title: Surgical consideration of cervical dumbbell tumors.
abstract: BACKGROUND
  Nineteen patients with cervical dumbbell tumors treated surgically were analyzed retrospectively.
  
  
  METHODS
  Surgical strategies for dumbbell tumor were discussed from the perspective of safe, less-invasive surgery.
  
  
  RESULTS
  Patients included 6 men and 13 women, with a mean age at the time of surgery of 48.3 years (range, 25-70 years). Underlying pathologies included 16 schwannomas, 2 neurofibromas, and 1 double tumor (schwannoma and meningioma). According to Eden's classification, one patient was classified as Type 1, 5 as Type 2, 8 as Type 3, and 5 as Type 4. In 13 cases, tumors were excised through the posterior approach alone, compared to five cases using the anterior approach. One case was excised using combined anterior and posterior approaches. Facetectomy was not performed in 18 cases. In one case, the facet joint on one side had already destroyed and needed instrumentation. Tumors were totally excised in all cases. Postoperatively, the patients did not display any further neurological deficit, with the exception of transient radiculopathy in two patients. Major surgical complications and cerebrospinal fluid leakage were not seen. Tumor recurrence and spinal segmental instability were not found during follow-up period (mean, 41.6 months).
  
  
  CONCLUSIONS
  Dumbbell tumor surgery requires sufficient debulking of the epidural and paravertebral mass, using intraoperative nerve stimulation and Doppler ultrasonography to detect the vertebral artery. When using a posterior approach, recapping laminoplasty using an ultrasonic bone curette is very useful to remove tumor without sacrificing facet joints.
authors.affiliation: Department of Neurosurgery, Southern Tohoku Research Institute for Neuroscience, Southern TOHOKU General Hospital, Koriyama, Fukushima, Japan, masatotomii@ybb.ne.jp.
authors.forename: Masato
authors.initials: M
authors.lastname: Tomii
authors.forename: Yasunobu
authors.initials: Y
authors.lastname: Itoh
authors.forename: Shinichi
authors.initials: S
authors.lastname: Numazawa
authors.forename: Kazuo
authors.initials: K
authors.lastname: Watanabe
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008577:Meningeal Neoplasms / Q000473:pathology / Q000601:surgery*; D008579:Meningioma / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery*; D009442:Neurilemmoma / Q000473:pathology / Q000601:surgery*; D009455:Neurofibroma / Q000473:pathology / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000379:methods*; D012189:Retrospective Studies; D021801:Zygapophyseal Joint / Q000473:pathology