Lateral Transforaminal Approach for Large Cervical Dumbbell Neurinomas

Abstract

  For the management of large cervical dumbbell-shaped neurinomas, generally, a posterior approach is first employed for the removal of the intraspinal tumor, and removal of the remaining extraspinal tumor is attempted through an anterior approach. However, several anterolateral approaches have attempted to remove some cervical dumbbell-shaped neurinomas by one-stage operation. These approaches are excellently organized to remove intraspinal portion of the tumors as well as extraspinal portion via the route medial to the sternocleidmastoid muscle (SCM).

  We report our experience of 2 cases in which large cervical dumbbell-shaped neurinomas laterally extended between the anterior and middle scalenus muscle to the external jugular vein. We performed surgery through a retro-SCM approach to remove the laterally extending tumors. For safe handling of vertebral arteries, we also used the pre-SCM route to expose the anterior tubercles of the transverse process. The retro-SCM approach along the extension of the tumors provided an excellent surgical corridor for the removal of extraspinal, intraforaminal, and even intraspinal portions of the tumor. Moreover, no obstacle, except for the supraclavicular nerve just on the surface of the tumor, was encountered. We were able to preserve this nerve without intense effort. Although 1 patient complained of transient dysesthesia over the ipsilateral clavicular region after the operation, the other patient had no complaints.

  We believe that this approach is safe and effective for the removal of large cervical dumbbell-shaped neurinomas with lateral extension ; however, the approach needs to be investigated in more cases in the near future.