Transuncodiscal approach to dumbbell tumors of the cervical spinal canal

Hakuba, Akira; Komiyama, Masaki; Tsujimoto, Tokuzou; Ahn, Myung Soo; Nishimura, Shüro; Ohta, Tomio; Kitano, Hideki

doi:10.3171/jns.1984.61.6.1100

Cited by 94 publications

(38 citation statements)

References 3 publications

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“…Various surgical approaches have been applied to resect dumbbell-shaped or extradural tumors of the cervical spine, but excessive bone resection and soft tissue T. Takami et al manipulation appear to be unnecessary in the majority of spinal NSTs originating from the C1 or C2 level. [2][3][4]8,9,11,15) In an exceptional case, another surgical strategy such as an anterolateral approach with management of vertebral artery may be adequate to resect tumor involving the vertebral artery or extending beyond the vertebral artery, which is one of the limiting factors of the radical resection. 2,15) Excessive bone resection for wide exposure of the tumor may necessitate a subsequent fusion procedure such as posterior occipitocervical or C1-2 fixation.…”

Section: Discussionmentioning

confidence: 99%

Surgery of Spinal Nerve Sheath Tumors Originating From C1 or C2 of High Cervical Spine -Technical Note-

Takami

Yamagata

Chokyu

et al. 2010

Neurol. Med. Chir.(Tokyo)

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Spinal nerve sheath tumors (NSTs) originating from the C1 or C2 level are unique from both anatomical and clinical perspectives. Surgical technique to accomplish radical but safe resection of these tumors is described in 8 cases treated during the past 5 years. Surgical measures included positioning the patient in the lateral oblique position, unilateral posterior approach, exposure of the tumor along the surgical plane of the dural or perineural boundary, and proximal and distal amputation of the tumor with resection of dural penetration. Excessive bone resection and soft tissue manipulation were unnecessary. Microscopic complete removal of the tumor was accomplished in seven of eight cases. Subtotal resection was done in one case where the tumor extended beyond the vertebral artery. Functional assessment demonstrated satisfactory improvement after surgery in all cases. Surgery-related complications were not encountered in any case. Exposure of the tumor along the surgical plane of the dural or perineural boundary may be the key procedure required to accomplish radical but safe resection of spinal NSTs originating from the C1 or C2 level.

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Section: Discussionmentioning

confidence: 99%

Surgery of Spinal Nerve Sheath Tumors Originating From C1 or C2 of High Cervical Spine -Technical Note-

Takami

Yamagata

Chokyu

et al. 2010

Neurol. Med. Chir.(Tokyo)

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“…The preferred way for removing this extraspinal part is to verify a new dissection plane along the anterior margin of the sternocleidomastoid muscle [3, 4]. The transuncodiscal approach [1, 5, 6]is another one-stage operation that enables the total removal of both extra- and intraspinal components. But this procedure requires cervical discectomy, division of accessory nerve, ipsilateral uncectomy, partial vertebrectomy, and excision of the PLL which complicate surgery and need the fusion procedures described by Hakuba et al [6].…”

Section: Discussionmentioning

confidence: 99%

“…This increases the importance of the direct relationship between the encapsulated tumor and gentle dissection of all these neurovascular structures during surgery. The usual strategies for these tumors are the combined anterior and posterior cervical approach either in one step or each at different time points [3, 4], besides the transuncodiscal technique described by Hakuba [5]and Hakuba et al [6]. We operated successfully a dumbbell-shaped schwannoma using an unusual one-stage procedure: through the posterior midline approach first, followed by posterolateral access to the anterolateral extraspinal component without repositioning the patient.…”

Section: Introductionmentioning

confidence: 99%

Combined Posterior and Posterolateral One-Stage Removal of a Giant Cervical Dumbbell Schwannoma

