Granlund AS, Sørensen MS, Jensen CL, Bech BH, Petersen MM. Clinical outcome after surgery on schwannomas in the extremities. World J Orthop 2021; 12(10): 760-767 [PMID: 34754832 DOI: 10.5312/wjo.v12.i10.760]
Corresponding Author of This Article
Andreas Saine Granlund, MD, Instructor, Surgeon, Musculoskeletal Tumor Section, Department of Orthopedic Surgery, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, Copenhagen 2100, Denmark. andreas.saine@gmail.com
Research Domain of This Article
Orthopedics
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Orthop. Oct 18, 2021; 12(10): 760-767 Published online Oct 18, 2021. doi: 10.5312/wjo.v12.i10.760
Clinical outcome after surgery on schwannomas in the extremities
Andreas Saine Granlund, Michala Skovlund Sørensen, Claus Lindkær Jensen, Birthe Højlund Bech, Michael Mørk Petersen
Andreas Saine Granlund, Musculoskeletal Tumor Section, Department of Orthopedic Surgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen 2100, Denmark
Michala Skovlund Sørensen, Department of Orthopedic Surgery, Copenhagen University Hospital, Copenhagen 2200, Denmark
Claus Lindkær Jensen, Michael Mørk Petersen, Musculoskeletal Tumor Section, Department of Orthopedic Surgery, University of Copenhagen, Copenhagen 2100, Denmark
Birthe Højlund Bech, Department of Radiology, Rigshospitalet, University of Copenhagen, Copenhagen 2100, Denmark
Author contributions: Granlund AS performed the research and wrote the paper; Sørensen MS made the protocol, statistics and supervised the report; Jensen CL gave surgical inputs and supervised the report; Bech BH performed and examined the radiological scanning; Petersen MM supervised the research and acknowledged the final report.
Institutional review board statement: The study was reviewed and approved by the University of Copenhagen Review Board, No. RH-2016-144.
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: All authors have nothing to disclose.
Data sharing statement: Statistical code and dataset available from the corresponding author at andreas.saine@gmail.com.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Andreas Saine Granlund, MD, Instructor, Surgeon, Musculoskeletal Tumor Section, Department of Orthopedic Surgery, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, Copenhagen 2100, Denmark. andreas.saine@gmail.com
Received: February 5, 2021 Peer-review started: February 5, 2021 First decision: May 3, 2021 Revised: May 16, 2021 Accepted: September 8, 2021 Article in press: September 8, 2021 Published online: October 18, 2021
ARTICLE HIGHLIGHTS
Research background
Schwannomas are one of the most common benign tumors in the peripheral nervous system and symptoms described in the literature are mainly sensory as radiating pain, local irritation, and sensation of a heavy mass, while primary motor involvement leading to paresis is uncommon.
Research motivation
Surgical removal of schwannomas in the peripheral nervous system is by many surgeons considered a high risk procedure with surgery directly on peripheral nerves and since the literature regarding the clinical results that can be expected after this procedure is relatively sparse, we found it of interest to examine the postoperative results after this procedure.
Research objectives
To evaluate the pre- and postoperative symptoms in patients treated surgically for benign schwannomas and examine whether tumor size, anatomical location or specific nerve location had an impact on the clinical symptoms prior to and after surgery. Finally, we also aimed to investigate the rate of malignant transformation.
Research methods
All patients who had surgery due to benign schwannomas from May 1997 to January 2018 at our institution were identified and included in the study. We registered preoperative baseline data and postoperative symptoms and objective findings were recovered from patient records and a questionnaire. Patients that reported new symptoms, recurrence of a mass, or unsatisfactory results were offered an magnetic resonance imaging-scanning and a follow-up to rule out a recurrence or malignant transformation of the tumor.
Research results
At the end of follow-up we recorded a significant post-operative decrease in clinical symptoms such as local pain and radiating pain. Multivariate analysis showed that tumors located within minor nerves had a significantly higher prevalence of postoperative symptoms compared with tumors in major nerves. One patient with schwannoma diagnosed initially by needle biopsy was diagnosed to have malignant transformation diagnosed in the surgically removed tumor. No local recurrences were reported.
Research conclusions
Surgery of schwannomas can be conducted with low risk of postoperative complications, acceptable decrease in clinical symptoms and risk of local recurrence and malignant transformation is low.
Research perspectives
Future studies should provide prospective data and especially give more detailed information for those few patients who got worsening of their pre-operative symptoms and give further information about the specific characteristics of the patient and the tumor that may affect the outcome of the surgical tumor removal.
