Lateral Transtumoral Transforaminal Removal of Cervical Dumbbell Tumors

Abstract

Abstract Background Cervical dumbbell tumors constitute 15% of cervical nerve sheath tumors. These tumors occupy intraspinal, foraminal, and extraspinal compartments. Laminectomy, laminectomy and facetectomy and anterolateral partial vertebrectomy are the approaches used to address these multicompartment tumors. Laminectomy leads to incomplete tumor removal. Other approaches ensure complete tumor excision but involve more extensive bone work. Objective We describe our surgical technique and clinical experiences of six patients treated through single lateral approach, addressing all compartments (transforaminal approach) with minimal or no bony resection. Methods Six patients with cervical dumbbell tumors underwent minimally invasive transforaminal approach and tumor excision. The cohort consisted of four women and two men. All patients underwent complete tumor excision Technique Intraoperative X-ray and ultrasound are used to localize the respective foramen. Skin is entered from the lateral side and sequential dilatation is done through muscles. The dilators and port are docked to the lateral surface of articular facets. Standard technique of capsule dissection, internal decompression and capsule mobilization is done to remove the tumor. Arachnoid is seen at the end. Tumor cavity is obliterated with fat graft. Results Total excision of tumor was documented in all patients with postoperative MRI scan. The mean blood loss was 100 mL. The patients could be discharged on second or third postoperative day. Mean follow-up is of 48 months (18–70 months) and all patients had resolution in features of myelopathy. Conclusions Endoportal transforaminal approach is technically feasible and minimally invasive option to remove the dumbbell schwannomas.