Neurinoma of the spine is a benign tumor from the myelin sheath of the spinal nerves - Schwann cells, therefore it has a second name - Schwannoma. The pathological process more often develops in patients of middle and older age, with predominantly affects women.
The tumor is at least 20% of all primary neoplasms of the spinal column, characterized by slow growth and low capacity for malignancy. Early diagnosis of the disease and timely treatment of neurinoma on the spine causes its favorable prognosis with a low probability of recurrence and lesions of the spinal cord.
Causes and location of the disease
The true causes of schwannom have not yet been studied. Long-term studies of scientists from many countries led to a genetic theory of the disease. The mutation of the gene material under the influence of unfavorable factors of the external and internal environment leads to an uncontrolled division of the Schwann cells of the myelin sheath of the spinal nerves. A gradual increase in neurinoma of the spine leads to compression of surrounding tissues, including the vertebrae and spinal cord. This causes a violation of trophism, blood circulation and transmission of nerve impulses, which adversely affects the functioning of the spine, worsens the work of the central and peripheral uneven system.
The cervical and thoracic spine is most often affected, less often the tumor is localized in the lumbar region and sacrum. The pathological process in the myelin sheaths of the cervical spinal nerves can proceed according to the "hourglass" type. The tumor grows into soft tissues through the spinal vascular openings of the vertebrae and can easily be visualized under the skin. In the lumbar region, the neoplasm for a long time remains unnoticed due to a large array of muscles, which makes it difficult to diagnose in the early stages of the disease.
tumor structure Neurinoma of the spine, like any benign tumor, has a capsule that does not allow it to germinate into surrounding tissues and metastasize to other organs. Outwardly it resembles a dense knot of irregular rounded shape with a tuberous surface. Depending on the structure, the neoplasm is divided into the following types:
- epithelioid schwannoma - characterized by a dense arrangement of cells with a small amount of fibrous tissue;
- angiomatous schwannoma - includes a large number of cavernous cavities formed by pathologically dilated blood vessels;
- xanthomatous schwannoma - contains a variety of pigmentary( xanthochromic) cells.
The most common growth of schwannoma by the type of "hourglass" is revealed in the neck
. The tumor can reach large sizes - up to 3-5 kg. The volume of neoplasm and its structure affect the technique of therapy. The most common malignant course of neurinoma in the spine occurs in the mediastinum and the cauda equina of the spinal cord, which is located in the sacral region, which requires early surgical intervention.
The disease is characterized by a long asymptomatic period. From the onset of the pathological division of Schwann cells to the first manifestations of the tumor can take several years and even a decade. At the initial stages of the disease, the only sign may be discomfort or dull periodic pain in the area of the spine. With the growth of benign neoplasm and compression of surrounding tissues, the following symptoms occur:
- increase in the intensity of pain in the back, upper and lower extremities;
- impairment of sensitivity and motor activity below the lesion site( hypoesthesia, paresis, in severe cases, anesthesia and paralysis);
- weakness of the muscles of the extremities, atrophy of the muscle fibers;
- feeling of numbness in the hands or feet, parasthesia( sensation of tingling, burning, "crawling crawling");
- dysfunction of the pelvic organs( incontinence, feces);
- decreased work of the genital area.
Large tumors that have reached a size of more than 5-7 cm, are probed under the skin in the form of densely elastic painless formations. Especially noticeable neurinoma of the cervical spine, where a large neoplasm can be localized in the supraclavicular fossa.
Diagnosis of the disease
Type of neurinoma when performing tomography
Slow progression of schwannoma and poor clinical picture lead to late diagnosis of a benign tumor. Often, the pathological process is accidentally detected with spondylography of the spine - research through X-rays. At the same time neurinoma is visualized in the affected area of the spine and changes in the structure of bone tissue caused by violation of trophic and blood supply. Therefore, it is extremely important when there is pain in the back area immediately go to the doctor to find out the cause of unpleasant sensations.
The main diagnostic methods for detecting schwannoma include:
- radiography of the spine;
- computed tomography( CT);
- magnetic resonance imaging( MRI);
- ultrasound( ultrasound);
- puncture a tumor located in the soft tissues of the back.
The performed complex examination allows to reveal localization of a neoplasm, its sizes, structure, degree of a lesion of surrounding vertebra and soft tissues.
With a small amount of schwannoma, conservative methods of treatment are used at the initial stages of the disease development. They include the appointment of diuretics( mannitol), glucocorticoids( dexamethasone, prednisalone), muscle relaxants( midocals), which reduce edema of the nervous tissue, slow the growth of a benign tumor, and have analgesic effect. It is also recommended to monitor the water-electrolyte balance and diuresis, reducing the daily intake of liquid and salt.
Treatment of neurinoma of the spine in a radical way consists in its removal by various methods.
Radio wave method( Cyberknife system)
It is used for tumor size up to 30mm, in old age with concomitant diseases, which are contraindications to surgical intervention, patient's refusal from surgical treatment. The technique consists in irradiating the lesion with ionizing radiation that destroys atypical cells, without adversely affecting healthy tissues. The therapy is performed under local anesthesia on an outpatient basis.
The "Cybernozh" system refers to the innovative treatment of neoplasms
The operation to remove the neoplasm together with the
capsule. It is performed at a small tumor site size. In the operating room, a cut is made over the lesion under general anesthesia. The neoplasm is carefully removed with the capsule, without traumatizing the nervous tissue of the spinal nerves. In recent years, using a low-traumatic technique with the use of endoscopic techniques.
Surgery for the next removal of a tumor and capsules
It is performed with a large size of the neoplasm, which is accompanied by the fusion of the capsule with the surrounding tissues. In this case, first the capsule is dissected, the schwannoma is removed, followed by the removal of the envelope.
Surgical intervention is associated with a risk of nerve tissue damage and is most safe in the early stages of the disease. With the localization of schwannoma in the region of the horse tail, it is seldom possible to carry out complete tumor excision, which often leads to a recurrence of the pathological process.
Neurinoma of the spine refers to benign tumors with slow progression and rare malignancy. However, untimely diagnosis and therapy can lead to compression of the spinal cord, which is fraught with a violation of motor activity, up to the development of paralysis. At the first symptoms of the disease it is necessary to consult a doctor for examination and the appointment of an adequate course of treatment.
- Reasons and location of the disease
- Tumor structure
- Clinical picture
- Diagnosis of the disease
- Therapeutic tactic