Schwannomas and Neurofibromas

Intradural tumours of the spine are rare. Two-thirds of these tumours are extramedullary. Nerve sheath tumours, including both schwannoma and neurofibroma, are intradural extramedullary tumours and are usually benign. Surgery represents the first-choice treatment for spinal intradural extramedullary tumours, including schwannomas and neurofibromas. On the other hand, whether it is the most appropriate approach for all cases and, in particular, in the setting of recurrence or in the case of residual or multiple lesions remains an open question. Moreover, some patients are less than ideal candidates for surgery and could be better treated with a non-invasive modality like radiotherapy. Barriers to radiation have included a concern for radiation-induced myelopathy and radiation-induced transformation. Despite this, at present the number of patients treated by radiation and in particular by stereotactic radiosurgery is increasing. With respect to the latter, the medium- to long-term results sustain the role of radiosurgery to treat such tumours as a primary treatment modality. The current literature and the most recent clinical results are summarized in this chapter.