Surgical considerations for maximal safe excision of subaxial cervical dumbbell Schwannoma in a single approach

BACKGROUND: Spinal dumbbell shaped tumors are tumors that grow over the constricted intervertebral foramen from the intraspinal canal to the extraspinal region. The best surgical approach for dumbbell tumors in the cervical spine is still debatable. OBJECTIVE: To evaluate the clinical outcome, extent of resection and postoperative cervical spine stability following surgical resection of subaxial cervical dumbbell shaped tumors through the posterior approach. METHODS: Patients with dumbbell shaped tumors in the subaxial cervical spine who were operated upon by the posterior approach in the department of neurosurgery at Cairo University hospitals between January 2019 and January 2021 were evalu - ated retrospectively. The preoperative and postoperative neurological conditions were assessed using the Japanese Orthopedic Association (JOA) score. Postoperative magnetic resonance imaging was performed for evaluation of the extent of resection. RESULTS: Six patients with subaxial cervical dumbbell shaped tumors underwent surgery via a posterior approach for tumor excision and fusion in 2 years. We reported clinical improvement in 3 cases, 2 cases had a stationary course and only one case showed mild immediate postoperative deterioration that improved within a month after surgery. In five patients gross total resection was achieved, and in one patient subtotal resection was achieved. The pathology was schwannoma in all cases. We reported no vascular injury or mortality in our study. CONCLUSION: For the excision of dumbbell shaped schwannomas in the subaxial cervical spine, one-stage posterior laminectomy with facetectomy appears to be a feasible and effective option. The tumor could be safely and fully excised in the majority of cases.