Approximately 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 – neurofibromatosis. Here you'll learn everything about the path from confirmed diagnosis to personalized therapy.
An innovative procedure for treating spinal neuroma is radiosurgery using the robot-guided CyberKnife system. At the European Radiosurgery Center Munich (ERCM), we have already treated numerous patients with this extremely precise technology.
Modern radiosurgery enables outpatient, gentle tumor treatment in a single session. Learn more about the benefits.
Spinal neurinomas are benign, slow-growing tumors that represent the most common primary spinal tumors [1]. "Primary" means that this tumor disease originates in the spine—it should not be confused with metastases, the spread of other tumors.
Spinal neurinomas can occur in any age group, but they are most common between the ages of 40 and 60 – and are roughly equal 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 radiosurgical experience in this benign tumor of the spine and spinal cord [3]. With CyberKnife therapy, we can treat neuromas on an outpatient basis and without surgical intervention. There are no complications. Complications from fixation or open surgery.
An inpatient hospital stay, follow-up treatment, or rehabilitation stay are also not required. In most cases, you as a patient can resume your usual daily routine and activities after your treatment.
Thanks to the innovative and state-of-the-art radiosurgical technology, you benefit from an 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 neuroma occurs in the extremely sensitive nerve roots of your spinal cord, it is referred to as a spinal neuroma. 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 neuromas in the thoracic spine.
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 neuroma occurs in the extremely sensitive nerve roots of your spinal cord, it is referred to as a spinal neuroma. 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 neuromas in the thoracic spine.
Spinal neurinomas are usually single, round, neoplasms. However, if the underlying cause is the rare chronic disease neurofibromatosis, multiple tumors may be present. Due to their usually very slow growth, nerve roots of sensitive nerves in the spinal canal often become trapped over time. As a result, affected individuals usually experience corresponding (radicular) pain, which radiate one-sidedly into the respective area.
However, there are also cases where the pain can radiate to the opposite side. This makes a detailed diagnosis and recording of your individual patient history all the more important.
If the pressure in the spinal canal increases, the pain can become more severe due to this compression. However, if a nerve root is completely destroyed, symptoms may decrease, only to disappear completely at the end of this destructive process.
Depending on the location of the spinal neuroma, the following may also occur:
Spinal nerve sheath tumors usually occur independently of typical symptoms; they are often discovered incidentally, for example, after a prolonged latency period of an average of 20 years 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 neuroma. Type 2 neurofibromatosis itself occurs in approximately one in 50,000 people.
Bilateral acoustic neuromas (vestibular schwannoma) are also characteristic of the hereditary NF2 disease, which we can treat here at ERCM – as well as spinal neuromas – with the robot-guided, particularly gentle CyberKnife therapy and the ZAP-X.
In many cases, benign spinal neurinomas initially remain asymptomatic, meaning they do not cause any discomfort. For you as a patient, the risk of untreated spinal neurinomas lies primarily in compression of the nerve roots or spinal cord, which can result in complete destruction of nerve roots. If the spinal cord is severely compressed and treatment is not promptly initiated, paraplegia can develop.
If a spinal neuroma is suspected, the diagnosis always begins with a thorough personal interview about your individual medical history and various neurological examinations. Further diagnostic tests include modern cross-sectional imaging and—depending on the situation—electromyography (EMG), which measures electrical activity of specific muscles, as well as nerve conduction velocity measurements [5].
For a reliable diagnosis, the cross-sectional imaging techniques of computed tomography (CT) and, in particular, magnetic resonance imaging (MRI) play an important role – both for the assessment of tumor growth before therapy, for example, but also for follow-up examinations and monitoring of the disease.
Imaging techniques such as MRI also allow us to assess the extent to which limitations of your motor skills (e.g., muscle strength, coordination) can possibly be improved through individually tailored therapy [6, 7, 8].
Not every spinal neuroma requires immediate treatment if no nerve damage is present. Depending on its size and location, the nerve sheath tumor may initially be monitored regularly.
In principle, various treatment options are available for spinal neurinoma. The standard treatment is microsurgical removal [4, 9] .
In selected situations, high-precision treatment with robotic systems such as the CyberKnife may be an alternative option for you. Overall, the innovative technologies of radiosurgery always offer an additional option when, for example, surgical intervention is not possible in a specific case or is not desired by you as a patient.
