Resection of a Lumbar Intradural Extramedullary Schwannoma: 2-Dimensional Operative Video : Operative Neurosurgery

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Resection of a Lumbar Intradural Extramedullary Schwannoma: 2-Dimensional Operative Video

Strong, Michael J MD, PhD, MPH; Yee, Timothy J MD; Khalsa, Siri Sahib S MD; Saadeh, Yamaan S MD; Muhlestein, Whitney E MD; North, Robert Y MD, PhD; Szerlip, Nicholas J MD

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Operative Neurosurgery 21(1):p E38, July 2021. | DOI: 10.1093/ons/opab097
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Schwannomas are typically benign tumors that arise from the sheaths of nerves in the peripheral nervous system. In the spine, schwannomas usually arise from spinal nerve roots and are therefore extramedullary in nature. Surgical resection-achieving a gross total resection, is the main treatment modality and is typically curative for patients with sporadic tumors.

In this video, we present the case of a 38-yr-old male with worsening left leg radiculopathy, found to have a lumbar schwannoma. Preoperative imaging demonstrated that the tumor was at the level of L4-L5. A laminectomy at this level was performed with gross total resection of the tumor. The key points of the video include use of intraoperative fluoroscopy to confirm surgical level and help plan surgical exposure, use of ultrasound for intradural tumor localization, and advocating for maximum safe resection using neurostimulation. The patient tolerated the surgery well without any complications. He was discharged home with no additional therapy needed.

Appropriate patient consent was obtained.

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This study did not receive any funding or financial support.


The authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article.


The authors present a concise summary of the management of a classic spinal pathology, lumbar intradural, extramedullary schwannoma. Review of the pertinent microsurgical techniques and tools used by the authors is of value to any surgeon who may encounter such pathology.

The use of adjunctive tools, such as ultrasound and neurostimulation, demonstrates the multi-faceted approach a spine surgeon utilizes to safely and effectively resect these lesions. Ultrasound improved spatial orientation to the lesion, assisting the authors in deciding to debulk prior to full circumferential dissection. The integrated, intraoperative decision-making in this video highlights current best practices.

Fortunately, the patient's presenting symptoms were sensory in nature and the associated nerve root did not convey motor function on neuromonitoring. The location of this lumbar intradural, extramedullary schwannoma and surgical acumen demonstrated in the video led to a great clinical outcome in early follow-up.

Niall Buckley

Amgad Hanna

Madison, Wisconsin, USA


Schwannoma; Lumbar laminectomy; Intradural; Extramedullary; Spinal tumor

© Congress of Neurological Surgeons 2021.