Surgical consideration for safe resection of cervical dumbbell Schwannoma: A case report

• Main Authors: Saujanya Rajbhandari, Kotaro Tatebayashi, Hiroto Kagayama, Shinichi Yoshimura
• Format: Article
• Language: English
• Published: Elsevier 2021-09-01
• Series: Interdisciplinary Neurosurgery
• Subjects: Cervical dumbbell schwannoma; Surgical strategy; Tumor resection
• Online Access: http://www.sciencedirect.com/science/article/pii/S2214751921001092

Background: Cervical dumbbell schwannomas are commonly occurring tumor in the cervical spine. Careful planning of the surgical strategy is necessary to achieve successful tumor resection while maintaining the spinal stability and preventing any adverse events. We describe the surgical management strategy for obtaining safe gross total resection of cervical dumbbell schwannomas. The role of preoperative tumor embolization and the importance of multi-axis angiography unit in supporting this surgical procedure has also been described. Informed consent was obtained for the case reporting. Case discussion: A 23-year-old male with newly diagnosed cervical dumbbell schwannoma at left C3-C4 level. Preoperative embolization of the tumor was done with coils. Following which, tumor resection was done with ultrasonic surgical aspiration/irrigation system via posterior approach in hybrid operating room. C3-C4 laminectomy and left C3-C4 facetectomy was performed to maximize tumor removal. Cervical stability was obtained with C3-C4 anterior cervical fusion and right C3-C4 lateral mass screw fixation. Postoperative magnetic resonance imaging and computed tomography scan showed complete resection of tumor with optimal placement of instruments. Conclusion: Careful surgical strategy facilitates successful tumor resection. Preoperative embolization can help to avoid intraoperative bleeding leading to better operative field visualization. Posterior approach with laminectomy and unilateral facetectomy provides adequate exposure for extensive tumor resection, however spinal reconstruction should be considered to secure postoperative spinal stability.