title: Single stage transforaminal retrojugular tumor resection: The spinal keyhole for dumbbell tumors in the cervical spine.
abstract: BACKGROUND
  Dumbbell tumors are defined as having an intradural and extradural component with an intermediate component within an expanded neural foramen. Complete resection of these lesions in the subaxial cervical spine is a challenge, and it has been achieved through a combined posterior/anterior or anterolateral approach. This study describes a single stage transforaminal retrojugular (TFR) approach for dumbbell tumors resection in the cervical spine.
  
  
  METHODS
  This is a retrospective review of a series of 17 patients treated for cervical benign tumors, 4 of which were "true" cervical dumbbell tumors operated by a simplified retrojugular approach. The TFR approach allows a single stage gross total resection of both the extraspinal and intraspinal/intradural components of the tumor, taking advantage of the expanded neural foramen. All patients were followed clinically and radiologically with magnetic resonance imaging (MRI).
  
  
  RESULTS
  Gross total resection was confirmed in all four patients by postoperative MRI. Minimal to no bone resection was performed. No fusion procedure was performed and no delayed instability was seen. At follow up, one patient had a persistent mild hand weakness and Horners syndrome following resection of a hemangioblastoma of the C8 nerve root. The other three patients were neurologically normal.
  
  
  CONCLUSIONS
  The TFR approach appears to be a feasible surgical option for single stage resection in selective cases of dumbbell tumors of the cervical spine.
authors.affiliation: Neurosurgical Service, Department of Clinical Neurosciences, University of Lausanne Hospital, CHUV, Lausanne, Switzerland.
authors.forename: Lukas
authors.initials: L
authors.lastname: Bobinski
authors.affiliation: Neurosurgical Service, Department of Clinical Neurosciences, University of Lausanne Hospital, CHUV, Lausanne, Switzerland.
authors.forename: Yves
authors.initials: Y
authors.lastname: Henchoz
authors.affiliation: Department of Ear, Nose, and Throat, University of Lausanne Hospital, CHUV, Lausanne, Switzerland.
authors.forename: Kishore
authors.initials: K
authors.lastname: Sandu
authors.affiliation: Neurosurgical Service, Department of Clinical Neurosciences, University of Lausanne Hospital, CHUV, Lausanne, Switzerland.
authors.forename: John Michael
authors.initials: JM
authors.lastname: Duff
keywords: Cervical spine; dumbbell tumors; transforaminal retrojugular approach