE DESCRIPTION: A 35-year-old man presented with occipital subcutaneous pulsatile thrill. We discussed and illustrated a rare sAVF, which was a high-flow sAVF fed by the occipital branch of the right ACE draining intraosseously into the SS. The case was treated by surgical origin ligation. CONCLUSION: This case was unusual in the sense that it was apparently spontaneous, and the major venous drainage was through the bone into the SS. Arterial supply pattern of sAVF is very important in therapeutic decision-making. We suggest that surgical origin ligation for sAVF be considered if the case has 1 feeding artery.

Microsurgical management of spinal schwannomas: evaluation of 128 cases.

OBJECT: The authors conducted a study to evaluate the clinical characteristics and surgical outcomes in patients with spinal schwannomas and without neurofibromatosis (NF). METHODS: The data obtained in 128 patients who underwent resection of spinal schwannomas were analyzed. All cases with neurofibromas and those with a known diagnosis of NF Type 1 or 2 were excluded. Karnofsky Performance Scale (KPS) scores were used to compare patient outcomes when examining the anatomical location and spinal level of the tumor. The neurological outcome was further assessed using the Medical Research Council (MRC) muscle testing scale. RESULTS: Altogether, 131 schwannomas were treated in 128 patients (76 males and 52 females; mean age 47.7 years). The peak prevalence is seen between the 3rd and 6th decades. Pain was the most common presenting symptom. Gross-total resection was achieved in 127 (97.0%) of the 131 lesions. The nerve root had to be sacrificed in 34 cases and resulted in minor sensory deficits in 16 patients (12.5%) and slight motor weakness (MRC Grade 3/5) in 3 (2.3%). The KPS scores and MRC grades were significantly higher at the time of last follow-up in all patient groups (p = 0.001 and p = 0.005, respectively). CONCLUSIONS: Spinal schwannomas may occur at any level of the spinal axis and are most commonly intradural. The most frequent clinical presentation is pain. Most spinal schwannomas in non-NF cases can be resected totally without or with minor postoperative deficits. Preoperative autonomic dysfunction does not improve significantly after surgical management.