Around 30% of all space-occupying lesions in the spinal canal are spinal neurinomas, also known as nerve sheath tumors or schwannomas. These benign tumors are often associated with a rare hereditary disease called neurofibromatosis. Here you can find out everything you need to know about the process from confirmed diagnosis to personalized treatment.
An innovative procedure in the treatment of spinal neurinoma is radiosurgery with the robot-guided CyberKnife system. At the European Radiosurgery Center Munich (ERCM), we have already treated many patients with this extremely precise technology.
Modern radiosurgery enables gentle tumor therapy on an outpatient basis in just a single session. Learn more about the advantages.
Spinal neurinomas are benign, slow-growing tumors that are the most common primary spinal tumors overall [1]. Primary means that this tumor disease develops in the spine area—it should therefore not be confused with metastases, which are the spread of other tumor diseases.
Spinal neurinomas can occur in any age group, but they are most common between the ages of 40 and 60, with approximately equal incidence in both sexes. Recent scientific studies have observed primary spinal tumors slightly more frequently in men than in women [2].
At the European Radiosurgery Center Munich, we have extensive experience in radiosurgery for this benign tumor disease in the spine and spinal cord [3]. With CyberKnife therapy, we can treat neurinoma on an outpatient basis without surgical intervention. There are also no complications from fixation or open surgery.
Inpatient hospital stays, follow-up treatment, or rehabilitation stays are also not necessary. In most cases, you as a patient can resume your normal daily routine and previous activities immediately after your treatment.
Thanks to innovative and state-of-the-art radiosurgical technology, you benefit from extremely precise, effective, painless, and comfortable treatment.
Neurinomas are connective tissue-encapsulated neoplasms (tumors) that originate from specialized cells (Schwann cells), which in turn perform important functions in the nervous system, such as improving signal transmission. Their capsule clearly delineates them and they usually do not infiltrate other structures.
If such a neurinoma occurs in the extremely sensitive nerve roots of your spinal cord, it is referred to as a spinal neurinoma. These mostly round tumors are benign and can develop at any level of the spinal cord. They are located within the spinal canal—most commonly in sections of the lumbar spine, followed by neurinomas in the thoracic spine.
Spinal neurinomas are usually single (solitary), round growths. However, if the underlying cause is the rare chronic disease neurofibromatosis, multiple tumors may also be present. Due to their usually very slow growth, sensitive nerve roots in the spinal canal often become pinched over time. This usually causes affected individuals to experience corresponding (radicular) pain that radiates to one side of the respective area.
However, there are also cases in which the pain can radiate to the opposite side. This makes it all the more important to carry out a detailed diagnosis and record your individual patient history.
If the pressure in the spinal canal increases, the pain can become more severe due to this compression. If a nerve root is completely destroyed, however, the symptoms may sometimes become less severe and eventually disappear completely at the end of this destructive process.
Depending on the location of the spinal neurinoma, the following may also occur:
In most cases, nerve sheath tumors of the spine occur independently of typical symptoms and are often discovered by chance, usually after a long latency period of 20 years on average following conventional radiation therapy.
Another possible trigger is type 2 neurofibromatosis (NF2) – a rare hereditary disease caused by genetic mutations: approximately 10% of all NF2 patients develop a neurinoma. Type 2 neurofibromatosis itself occurs in approximately one in 50,000 people.
Another characteristic feature of hereditary NF2 disease is bilateral acoustic neuromas (vestibular schwannoma), which we at ERCM can treat—as well as spinal neurinomas—with robot-guided, particularly gentle CyberKnife therapy and ZAP-X.
In many cases, benign spinal neurinomas remain asymptomatic at first, meaning they do not cause any symptoms. For you as a patient, the risk of untreated spinal neurinomas lies primarily in compression of the nerve roots or spinal cord, because the consequences can be complete destruction of the nerve roots. If the spinal cord is severely compressed and timely treatment is not provided, paraplegia can develop.
When spinal neurinoma is suspected, diagnosis always begins with a thorough personal consultation about your individual patient history and various neurological examinations. Further diagnostic tests include modern cross-sectional imaging and, depending on the situation, electromyography (EMG), which measures the electrical activity of certain muscles, and measurement of nerve conduction velocity [5].
Computed tomography (CT) and, in particular, magnetic resonance imaging (MRI) play an important role in confirming the diagnosis—both for assessing tumor growth prior to therapy and for follow-up examinations and monitoring progress.
Imaging techniques such as MRI also allow an assessment of the extent to which limitations in your motor skills (e.g., muscle strength, coordination) can potentially be improved through individually tailored therapy [6, 7, 8].
Not every spinal neurinoma needs to be treated immediately if there is no nerve damage. Depending on its size and location, the nerve sheath tumor can initially be monitored regularly.
In principle, several therapeutic options are available for the treatment of spinal neurinomas. The standard treatment is microsurgical removal [4, 9].
In selected situations, highly precise treatment using robotic systems such as CyberKnife may be considered as an alternative. Overall, the innovative technologies of radiosurgery offer an additional option whenever surgical intervention is not possible in a specific individual case or is not desired by the patient.
Furthermore, targeted CyberKnife therapy may also be used after microsurgical surgery, for example if tumor remnants remain, if a recurrence occurs—meaning that a previously treated spinal neurinoma reappears—or if multiple lesions need to be treated [4].
