title: Surgical strategies for removal of intra- and extraforaminal dumbbell-shaped schwannomas in the subaxial cervical spine.
abstract: OBJECTIVE
  Spinal dumbbell-shaped schwannoma is common neoplasm, usually occurring in the cervical spine. Posterior or anterolateral approaches are frequently used to remove this benign tumor. We analyzed how much amount of tumor could be possible to be totally removed with posterior approach.
  
  
  METHODS
  Surgery was performed on 41 cases of cervical, dumbbell-shaped subaxial schwannomas with both intra- and extraforaminal involvement. The same surgeon performed all the procedures. Mean follow-up was 42.5 months (24-108 months). A combined anterolateral and posterior approach was used if the extraforaminal tumor was larger than 10 mm. A posterior approach and unilateral facet removal were used if it was smaller than 10 mm. We performed MRI and serial dynamic X-rays for postoperative 2 years.
  
  
  RESULTS
  We used the posterior approach with facetectomy in 35 cases and the combined approach in six. Complete removal was achieved with the combined approach in all six, and with the posterior approach in 28 of 35 cases. With the posterior approach, the extraforaminal dimension of totally resected tumors ranged from 3 to 5.4 mm. Subtotal resection was limited to extraforaminal tumors larger than 5.7 mm. On follow-up, instability on dynamic X-ray was not observed before 24 months in any patient after unilateral facetectomy.
  
  
  CONCLUSIONS
  Total removal of intra- and extraforaminal cervical subaxial schwannomas could be possible using a posterior approach with facet removal if the size of extraforaminal tumor was less than 5.4 mm.
authors.affiliation: Department of Neurological Surgery, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea.
authors.forename: Bon Sub
authors.initials: BS
authors.lastname: Gu
authors.affiliation: Department of Neurological Surgery, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea.
authors.forename: Jin Hoon
authors.initials: JH
authors.lastname: Park
authors.affiliation: Department of Neurological Surgery, Asan Medical Center, College of Medicine, University of Ulsan, 388-1 Pungnap-2dong, Songpa-gu, Seoul, 138-736, Korea.
authors.forename: Sung Woo
authors.initials: SW
authors.lastname: Roh
authors.affiliation: Department of Neurological Surgery, Asan Medical Center, College of Medicine, University of Ulsan, 388-1 Pungnap-2dong, Songpa-gu, Seoul, 138-736, Korea.
authors.forename: Sang Ryong
authors.initials: SR
authors.lastname: Jeon
authors.affiliation: Department of Neurological Surgery, Asan Medical Center, College of Medicine, University of Ulsan, 388-1 Pungnap-2dong, Songpa-gu, Seoul, 138-736, Korea.
authors.forename: Jun-Won
authors.initials: JW
authors.lastname: Jang
authors.affiliation: Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
authors.forename: Seung-Jae
authors.initials: SJ
authors.lastname: Hyun
authors.affiliation: Department of Neurological Surgery, Asan Medical Center, College of Medicine, University of Ulsan, 388-1 Pungnap-2dong, Songpa-gu, Seoul, 138-736, Korea. scrhim@amc.seoul.kr.
authors.forename: Seung Chul
authors.initials: SC
authors.lastname: Rhim
mesh_terms: D000328:Adult; D000368:Aged; D002574:Cervical Vertebrae; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009442:Neurilemmoma / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000379:methods; D011182:Postoperative Care / Q000379:methods; D013120:Spinal Cord Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D055815:Young Adult
keywords: Cervical schwannoma; Dumbbell shaped; Facetectomy; Instability; Posterior approach