title: Dumbbell C2 schwannomas involving both sensory and motor rootlets: report of two cases.
abstract: OBJECTIVE
  Intradural-extradural dumbbell C2 schwannomas are rare. This report concerns two such cases with the intradural compartment located ventral to the spinal cord and involving both sensory and motor rootlets.
  
  
  METHODS
  One patient was a 57-year-old woman with sensory disturbances in the right extremities and hyperreflexia in the left extremities. The other patient was a 73-year-old man who presented with tetraparesis, walking disability, atrophy of the nuchal and bilateral shoulder muscles, and pain in the right C2 dermatome.
  
  
  METHODS
  The extradural component of the tumor was removed first; next, the intradural component was removed successfully via the posterior approach combined with a C1-C2 laminectomy. The patients experienced symptomatic improvement without further deficits except for sensory impairment of the C2 dermatome in one of the patients.
  
  
  CONCLUSIONS
  Intradural-extradural dumbbell C2 schwannomas can be satisfactorily managed with a posterior approach. Removal of the extradural component and opening of the dural ring of the C2 nerve root are necessary for safe extraction of the intradural ventrally located component after debulking. These tumors may arise extradurally within the nerve sheath, extend intradurally and ventrally toward the spinal cord, and involve both sensory and motor rootlets.
authors.affiliation: Department of Neurosurgery, Shinshu University School of Medicine, Asahi, Matsumoto, Japan. kakyosh@hsp.md.shinshu-u.ac.jp
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Kyoshima
authors.forename: Takashi
authors.initials: T
authors.lastname: Uehara
authors.forename: Junichi
authors.initials: J
authors.lastname: Koyama
authors.forename: Koji
authors.initials: K
authors.lastname: Idomari
authors.forename: Shoji
authors.initials: S
authors.lastname: Yomo
mesh_terms: D000368:Aged; D002574:Cervical Vertebrae / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery*; D004388:Dura Mater / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009046:Motor Neurons / Q000473:pathology* / Q000502:physiology*; D009442:Neurilemmoma / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery*; D020127:Recovery of Function / Q000502:physiology; D011984:Sensory Receptor Cells / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery*; D013120:Spinal Cord Neoplasms / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery*; D013126:Spinal Nerve Roots / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery*