Occult residual disease after presumed gross-total resection of a predominantly intramuscular paraspinal lumbar schwannoma: a case report introducing the VERIFY-GTR end-of-resection bundle.

Authors

Quang-Phuc Pham, Manh-Cuong Vo

Published in

Journal of spine surgery (Hong Kong). Volume 12. Issue 6. Pages 107. Jun 30, 2026. Epub Jun 26, 2026.

Abstract

Paraspinal schwannomas arising from exiting lumbar nerve roots are uncommon but clinically important because deep intramuscular extension can obscure tumor boundaries. In multilobulated lesions, an intraoperative declaration of gross-total resection (GTR) based on direct visualization alone can be misleading.
A 60-year-old man presented with 12 months of progressive left anterolateral thigh pain and numbness [Visual Analogue Scale (VAS) 6/10; Oswestry Disability Index (ODI) 70%] without motor deficit. Magnetic resonance imaging (MRI) demonstrated a large, predominantly extraforaminal/paraspinal dumbbell schwannoma from L1 to L2 (30 mm × 43 mm × 72 mm; ellipsoid volume approximately 48.6 cm³). Computed tomography (CT)-guided biopsy confirmed schwannoma [World Health Organization (WHO) grade 1]. Microsurgical excision was performed via a posterior paramedian (Wiltse) muscle-splitting corridor with limited L1-L2 hemilaminectomy and continuous neurophysiological monitoring. Recovery was uncomplicated with complete symptom resolution by 2 months (VAS 0; ODI 0%). Nevertheless, contrast-enhanced MRI demonstrated a residual enhancing nodule (15 mm × 22 mm × 23 mm; ellipsoid volume approximately 4.0 cm³), approximately 8% (8.2%) of the initial tumor volume.
Occult residual tumor can persist after apparent GTR and complete clinical recovery. We propose VERIFY-GTR: a proposed, auditable end-of-resection verification bundle coupled with an early postoperative contrast-enhanced MRI baseline (ideally within 48-72 hours when feasible) to define a combined surgical plus radiologic endpoint for radiologically verified GTR, avoid premature finalization of GTR status based on intraoperative inspection alone, and to guide surveillance intensity.

PMID:
42434581
Bibliographic data and abstract were imported from PubMed on 11 Jul 2026.

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