{"id":"c75c53de-6e19-437f-9dbb-77c994c95268","slug":"sacrifice-of-chronically-impaired-spinal-nerve-roots-in-schwannomas-with-functional-compensation-by-adjacent-roots-a-case-report-and-literature-review","title":"Sacrifice of chronically impaired spinal nerve roots in schwannomas with functional compensation by adjacent roots: A case report and literature review","authors":["Carlo Mandelli","Cinzia Mura","Ubaldo Del Carro","Gaetano Giulio Vitale","Pietro Mortini"],"abstract":"Background: Spinal nerve sheath tumors (NSTs), including schwannomas and neurofibromas, are slow-growing lesions often arising from dorsal sensory roots. Surgical resection is the gold-standard treatment, but the necessity of sacrificing the affected nerve root to achieve gross total resection remains controversial due to concerns about postoperative deficits. Methods: A comprehensive review of the literature was conducted to evaluate neurological outcomes following nerve root sacrifice and the functional reorganization by adjacent roots during the resection of large spinal schwannomas and neurofibromas. In addition, we report a representative case of a patient with a 20-year history of a large left L5 schwannoma, showing preoperative and intraoperative electrophysiological evidence of chronic radicular impairment. The patient underwent microsurgical tumor excision under intraoperative neurophysiological monitoring, with sacrifice of the affected root to allow the resection of the lesion tightly adherent to adjacent structures. Results: The literature consistently demonstrates that chronically compressed nerve roots in large, slow-growing NSTs are often nonfunctional or poorly functional, with compensatory reorganization by adjacent cranial and caudal roots. Reported rates of new postoperative motor deficits are low, even after root sacrifice. In our case, postoperative clinical and electromyographic follow-up confirmed the absence of new neurological deficits and the persistence of chronic, compensated impairment of the sacrificed root. Conclusion: Chronic impairment of spinal nerve roots in patients with large neoplasms, as documented by preoperative and intraoperative electromyographic data, allows for the safe resection of adherent NSTs with the possibility of sacrificing nonfunctional nerve roots. Functional compensation by adjacent roots preserves motor function, thereby minimizing the risk of postoperative deficits following root sacrifice.","thumbnailUrl":"https://sni-digital-videos.s3.amazonaws.com/articles/c75c53de-6e19-437f-9dbb-77c994c95268/featured/hero-1781558198204.png","publishDate":"2025-11-14T00:00:00.000Z","doi":"10.25259/SNI_1130_2025","categories":["Neuroanatomy and Neurophysiology","Review Article"],"fullTextUrl":"https://surgicalneurologyint.com/wp-content/uploads/2025/11/14071/SNI-16-483.pdf"}