In addition, targeted CyberKnife therapy is also used after microsurgical surgery, for example, if tumor remnants remain, if there is a recurrence – i.e. a spinal neurinoma that has already been treated recurs – or if multiple lesions need to be treated [4].
The goal of microsurgical intervention is to remove the spinal neurinoma as completely as possible (resection). The tumor mass must first be carefully isolated from the surrounding nerve structures [6, 7].
In more than 90% of cases, the benign tumor can actually be completely removed. However, possible prior damage to nerves in the spinal cord is usually irreversible despite successful surgery. Scientific studies have shown that approximately 30% of surgical patients experienced complications after resection, the most common being new or worsening sensory disturbances [8].
If spinal neurinomas regrow—which can happen in rare cases, for example, if tumor remnants remain—a repeat operation is possible. In most cases, however, follow-up with residual neurinomas is often initially performed using CT or MRI. This is because it's possible that growth may initially stagnate for years—and therefore, it's possible to wait until further treatment is initiated.
There are also circumstances that may generally speak against surgery – including the patient’s general condition, the individual surgical risk or the type and location of the tumor.
Conventional radiotherapy can also be performed, although it is fractionated, meaning that the treatment of the spinal neuroma must be divided into several sessions, since the spinal cord and nerve roots are in the radiation field.
The fractional approach is intended to minimize damage to healthy tissue. Patients may require between 10 and 25 sessions over a period of 2 to 5 weeks.
Radiotherapy can also be administered after tumor surgery as part of a combined treatment strategy, e.g., to eliminate remaining microscopic cell clusters.
CyberKnife therapy, as we perform it here at ERCM, represents a possible treatment option for spinal neuroma that can support you as a patient with the greatest possible therapeutic safety and for long-term health and the best possible quality of life.
In contrast to conventional radiotherapy, with the CyberKnife and thanks to advanced non-invasive technologies – which are often already available in modern personalized medicine – the sensitive regions of the spinal cord and adjacent healthy structures are protected to the greatest possible extent.
A targeted, high-dose CyberKnife therapy, which precisely targets the tumor cells to be destroyed, enables this effect. Long-term control rates—with tumor cell elimination and, ideally, no recurrence—are over 90% [3].
During CyberKnife therapy, real-time image guidance is used, among other things, which enables extremely precise targeting – even with occasional natural patient movements, such as those caused by breathing [3]. Continuous tracking and correction of spinal movement throughout the entire treatment are therefore an important prerequisite for the success of radiosurgical treatment as a particularly effective form of therapy.
The increasing complexity of treatment options means that the decision to undergo therapy should always be made with your individual life situation in mind. It is important to us that you, your family, and those who support and accompany you have a thorough understanding of all aspects of your illness and its treatment options, and are able to make sense of them for yourself.
Together with our medical partners, we will accompany you on this journey and, together with our team, will 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 neuroma is a slow-growing, benign tumor, usually surrounded by a connective tissue capsule, which displaces the surrounding tissue as it grows. It can often be treated very effectively and safely by choosing the appropriate therapy for the individual.
The probability that a spinal neurinoma will become malignant (neurofibrosarcoma, malignant nerve sheath tumor) is extremely low (less than 1%). Arms and legs are particularly often affected in such cases, whereas benign spinal neurinomas occur primarily in the spine.
Growth is usually extremely slow, at approximately 1 to 2 mm per year. This allows affected patients, with early diagnosis, to initially monitor the tumor's further growth behavior through regular follow-up visits before making an appropriate treatment decision.
Patients with a benign spinal neuroma can be successfully treated with CyberKnife therapy in certain situations. The size, type, and number of tumors must meet the requirements for radiosurgical treatment. Furthermore, there should be no acute neurological deficits, as surgery is unavoidable in these cases.
A removed spinal neuroma usually does not recur. However, in rare cases, parts of the tumor cannot be removed surgically; in these cases, regrowth is possible. In such situations, the particularly gentle radiosurgical CyberKnife therapy can be used to remove the regrown or remaining tumor remnants without damaging the surrounding tissue.
Only in very rare cases (approximately 1 to 2%) do the benign tumors regress spontaneously without treatment.
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