Surgery performed by Dr. César Yanes-Guandique
In this case, the Dr. César Yanes-Guandique carries out the complete resection of an intradural extramedullary schwannoma Located at the dorsal level (T10-T11), in a patient in her fourth decade of life with progressive neurological symptoms. The surgery is available for complete viewing in the surgical training app SurgSchool, along with other advanced spinal surgeries.
Clinical context and diagnostic imaging
The patient presented back pain, paresthesia and loss of strength in both lower limbs, with progressive inability to walk. Upon admission to hospital, she was classified as grade C according to the Frankel scale.
La magnetic resonance revealed a intradural extramedullary mass at the level of the T10-T11 vertebrae, with severe ventral compression of the spinal cordThis finding is characteristic of spinal schwannomas, slow-growing tumors that can reach a large size before becoming clinically apparent.
Surgical technique: approach and resection
The approach was right posterolateralAfter opening the dura mater and draining the cerebrospinal fluid, Dr. Yanes-Guandique identified the tumor. well defined on the ventral aspect of the spinal cord.
The procedure included:
- Section of the dentate ligament to allow safe mobilization of the cord.
- Microsurgical release of tumor adhesions, both at its cephalic and caudal poles.
- Complete removal of trilobulated schwannoma with micro biopsy forceps.
- Electrocoagulation and section of the tumor pedicle with microscissors, under microscopic vision.
During the intervention, a copious bleeding from surrounding tissues, controlled with profuse lavage and meticulous hemostasis.
Prevention of post-surgical complications
To avoid complications such as arachnoiditis o syringomyelia, a thorough wash with saline solution was performed, followed by:
- Hermetic closure of the dura mater with 4-0 Prolene suture.
- Application of local hemostatics (bone wax, Surgicel).
- Placing a spinal dural sealant to prevent cerebrospinal fluid leaks.
El postoperative monitoring by nuclear magnetic resonance confirmed complete resection of the schwannoma and adequate spinal cord decompression.
Spinal schwannomas: clinical and surgical keys
Spinal schwannomas represent approximately 25% of extramedullary intradural tumorsThey have no gender preference and are usually diagnosed in patients between 30 and 50 years of age.
Its symptoms include:
- Localized pain or radiculopathy
- Sensory disorders
- Paresis or partial paralysis
El Clinical outcome depends largely on the preoperative neurological status. When they are not associated with neurofibromatosis type 2, complete resection is usually curativeIncomplete resections, on the other hand, have a higher risk of recurrence, even with adjuvant radiotherapy.