Oruçkaptan¹,

O²

1999

Pediatr Neurosurg

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Objective: Huge dumbbell schwannomas in the cervical region are not a rare clinical entity in neurosurgical practice. Despite the benign nature, the adhesions between tumor capsule and spinal cord, vertebral artery, cervical plexus, and carotid sheath can complicate surgery, leading to a fatal outcome. We performed one-stage combined surgery through the posterior midline and an unusual posterolateral cervical route in the same position and describe its advantages. Method: We removed the intraspinal component totally through a posterior midline approach and freed spinal cord and vertebral artery. After removal of the posterolateral extraspinal component using the same incision, a posterolateral cervical approach along the posterior margin of sternocleidomastoid muscle was performed, and the anterolateral extraspinal tumor was excised totally through the dissection plane between anterior and middle scalene muscles. Results and Conclusions: The operative time was less than 3 h, and the patient was discharged on the 3rd postoperative day without any neurological sequel. The combination of posterior midline and posterolateral approach in large dumbbell schwannomas is easier to perform and a more safe technique than the combination with anterolateral accesses in the cervical region and also less invasive than the transuncodiscal technique in selected cases. This approach reduces the risk of neurovascular injury, since it does not require retraction and repositioning of the patient and, therefore, facilitates total excision and reduces the operative time.

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“…This approach, based on posterolateral dissection of muscles in anatomical layers, provided adequate exposure of the posterior cervical spine, vertebral artery and the vertebral triangle of the neck. Another described approach for such tumors is that described by Hakuba et al, 7 which is the anterolateral transuncodiscal. This procedure consists of anterior cervical discectomy and unilateral uncectomy, and removal of the posterolateral parts of the related vertebral bodies in front of the tumor.…”

Section: Clinical Outcomementioning

confidence: 99%

Cervical Spine Nerve Sheath Tumor: Surgical Experience of a Clinical Case Series

Eissa¹,

El-Fol²

2013

Egyptian Spine Journal

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Background Data: Cervical spine nerve sheath tumors (SNTSs) represent a special location of interest and challenge for neurosurgeons because the lesion in this region tend more to have extradural and extraspinal component (dumb-bell tumors) than dorsal or lumbar region. These tumors extension is most likely because of short intraduradural root in the cervical region. Dumb-bell tumors require special surgical strategy and approaches to allow complete removal of these tumors from both intraspinal and extraspinal components without traction on the spinal cord. Purpose: to evaluate our experience in management of cervical spinal nerve sheath tumors with special consideration for dumb-bell tumors that operated by multidisciplinary team and discussing our result. Study Design: A prospective descriptive clinical case study. Patients and Methods:This was a prospective study including nine patients suffering from cervical spinal nerve sheath tumors who were treated from January 2006 to December 2012. Each case was analyzed according to sex, age, clinical presentation, magnetic resonance imaging (MRI) of the brain and whole spine, surgical intervention, pathology and outcomes. The patients were followed in our outpatient clinic, where they were assessed clinically and functionally by VAS score and JOA score as well as radiologically by MRI of the cervical spine. Results: There were nine cases in this study with cervical SNTSs with age ranged from 30 to 56 years in eight cases with one case reported at 6 years. There were 5 females and 4 males. Five cases in this study (56%) were dumb-bell tumors and four cases were only intraspinal. All dumb-bell tumors were operated by combined posterior and anterior approach at the same session. Six cases (67%) were schwannoma, two cases (22%) were neurofibromas and one case was malignant nerve sheath tumor. The results were generally good. 80% of patients with preoperative pain (78%) had moderate to complete pain relive. All cases with preoperative cord related motor deficit (56%) had improvement to satisfying degree. Conclusion: SNTSs are uncommon lesions and tend to have extradural component in the cervical region. Proper clinical and radiological evaluation should be performed to exclude Neurofibromatosis 1 or 2 with associated spinal and /or intracranial tumors. Multidisciplinary team management provides optimum result for removal of dumb-bell tumors but the posterior approach should be performed first to prevent neurological manipulation. The incidence for recurrence and reoperation of small residual tumor are generally low. (2013ESJ059)

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Transuncodiscal approach to dumbbell tumors of the cervical spinal canal

Cited by 94 publications

References 3 publications

Surgery of Spinal Nerve Sheath Tumors Originating From C1 or C2 of High Cervical Spine -Technical Note-

Surgery of Spinal Nerve Sheath Tumors Originating From C1 or C2 of High Cervical Spine -Technical Note-

Combined Posterior and Posterolateral One-Stage Removal of a Giant Cervical Dumbbell Schwannoma

Cervical Spine Nerve Sheath Tumor: Surgical Experience of a Clinical Case Series

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