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Tumours
Schwannoma
An in-depth, evidence-based guide to schwannomas — usually benign tumours arising from the protective sheath of a nerve — and how they are recognised, imaged and referred for specialist care.
A schwannoma is a tumour that grows from Schwann cells, the cells that form the insulating sheath around nerves. Schwannomas can arise from almost any nerve in the body, and when they involve the spine or the nerves close to it they are among the commonest nerve-sheath tumours we see. The great majority are benign, slow-growing and clearly separated from the nerve they arise from. I want to be honest about my role from the outset: I do not personally operate on primary nerve tumours such as schwannomas. My job is to recognise the problem, arrange the right imaging, and refer you promptly to a trusted colleague who specialises in this surgery and does it in high volume. This page explains what a schwannoma is and how it is assessed.
For information only — not medical advice. The content on this page is patient education to help you understand a condition or treatment. It is not a substitute for personalised assessment by a qualified clinician. Always consult your doctor or specialist about your own symptoms, diagnosis, and treatment decisions.
My role — recognising and referring, not operating
I believe in being clear about what I do and do not take on. Primary nerve-sheath tumours are a specialised area, and this surgery is not something I perform. In my view it is best carried out by surgeons who do a high volume of nerve-tumour surgery, because that experience directly affects how safely the tumour can be removed while preserving the nerve. So when a schwannoma is found, my role is to identify it, ensure the correct imaging is obtained, and refer you without delay to an expert. What follows is written to help you understand the tumour.
What a schwannoma is and how it causes symptoms
Because a schwannoma grows on a nerve and enlarges slowly, symptoms usually develop gradually and depend on which nerve is involved. A schwannoma affecting a spinal nerve root commonly causes pain radiating along that nerve, sometimes worse at night, with numbness, tingling or weakness in the same distribution. A schwannoma on a peripheral nerve may be felt as a lump that is tender or gives an electric-shock sensation when pressed. Most schwannomas are solitary, but multiple tumours can occur in genetic conditions such as schwannomatosis or neurofibromatosis type 2, which a specialist will take into account. Malignant change is uncommon.
How it is diagnosed
The key investigation is an MRI scan with contrast, which shows the tumour, its relationship to the nerve, and features that usually indicate that it is a schwannoma. This imaging is essential both for diagnosis and for the specialist surgeon to plan treatment and preserve nerve function. My part is to make sure this imaging is arranged and interpreted correctly so you reach the right specialist promptly.
How it is treated — by a specialist colleague
The standard treatment for a symptomatic or enlarging schwannoma is careful microsurgical removal by a nerve-tumour specialist, working under the microscope and, where relevant, using nerve monitoring to protect function. Because most schwannomas are benign and arise from the sheath rather than the working fibres of the nerve, an experienced surgeon can often remove the tumour completely while preserving the nerve, and the published evidence shows good outcomes and low recurrence in expert hands. Small, symptomless schwannomas can sometimes simply be monitored. Where surgery is needed, it belongs with a high-volume specialist — which is exactly why I refer these cases on rather than operating myself.
The information provided on this page is intended for educational purposes only and should not be considered personalised medical advice. Every patient is different, and treatment options, risks, expected recovery and outcomes depend upon an individual's diagnosis, general health and personal circumstances. Decisions regarding treatment should always be made following consultation with your treating spinal surgeon or healthcare professional.
Evidence & further reading
- —Alvarez-Crespo DJ, et al. Clinical characteristics and surgical outcomes of 2542 patients with spinal schwannomas: systematic review and meta-analysis. World Neurosurg 2024. (PMID 38006933)
- —Seppälä MT, et al. Long-term outcome after removal of spinal schwannoma: 187 cases. J Neurosurg 1995. (PMID 7674010)
- —Lenzi J, et al. Spinal nerve schwannomas: experience on 367 cases over 60 years. Neurol Res Int 2017. (PMID 29075532)
- —Emel E, et al. Long-term surgical outcomes of spinal schwannomas: 49 consecutive cases. Turk Neurosurg 2017. (PMID 27593781)
- —Sridhar K, et al. Giant invasive spinal schwannomas: definition and surgical management. J Neurosurg 2001. (PMID 11302622)
- —Gui C, et al. Current state of spinal nerve sheath tumour management and future advances. Neurooncol Adv 2024. (PMID 39430389)
- —Guha D, et al. Management of peripheral nerve sheath tumours: 17 years at Toronto Western Hospital. J Neurosurg 2018. (PMID 28686119)
- —Ball JR, et al. Operative steps in the management of benign nerve sheath tumours. Neurosurg Focus 2007. (PMID 17613224)
- —Mehta GU, et al. Peripheral nerve sheath tumours in neurofibromatosis type 2. Clin Neurol Neurosurg 2020. (PMID 31881415)
- —Halliday AL, et al. Benign spinal nerve sheath tumours: sporadic and in NF1/NF2. J Neurosurg 1991. (PMID 1846409)
- —Levi AD, et al. Surgical management of symptomatic peripheral nerve sheath tumours. Neurosurgery 2010. (PMID 20190660)
- —Takahashi T, et al. Risk factors for recurrence and regrowth of spinal schwannoma. J Orthop Sci 2023. (PMID 35382954)
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