Dr. Jorge Torales
Neurosurgeon · Skull base and spinal endoscopy
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Nerve root surgery
Spinal nerve root tumours
Microsurgical resection of schwannomas, neurofibromas, and spinal nerve root tumours with functional preservation. Intraoperative neurophysiological monitoring to minimise risk.
What is it?
Spinal nerve root tumours
Nerve root tumours are (mostly) benign tumours that originate in the myelin sheaths of the spinal nerves. The most common are schwannomas (also called neuromas) and neurofibromas. They cause radicular pain, sensory or motor deficit through compression. Microsurgical resection with neurophysiological monitoring achieves complete resection in most schwannomas while preserving nerve function.
25%
of intradural extramedullary tumours
>95%
benign (WHO grade I)
<5%
new neurological deficit in monitored surgery
Symptoms
When to consult a neurosurgeon?
Symptoms depend on location and size:
- Chronic radicular pain in the corresponding dermatome
- Paraesthesias or numbness in the distribution of the affected nerve
- Progressive focal motor weakness
- Palpable mass if the tumour reaches subcutaneous tissues (brachial or lumbosacral plexus)
- Lumbar or cervical pain with characteristic radiation
- Spinal cord compression in large central tumours (associated myelopathy)
- Radicular syndrome not responding to conservative treatment for more than 3 months
Urgent attention: Progressive onset of motor weakness or spinal cord compression requires prompt neurosurgical assessment.
Treatments
Which techniques do we use?
Microsurgical resection of schwannomas
Benign tumour with a clear cleavage plane. Complete resection preserving the nerve root can be achieved in most cases.
Resection of neurofibromas
More infiltrative than schwannoma. Fascicular preservation may be more difficult. In neurofibromatosis type 1, surgery is selective.
Surgery for dumbbell-shaped tumours
Tumour with intra- and extradural/foraminal components. Requires a combined approach with hemilaminectomy and foraminotomy.
Resection of brachial or lumbosacral plexus tumours
Supraclavicular, subclavicular, abdominal, or pelvic approaches depending on location. Continuous EMG monitoring.
Surgery in neurofibromatosis
Individualised selection of symptomatic lesions or those with demonstrated growth. Higher risk of neurological deficit due to fascicular involvement.
Intraoperative neurophysiological monitoring
Continuous stimulated and spontaneous EMG to identify and protect functional fascicles during dissection.
Our protocol
How we approach each case
The workup includes contrast-enhanced MRI of the affected segment with specific sequences (tumour spine protocol). Where neurofibromatosis is suspected, systemic evaluation with whole-body MRI and genetic assessment is performed. Preoperative electromyography documents the function of the affected fascicle. Surgery is performed with continuous neurophysiological monitoring to identify functional fascicles and preserve them through direct stimulation. Follow-up includes MRI at 3 months, 1 year, and then annually.
Perioperative protocol
How we organise each case
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1 · Preoperative workup
MRI with and without contrast of the affected region, MR neurography or ultrasonography for peripheral lesions, genetic testing (NF1, NF2, schwannomatosis) where indicated.
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2 · Surgery
Microsurgery with fascicular monitoring. Direct electrical stimulation to identify and preserve functional fascicles.
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3 · Immediate postoperative
Sensory and motor functional assessment. Follow-up MRI at one month and at six months.
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4 · Discharge and follow-up
Discharge at 2-5 days. Specific physiotherapy if residual deficit. Annual follow-up in patients with neurofibromatosis.
Team
Neurosurgeons who treat this condition
Dr. Abel Ferrés Pijoan
Neurosurgeon · Spine, neuro-oncology, and skull base
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Dr. Pedro Roldán Ramos
Neurosurgeon · Spine, functional, and brain surgery
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Results
Prognosis and recovery
Complete resection of schwannomas is achieved in more than 90% of cases with functional preservation in the majority. Isolated neurofibromas have similar outcomes; in neurofibromatosis, surgery is individualised. Recurrence after complete resection is low (below 5%). Permanent new neurological deficit at specialist centres with monitoring is below 5%. Typical hospital stay is 3-5 days and return to work is 4-6 weeks.
Frequently asked questions
Answers to your questions
What are spinal schwannomas?
These are benign tumours that grow in the myelin sheaths of the spinal nerve roots. They are the most common tumours of the spinal nerves and are usually solitary, except in neurofibromatosis. They cause radicular pain, sensory deficit, or motor deficit depending on location and compression.
What is neurofibromatosis?
It is a group of genetic syndromes that predispose to peripheral nerve tumour formation. NF1 (von Recklinghausen type) presents with café-au-lait spots and multiple neurofibromas; NF2 with bilateral vestibular schwannomas and meningiomas. They require multidisciplinary follow-up.
Can the nerve be preserved during surgery?
Yes, in most cases. Schwannomas grow by displacing functional nerve fibres, allowing complete resection while preserving the nerve using microsurgical technique and neurophysiological monitoring (intraoperative EMG). In neurofibromas, which infiltrate the nerve, preservation is more difficult.
When should a nerve root tumour be operated on?
Surgery is indicated when there are neurological symptoms (disabling pain, motor or sensory deficit), demonstrated growth, or associated spinal cord compression. Small asymptomatic tumours are monitored with annual MRI.
What are the risks of surgery?
The main risks are new neurological deficit (transient or permanent), CSF fistula, infection, and, in cases of incomplete resection or neurofibromatosis, recurrence. The rate of permanent neurological deficit at specialist centres with monitoring is below 5%.
References
What clinical guidelines say
"Surgery for peripheral nerve tumours should be performed with intraoperative electrophysiological monitoring to optimise functional outcomes."
"In patients with neurofibromatosis, the surgical indication should be based on symptoms or demonstrated growth, not on isolated radiological findings."
Bibliography
Scientific references consulted
Studies and clinical guidelines on which we base our approach to this condition.
- Plotkin SR. et al. Update from the 2011 International Schwannomatosis Workshop. Am J Med Genet A. 2013. View publication
- Wilson TJ. et al. Benign peripheral nerve sheath tumors: surgical outcomes and functional recovery. Neurosurgery. 2017. View publication
- Rodriguez FJ. et al. Pathology of peripheral nerve sheath tumors. Acta Neuropathol. 2012. View publication
- Donner TR. et al. Neural sheath tumors of major nerves. J Neurosurg. 1994. View publication
- Evans DGR. et al. Management of the patient and family with neurofibromatosis 2. J Med Genet. 2005. View publication
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ALAYA guides the trajectory of the surgical instruments through a patented kinematic tracking system that requires no optical navigation cameras: it avoids the classic line-of-sight problems and takes up less space in theatre. The patient's position is monitored in real time by a bone reference clamp attached directly to the tracking device, which improves the overall accuracy of the procedure.
What do we use it for?
- Pedicle screw placement in the posterior thoracic and sacro-lumbar spine.
- Spinal fusion surgery, both open and minimally invasive.
- Intraoperative 3D planning using preoperative or intraoperative 2D/3D CT.
- Implant-brand independence: compatible with any commercially available cannulated screw.
A real benefit for the patient: a reduction in mean hospital stay from 9.4 to 6.8 days documented with robotic assistance in spinal fusion, together with lower intraoperative radiation exposure for both patient and team.
↑
Greater accuracy
Significantly more accurate pedicle screw placement than with conventional technique.
↓
Minimally invasive
Less tissue damage, lower risk of infection and faster postoperative recovery.
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Shorter operating time
An intuitive workflow and fast set-up that shorten the length of the procedure.
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Lower radiation
The system minimises the number of image acquisitions needed during surgery.
Patient reviews
What our patients say
High-grade glioma
"I arrived with a glioma I had been told was inoperable. Here they reviewed it at the tumour board and offered me a plan. The surgery was a success. Four years on, I am well."
Cervical disc herniation
"For years I had a cervical disc herniation, operated on by another team with no improvement. Minimally invasive surgery gave me back my mobility and took the pain away."
International patient
"I travelled from outside Spain. The team reviewed my case before I came and gave me a clear plan. Caring people and impeccable technique."
Request information
Enquiry about nerve root tumour
Send us your contrast-enhanced MRI and report. Nerve root and peripheral nerve lesions require specific expertise · we will guide you towards the best approach.