title: Anterolateral approach without fixation for resection of an intradural schwannoma of the cervical spinal canal: technical note.
abstract: OBJECTIVE
  Although an anterolateral approach is an ideal approach to the anterior part of the cervical spinal canal, it is not often used because of various technical difficulties. This article presents the case of a patient with an intradural schwannoma ventrolateral to the spinal cord and describes the technique, anterolateral surgery without fixation, that was used to remove it.
  
  
  METHODS
  A 71-year-old man presented with neck pain and easy fatigability of the legs. Magnetic resonance imaging showed an intradural tumor ventrolateral to the spinal cord at the C3 level. The diagnosis was a schwannoma.
  
  
  METHODS
  A right anterolateral approach was selected for the resection. In the dissection between the sternocleidomastoid muscle and the internal jugular vein, the accessory nerve was retracted with the fat tissue. At C3, the prevertebral aponeurosis was laterally retracted to protect the sympathetic chain. The C3 transverse process was rongeured, and the vertebral artery was shifted laterally with the venous plexus. The C2-C3 uncovertebral joint and the right third of the C3 body were removed (partial corpectomy). The tumor was easily found in the dural sac and was totally removed. The surgical wound was closed in a watertight fashion. No fixation was necessary. The symptoms improved after the operation.
  
  
  CONCLUSIONS
  The anterolateral approach is one of the best approaches for resecting ventrally located intradural lesions because it allows minimally invasive surgery. Control and protection of the accessory nerve, sympathetic chain, and vertebral artery are the keys to success.
authors.affiliation: Department of Neurosurgery, Aichi Medical University, Nagakute, Aichi, Japan. myasuda@aichi-med-u.ac.jp
authors.forename: Muneyoshi
authors.initials: M
authors.lastname: Yasuda
authors.forename: Damien
authors.initials: D
authors.lastname: Bresson
authors.forename: Jan F
authors.initials: JF
authors.lastname: Cornelius
authors.forename: Bernard
authors.initials: B
authors.lastname: George
mesh_terms: D000368:Aged; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery; D019299:Decompression, Surgical; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009442:Neurilemmoma / Q000601:surgery*; D011182:Postoperative Care; D013115:Spinal Canal / Q000000981:diagnostic imaging / Q000601:surgery*; D013120:Spinal Cord Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D014057:Tomography, X-Ray Computed / Q000379:methods; D014711:Vertebral Artery / Q000000981:diagnostic imaging / Q000601:surgery