Subtotal Resection of Cervical Dumbbell Schwannomas: Radiographic Predictors for Surgical Considerations

Currently, radiologic predictors for the resectability of cervical dumbbell schwannomas remain unknown. To identify radiologic predictors for resectability, we retrospectively reviewed data from 72 patients. From January 1995 to June 2017, 72 patients who underwent surgical treatment for cervical dumbbell schwannomas were enrolled. We focused on the relationship between preoperative magnetic resonance imaging (MRI) features and the extent of tumor removal. The MRI features evaluated were tumor size, tumor level, Eden classification, degree of vertebral artery (VA) involvement, and signal intensity (SI) on T2-weighted images (WIs). Among the 72 patients, gross total resection (GTR) and subtotal resection (STR) were achieved in 37 (51.4%) and 35 (48.6%) patients, respectively. Mean maximal tumor size (P = 0.011), mean size of foraminal and extraforaminal portion (P = 0.017), tumor level (P < 0.001), VA involvement (P < 0.001), and SI on T2-WIs (P = 0.006) were significantly different between the GTR and STR groups. Univariate analyses demonstrated that maximal tumor size (odds ratio [OR]: 0.93, P = 0.012), high cervical level (OR: 11.37, P < 0.001), pushed VA (OR: 0.11, P = 0.002), encased VA (OR: 0.02, P < 0.001), and hyper-SI on T2-WIs (OR: 12.46, P = 0.020) were significant predictors for GTR. In the multivariate analysis, only high cervical level (OR: 5.48, P = 0.033) and encased VA (OR: 0.07, P = 0.014) were significant predictors for GTR. The resectability of cervical dumbbell schwannomas may be predicted by MRI features, including tumor size, tumor level, and degree of VA involvement. •Magnetic resonance imaging features may predict the resectability of cervical dumbbell schwannomas.•Tumor sizes and levels differed between subtotal and gross total resection (GTR).•Vertebral artery (VA) involvement and signal intensity (SI) on T2-weighted images also differed.•Tumor size, high cervical level, pushed/encased VA, and hyper-SI predicted GTR.•Only high cervical level and encased VA predicted GTR in multivariate analyses.