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Surgical and clinical outcomes of ventral versus dorsal/lateral intradural extramedullary schwannomas: a retrospective comparative study

Spinal Cord volume 63, pages 410–417 (2025)Cite this article

Subjects

Abstract

Study Design

Retrospective comparative study.

Objectives

To compare the surgical and clinical outcomes of ventral intradural extramedullary (IDEM) schwannomas to those of dorsal/lateral IDEM schwannomas.

Setting

The single institution in Japan.

Methods

This study included 94 patients with cervical or thoracic IDEM schwannomas who underwent tumor resection via a posterior approach between 2012 and 2022. Patients were categorized into Ventral (n = 12) and Dorsal/Lateral (n = 82) groups based on tumor localization. Demographic and surgical data, including surgical time and intraoperative motor evoked potential (MEP) changes, as well as clinical outcomes such as Japanese Orthopaedic Association (JOA) scores and gait function (modified McCormick scale, MMCS), were evaluated.

Results

The Ventral group had a significantly longer surgical time (p = 0.039) and was more likely to experience a temporary decrease in intraoperative MEP waveforms (p = 0.008) compared to the Dorsal/Lateral group. However, there were no significant differences between the groups in age at surgery, sex, level, tumor size, estimated blood loss, JOA score improvement, JOA recovery rate, or gait function at the final follow-up. Gross total resection (GTR) was achieved in all cases.

Conclusions

Despite longer surgical times and more likely to experience a temporary decrease in intraoperative MEP waveforms, ventral IDEM schwannomas do not result in significantly worse surgical or clinical outcomes compared to dorsal/lateral IDEM schwannomas. These findings suggest that even if the surgical procedure requires longer, gross total resection of ventral schwannomas via a posterior approach is resulting in favorable treatment outcomes.

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Fig. 1: Representative sagittal and axial MR images of a patient with ventral IDEM schwannoma.
Fig. 2: Representative sagittal and axial MR images of a patient with dorsal IDEM schwannoma.

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Data availability

The datasets generated and/or analyzed in this study are available from the corresponding author on request.

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Funding

The authors did not receive any financial support for this research, authorship, and publication of this article.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan

    Toshiki Okubo, Narihito Nagoshi, Takahito Iga, Kazuki Takeda, Masahiro Ozaki, Satoshi Suzuki, Morio Matsumoto, Masaya Nakamura & Kota Watanabe

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  1. Toshiki Okubo
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  2. Narihito Nagoshi
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  3. Takahito Iga
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  5. Masahiro Ozaki
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  8. Masaya Nakamura
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  9. Kota Watanabe
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Contributions

TO collected and interpreted the data and drafted the initial manuscript. NN assisted with manuscript preparation. TO also designed the study, while TI, KT, MO, SS, MM, MN, and KW critically reviewed the manuscript. All authors approved the final version and share collective responsibility for all aspects of the work, ensuring that any questions regarding the study’s accuracy or integrity are thoroughly addressed and resolved.

Corresponding author

Correspondence to Narihito Nagoshi.

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Competing interests

The authors declare no competing interests.

Ethical approval

The study was conducted in accordance with the guidelines of the Declaration of Helsinki and was approved by the Ethics and Institutional Review Board at Keio University School of Medicine (approval number: #20110142). Informed consent was obtained from all participants before surgery. We confirm that all relevant governmental and institutional regulations regarding the ethical use of human subjects were strictly followed throughout the study.

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Okubo, T., Nagoshi, N., Iga, T. et al. Surgical and clinical outcomes of ventral versus dorsal/lateral intradural extramedullary schwannomas: a retrospective comparative study. Spinal Cord 63, 410–417 (2025). https://doi.org/10.1038/s41393-025-01105-w

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