• Giuseppe Corazzelli, Sergio Corvino, Maria Marvulli, Valentina Cioffi, Alessandro D'Elia, Vincenzo Meglio, Roberto Tafuto, Ciro Mastantuoni, Maria Rosaria Scala, Francesco Ricciardi, Salvatore Di Colandrea, Settimio Leonetti, Pasqualino De Marinis, Sergio Paolini, Vincenzo Esposito, Alfonso Fiorelli, Gualtiero Innocenzi, Oreste de Divitiis, Raffaele de Falco, and Antonio Bocchetti.
• Neurosurgery Department, Santa Maria delle Grazie Hospital, ASL Napoli 2 Nord, Naples, Italy.
• Neurosurgery. 2024 Nov 1.

Background And ObjectivesThe optimal surgical management of thoracic schwannomas (TSs) remains contentious, with various approaches proposed. Video-assisted thoracoscopic surgery (VATS) and combined VATS with neurosurgical procedures have shown promise, particularly for Eden type IV and III lesions. However, unanimous consent on the most effective surgical intervention and understanding of prognostic factors for tumor recurrence needs to be improved. The aim of this study was to elucidate the optimal surgical approach according to the Eden type and investigate predictive factors for TS recurrence.MethodsThis retrospective, multicentric, observational study analyzed 98 surgically treated patients with TS from 2011 to 2023, assessing preoperative and 6-month follow-up clinical (recurrences, pain, and myelopathy recovery) and surgical parameters (operative time, intraoperative blood loss, extent of resection). Surgical procedures included thoracic laminectomy or hemilaminectomy for type I, laminectomy or thoracic transpedicular (TPD) approach for type II, laminectomy alone or combined laminectomy with VATS for type III, and VATS or thoracotomy (open thoracotomy [OT]) for type IV. Descriptive and deductive analyses were conducted between and within the 4 cohorts, with multivariate analysis assessing the contribution of predictor variables.ResultsNo significant differences were found between hemilaminectomy and laminectomy for all analyzed parameters for type I. Type II lesions treated with TPD exhibited similar outcomes to laminectomy, albeit with longer procedure times. Type III lesions benefited from combined approaches compared with neurosurgical-only approaches. Video-assisted thoracoscopic surgery emerged as more favorable than OT for type IV lesions. Multivariate analysis revealed that patient sex, tumor location, extent of resection, and pathology significantly influenced recurrence rates.ConclusionFor Eden type III TSs, neurosurgical and VATS combined surgery achieved better outcomes than neurosurgery alone; for Eden type IV TSs, VATS achieved better results than OT. For Eden types I and II, hemilaminectomy and bilateral laminectomy and laminectomy and TPD achieved similar outcomes, respectively.Copyright © Congress of Neurological Surgeons 2024. All rights reserved.

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