C2 dumbbell-shaped peripheral nerve sheath tumors: Surgical management and relationship with venous structures

Wang, Zuowei; Wang, Xingwen; Wu, Hao; Chen, Zan; Yuan, Quan; Jian, Fengzeng

doi:10.1016/j.clineuro.2016.10.016

Cited by 8 publications

(6 citation statements)

References 21 publications

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“…In clinical surgery, Ibn Essayed and Al‐Mefty (2021) mentioned that the SCS could be encountered in the transcondylar decompression approach for craniovertebral junction lesions. Wang et al (2016) reported that the SCS, the vertebral artery venous plexus, and the VVP are the main sources of hemorrhage during surgery for tumors involving the upper cervical peripheral nerve sheath. Haffajee et al (2008) also proposed that injury to the extensive venous plexus (such as cavernous‐like veins) around the craniocervical junction should be avoided because it can cause hemorrhage.…”

Section: Discussionmentioning

confidence: 99%

“…Abidin et al (Geyik et al, 2021; Hanakita et al, 2019) suggested that subperiosteal dissection of the SCS (paravertebral plexus surrounding the VA) is crucial for obtaining a clear operative field in diseases of the craniovertebral junction. Some authors have proposed that preservation of the fibrous membrane or wall surrounding the SCS will minimize bleeding (Wang et al, 2016). The thin fibrous membrane surrounding numerous venous sinuses identified in this research is the wall of SCS.…”

Section: Discussionmentioning

confidence: 99%

“…Hence, owing to their anatomical resemblance, the venous compartment that cushions the horizontal portion of the suboccipital segment of the VA was named the SCS by Arnautovi c et al (1997). The SCS is implicated in several diseases such as the meningeal arteriovenous fistulae that involve it (Crockett et al, 2019;Hiramatsu et al, 2015), the metastatic spread of cancer to the intracranial compartment (Arnautovi c et al, 1997), and intraoperative bleeding in the craniocervical junction area (Wang et al, 2016).…”

Section: Introductionmentioning

confidence: 99%

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An anatomical study of the suboccipital cavernous sinus and its relationship with the myodural bridge complex

et al. 2023

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The suboccipital cavernous sinus (SCS) and the myodural bridge complex (MDBC) are both located in the suboccipital region. The SCS is regarded as a route for venous intracranial outflow and is often encountered during surgery. The MDBC consists of the suboccipital muscles, nuchal ligament, and myodural bridge and could be a power source for cerebrospinal fluid circulation. Intracranial pressure depends on intracranial blood volume and the cerebrospinal fluid. Since the SCS and MDBC have similar anatomical locations and functions, the aim of the present study was to reveal the relationships between them and the detailed anatomical characteristics of the SCS. The study involved gross dissection, histological staining, P45 plastination, and three‐dimensional visualization techniques. The SCS consists of many small venous sinuses enclosed within a thin fibrous membrane that is strengthened by a fibrous arch closing the vertebral artery groove. The venous vessels are more abundant in the lateral and medial portions of the SCS than the middle portion. The middle and medial portions of the SCS are covered by the MDBC. Type I collagen fibers arranged in parallel and originating from the MDBC terminate on the SCS either directly or indirectly via the fibrous arch. The morphological features of SCS revealed in this research could serve as an anatomical basis for upper neck surgical procedures. There are parallel arrangements of type I collagen fibers between the MDBC and the SCS. The MDBC could change the blood volume in the SCS by pulling its wall during the head movement.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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An anatomical study of the suboccipital cavernous sinus and its relationship with the myodural bridge complex

et al. 2023

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“…Several authors discussed surgical management of VA for PNST. [ 17 , 26 , 32 ] George et al . suggested that proximal control of VA should be routinely performed before tumor resection.…”

Section: Discussionmentioning

confidence: 99%

Surgical management of spinal schwannomas arising from the first and second cervical roots: Results of a cumulative case series

