Post-Doctoral Neurosurgery Research Fellow Johns Hopkins University Johns Hopkins University School of Medicine Baltimore, MD, US
Disclosure(s):
Abdel-Hameed Al-Mistarehi, MD: No financial relationships to disclose
Introduction: Schwannomas are the most frequent primary benign tumors of the peripheral nervous system. The gold standard treatment is surgical resection. When lesions are ambiguous, biopsy is often employed as a minimally invasive method of determining tumor type. Recent papers have suggested that biopsies carry a risk of inflammation and adhesions which can lead to adverse outcomes. We aim to determine the risk of biopsy in peripheral non-syndromic schwannomas.
Methods: A retrospective review of the electronic records of patients who underwent surgical resection for peripheral non-syndromic schwannomas at Johns Hopkins Medical Institutes from 2009 to 2023 was conducted. The patients were categorized into two groups depending on whether they underwent at least one biopsy. Outcomes, including pain, sensory deficits, and motor weakness at the last follow-up visit, were studied. Surgical variables such as duration, blood loss, and post-operative complications were also noted.
Results: A total of 169 patients were included in this study with a male-female ratio of 82:97. The mean age was 48.49±15.90, mean symptom duration was 36.86±46.46 months, and mean follow-up time was 17.39±25.97 months. The biopsy cohort had longer surgical duration (p=0.007), higher estimated blood loss (p < 0.001), were more likely to require transfusion (p=0.016), longer length of stay (LOS) (p=0.002), and were more likely to experience postoperative deficits (sensory p=0.046, weakness p=0.050). These effects persisted in a multivariate analysis with tumor size, which itself was a significant predictor of outcome.
Conclusion : Overall, larger lesions, with suspicion for malignancy were more likely to be biopsied, therefore it is difficult to recommend against biopsy when the consequence of missing a malignant tumor is so severe. However, the decision to proceed with biopsy must be made with the knowledge that surgery will likely be more severe and complex and so the degree of suspicion must warrant the worsening of outcomes associated with a diagnostic biopsy.
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