63
Large Upper Cervical Nerve Sheath Tumor

On axial cervical gadolinium-enhanced fluid-attenuated inversion recovery (FLAIR) magnetic resonance imaging (MRI), there is an enhancing C3 dumbbell-shaped lesion displacing the cord to the left and extending outside the foramen into the sternocleidomastoid muscle (Fig. 63-1).

FIGURE 63-1 MRI with dumbbell-shaped lesion.

Diagnosis

Schwannoma

Treatment

The patient underwent a combined anterior/posterior approach. First, C3 was laminectomized for microsurgical resection of the intradural component of the tumor under electromyogram (EMG) monitoring and somatosensory evoked potentials. This was followed by an anterior approach to resect the remaining tumor. Post-operatively, the patient lost his pathologic reflexes and had an improvement in his paresthesias.

Discussion

Spinal tumors are classified according to three anatomic compartments: extradural (commonly primary and metastatic bone tumors), intradural extramedullary (meningiomas, nerve sheath tumors, lipomas), and intradural intramedullary (astrocytomas, ependymomas, hemangioblastomas). Schwannomas are common, benign, intradural, and extramedullary spinal tumors. They are amenable to surgical resection.

This procedure had two stages that were completed in one sitting. A posterior midline exposure was used to resect the tumor from the cord and for lateral disconnection of the tumor. Then a longitudinal, carotid type incision was made for retrieval of the rest of the tumor. No instrumentation was used because no instability was created.

SUGGESTED READING

Slin’ko EI, Al-Qashqish II. Intradural ventral and ventrolateral tumors of the spinal cord: surgical treatment and results. Neurosurg Focus 2004;17:ECP2