Corrivetti,

Roperto,

Sufianov

et al. 2023

Journal of Craniovertebral Junction and Spine

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Objective: Schwannomas of the first and second nerve roots are rare neurosurgical entities, harboring specific surgical features that make surgical resection particularly challenging and deserve specifics dissertations. This study is a retrospectively analysis of 14 patients operated in two different neurosurgical centers: the San Filippo Neri Hospital of Rome and the Federal Centre of Neurosurgery of Tjumen. Materials and Methods: In the last 6 years, 14 patients underwent neurosurgical resection of high cervical (C1–C2) schwannomas, in two different neurosurgical centers. Patients data regarding clinical presentation, radiological findings, and surgical results were retrospectively analyzed. Results: The mean age was 50 years (range 13–74), the follow-up mean duration was 30 ± 8.5 (range 24–72 months), and there was no significant differences among different tumor locations (intradural, extradural, and dumbbell). Surgical results were excellent: gross total resection was achieved in all cases and there were no intraoperative complications or postoperative mortality. All patients presented postoperative clinical improvement except one who remained stable. Karnofsky performance status, at the last follow-up, confirmed a global clinical improvement. No vertebral artery (VA) injury neither spinal instability occurred; nerve root sacrifice was reported in one case. Conclusions: Neurosurgical treatment of C1–C2 schwannomas is associated with good outcomes in terms of extent of resection and neurological function. In particular, dumbbell shape and VA involvement do not represent limitations to achieve complete tumor resection and good clinical outcome. In conclusion, microsurgery represents the treatment of choice for C1–C2 schwannomas.

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“…Tumors can be intradural extramedullary or entirely extradural, and they usually arise in a dorsal location. If they become large, they may either align with the long axis of the spinal cord and generate fusiform masses that can extend over multiple levels, or they may protrude out of the neural foramen with an intracanal and a paravertebral component (called dumbbell nerve sheath tumors) [ 57 , 58 ]. Multiple upper cervical nerve sheath tumors characteristically occur in cases of neurofibromatosis.…”

Section: Pathological and Radiological Features Of The Cvj Neoplasmsmentioning

confidence: 99%

Craniovertebral Junction Instability after Oncological Resection: A Narrative Review

et al. 2023

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The craniovertebral junction (CVJ) is a complex transition area between the skull and cervical spine. Pathologies such as chordoma, chondrosarcoma and aneurysmal bone cysts may be encountered in this anatomical area and may predispose individuals to joint instability. An adequate clinical and radiological assessment is mandatory to predict any postoperative instability and the need for fixation. There is no common consensus on the need for, timing and setting of craniovertebral fixation techniques after a craniovertebral oncological surgery. The aim of the present review is to summarize the anatomy, biomechanics and pathology of the craniovertebral junction and to describe the available surgical approaches to and considerations of joint instability after craniovertebral tumor resections. Although a one-size-fits-all approach cannot encompass the extremely challenging pathologies encountered in the CVJ area, including the possible mechanical instability that is a consequence of oncological resections, the optimal surgical strategy (anterior vs posterior vs posterolateral) tailored to the patient’s needs can be assessed preoperatively in many instances. Preserving the intrinsic and extrinsic ligaments, principally the transverse ligament, and the bony structures, namely the C1 anterior arch and occipital condyle, ensures spinal stability in most of the cases. Conversely, in situations that require the removal of those structures, or in cases where they are disrupted by the tumor, a thorough clinical and radiological assessment is needed to timely detect any instability and to plan a surgical stabilization procedure. We hope that this review will help shed light on the current evidence and pave the way for future studies on this topic.

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C2 dumbbell-shaped peripheral nerve sheath tumors: Surgical management and relationship with venous structures

Abstract: The C2 dumbbell-shaped PNSTs were closely related to the suboccipital venous structures. Understanding and proper management of these venous structures is critical for reduced bleeding and successful surgery.

Cited by 8 publications

References 21 publications

An anatomical study of the suboccipital cavernous sinus and its relationship with the myodural bridge complex

An anatomical study of the suboccipital cavernous sinus and its relationship with the myodural bridge complex

Surgical management of spinal schwannomas arising from the first and second cervical roots: Results of a cumulative case series

Craniovertebral Junction Instability after Oncological Resection: A Narrative Review

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