Resection of 2 Intradural Extramedullary Cervical Spine Tumors in a Patient With Neurofibromatosis Type 2: 3-Dimensional Operative Video

Abstract

This 3-dimensional operative video illustrates resection of 2 cervical spine schwannomas in a 19-yr-old female with neurofibromatosis type 2. The patient presented with lower extremity hyperreflexity and hypertonicity. Magnetic resonance imaging (MRI) demonstrated 2 contrast-enhancing intradural extramedullary cervical spine lesions causing spinal cord compression at C4 and C5. The patient underwent a posterior cervical laminoplasty with a midline dural opening for tumor resection. Curvilinear spine cord compression is demonstrated in the operative video. After meticulous dissection, the tumors were resected without complication. The dural closure was performed in watertight fashion followed by laminoplasty using osteoplastic titanium miniplates and screws. Postoperative MRI demonstrated gross total resection with excellent decompression of the spinal cord. The postoperative course was uneventful. The natural history of this disease, treatment options, and potential complications are discussed.

Intradural Extramedullary Lesions in the Cervical Spine in Neurofibromatosis

“…In a case report in 2016, a patient presented with recurrent ependymoma located in C1–2; despite multiple decompressions and laminectomy, the patient presented with signs of increased intracranial pressure, so sub-occipital craniotomy was done [ 8 ]. In a case report in 2019, the authors performed cervical laminectomy and fusion with mini-plates and screws in a C4–5 cervical lesion and the patient had no postoperative deficits [ 10 ]. A retrospective series of nearly 180 patients found total gross resection was performed in nearly 2/3 of patients, with postoperative complications in 2 patients, including cerebrospinal leak and wound infection, with no mortalities [ 9 ].…”

“…A few neurofibromatosis type 2 patients diagnosed with cervical lesions have had over 25 lesions [ 6 – 12 ]. The most recent case reports, in 2016 and 2019, mention the main presentation was cervical pain (C1–2 lesion) [ 8 ] and lower limb weakness (C4–5 lesion) [ 10 ]. The patients underwent decompression (suboccipital for upper cervical lesion and laminectomy for middle cervical lesion), and neither had any deficits postoperatively [ 8 , 10 ].…”

“…The most recent case reports, in 2016 and 2019, mention the main presentation was cervical pain (C1–2 lesion) [ 8 ] and lower limb weakness (C4–5 lesion) [ 10 ]. The patients underwent decompression (suboccipital for upper cervical lesion and laminectomy for middle cervical lesion), and neither had any deficits postoperatively [ 8 , 10 ]. Here, we report the case of an intradural extramedullary cervical lesion in a patient later diagnosed with neurofibromatosis type 2.…”

Novel Technique of Coregistered Intraoperative Computed Tomography and Preoperative Magnetic Resonance Imaging and Diffusion Tensor Imaging Navigation in Spinal Cord Tumor Resection

“…Intradural spinal tumors (ISTs), both intradural extramedullary (IDEM) tumors and intramedullary spinal cord tumors (IMSCTs), represent a rare but challenging disease state secondary to local anatomy and proximity of critical structures within a compact and often restricted operative environment. [1][2][3][4][5][6][7][8] Preservation of surgical corridors and identification of normal anatomy often necessitate a generous exposure of intradural anatomy, and tumor localization can be difficult-particularly with IMSCTs that are obscured by a normal-appearing spinal cord. 8 IMSCTs are further complicated by little room for localization error that can lead to profound spinal cord parenchyma damage and devastating complications.…”

“…8 IMSCTs are further complicated by little room for localization error that can lead to profound spinal cord parenchyma damage and devastating complications. [1][2][3][4][5][6][7][8][9][10] The majority of ISTs are benign lesions for which surgical resection remains the frontline therapy. 1 Spinal cord surgeons must therefore possess a thorough understanding of local anatomy, but often that knowledge is not sufficient, so intradural spinal neuronavigation has a clear potential role in guiding intraoperative decision-making.…”