Complete surgical removal
The goal of a microsurgical procedure is to remove the spinal neurinoma as completely as possible (resection). To achieve this, the tumor mass must first be carefully isolated in its entirety from the surrounding nerve structures [6, 7].
In more than 90% of cases, the benign tumor can in fact be completely removed. However, any pre-existing damage to nerves within the spinal cord is usually irreversible despite successful surgery. Scientific studies have shown that approximately 30% of patients experience complications after resection, most commonly new or worsening sensory disturbances [8].
If spinal neurinomas regrow—which can occur in rare cases, for example when tumor remnants remain—a repeat operation is possible. In most cases of residual neurinomas, however, follow-up monitoring using computed tomography or magnetic resonance imaging is initially pursued. The reason is that a prolonged period of growth arrest may occur, allowing further treatment to be postponed.
There are also circumstances that may generally argue against surgery, including in particular the patient’s general condition, individual surgical risk, or the type and location of the tumor.
Fractionated radiotherapy
Conventional radiotherapy can also be performed, but it must be delivered in a fractionated manner—that is, the treatment of the spinal neurinoma is divided into multiple sessions—because the spinal cord and nerve roots lie within the radiation field.
The fractionated approach is intended to minimize damage to healthy tissue. For patients, this may require between 10 and 25 treatment sessions over a period of 2 to 5 weeks.
Radiotherapy may also be administered after tumor surgery as part of a combined treatment strategy, for example to eliminate remaining microscopic tumor cell clusters.
CyberKnife therapy, as we perform it here at the ERCM, represents a possible treatment option for spinal neurinomas that can support you as a patient with the highest possible level of treatment safety, long-term health, and the best possible quality of life.
In contrast to conventional radiotherapy, CyberKnife treatment—and the advanced non-invasive technologies available today in modern personalized medicine—allows for maximal protection of the sensitive regions of the spinal cord and adjacent healthy structures.
This effect is achieved through the delivery of a targeted high radiation dose with CyberKnife therapy, precisely focused on the tumor cells to be destroyed. Long-term control rates—with successful inactivation of tumor cells and ideally without recurrent regrowth—exceed 90% [3].
During CyberKnife therapy, real-time image guidance is used, enabling this extremely high level of targeting accuracy—even in the presence of occasional natural patient movements, such as those caused by breathing [3]. Continuous tracking and correction of spinal movement throughout the entire treatment are therefore key prerequisites for the success of radiosurgical treatment as a particularly effective therapeutic option.
At ERCM, we will discuss with you personally in a confidential discussion whether an existing meningioma requires treatment in your individual case. All treatment decisions are always made jointly with you and the treatment team. It is important to us that you, your family, and those who support and accompany you, fully understand and can make sense of all aspects of your disease and its treatment options.
Together with our medical partners, we will accompany you on your journey and, together with our team, ensure that you feel well looked after at ERCM right from the start.
For treatment inquiries, please use the contact form. You can also reach us by phone during our opening hours or via our social media channels.
Your request will be processed individually and promptly.
A spinal neurinoma is a slow-growing, benign tumor that is usually surrounded by a connective tissue capsule and displaces the surrounding tissue as it grows. With the choice of an individually appropriate therapy, it can often be treated very effectively and safely.
The probability that a spinal neurinoma becomes malignant (neurofibrosarcoma, malignant peripheral nerve sheath tumor) is extremely low (less than 1%). In such cases, the arms and legs are particularly often affected, whereas benign spinal neurinomas mainly occur in the region of the spine.
Growth is usually very slow, at approximately 1 to 2 mm per year. This allows affected patients, when diagnosed early, to initially monitor the tumor’s growth behavior through regular follow-up examinations before a suitable treatment decision is made.
Patients with a benign spinal neurinoma can be treated effectively with CyberKnife therapy in selected situations. In particular, the size, type, and number of tumors must meet the criteria for radiosurgical treatment. In addition, there should be no acute neurological deficits, as surgery is unavoidable in such cases.
A removed spinal neurinoma generally does not recur. However, in rare cases, parts of the tumor cannot be completely removed surgically, and renewed growth is possible. In such situations, the particularly tissue-sparing radiosurgical CyberKnife therapy can be used to treat regrown tumors or residual tumor tissue without damaging the surrounding tissue.
Only in very rare cases (approximately 1–2%) do these benign tumors regress spontaneously without treatment.
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[6] Lenzi, J., Anichini, G., Landi, A., Piciocchi, A., Passacantilli, E., et al., Spinal Nerves Schwannomas: Experience on 367 Cases, Historic Overview on How Clinical, Radiological, and Surgical Practices Have Changed over a Course of 60 Years. Neurol Res Int. 2017;ID 3568359:1-12.
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[7] Srinivas, M., Nichkaode, P., Sharma, B., Haval, S., Schwannoma as Extraspinal Swelling Over the Thoracolumbar Region: A Tumor at a Rare Site. Cureus. 2024;16(4):e58157.
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[8] Kobayashi, K., Imagama, S., Ando, K., Hida, T., Ito, K., et al., Contrast MRI findings for spinal schwannoma as predictors of tumor proliferation and motor status. Spine (Phila Pa 1976). 2017;42(3):E150-155.
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