Spinal Schwannoma

I think honesty here is important. Although I am a spinal surgeon, primary nerve-sheath tumours of the spine are a specialised area that I do not take on. I believe strongly that this surgery should be carried out by colleagues who do it in high volume, because that experience means safer removal and better preservation of nerve function. So when a schwannoma is found, my role is to identify it, ensure the correct scans are done, and refer you without delay to an expert. What follows is written to help you understand the tumour.

Because a schwannoma arises from a nerve root and grows slowly, its symptoms usually develop gradually. The commonest is pain in the distribution of the affected nerve — a radiating pain into an arm or leg, sometimes worse at night — and this may be accompanied by numbness, tingling or weakness in the same distribution. If the tumour grows large enough to press on the spinal cord, it can cause more widespread symptoms such as balance and walking difficulty. Large "dumbbell" schwannomas that extend outside the spine can occasionally form a palpable mass. Most schwannomas are solitary, but multiple tumours can occur in genetic conditions such as neurofibromatosis, which the specialist will consider.

The key investigation is an MRI scan with contrast, which shows the tumour, its relationship to the nerve root and cord, and any dumbbell extension outside the spine. The imaging usually gives a strong indication that the tumour is a schwannoma and is essential for the specialist to plan surgery. My part is to make sure this imaging is arranged and interpreted correctly so you reach the right specialist promptly.

The standard treatment for a symptomatic or enlarging spinal schwannoma is careful microsurgical removal by a spinal tumour specialist, using an operating microscope and nerve monitoring to protect function. Because most schwannomas are benign and separate cleanly from the nerve, complete removal usually gives an excellent, lasting result, and the published evidence — including large series and systematic reviews of thousands of patients — shows good outcomes and low recurrence in experienced hands. Larger dumbbell tumours may need a specifically planned approach. Some small, symptomless tumours can simply be monitored. Where surgery is needed, it belongs in high-volume specialist hands, which is why I refer these cases on.

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