====== Cervical spinal schwannoma treatment ======


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In the series of Asazuma et al., a posterior approach was used in 35 patients; 7 others underwent a combined anterior and posterior approach. A posterior approach was used for all type IIa and IIIa tumors, and for some type IIIb (upper cervical), IV, and VI tumors; a combined posterior and anterior approach was used for type IIb and the remainder of type IV and VI. Reconstruction was performed using spinal instrumentation in 4 patients (9.5%). Resection was subtotal in 6 patients (14.3%) and total in 36 (85.7%).
((Asazuma T, Toyama Y, Maruiwa H, Fujimura Y, Hirabayashi K. Surgical strategy
for cervical dumbbell tumors based on a three-dimensional classification. Spine
(Phila Pa 1976). 2004 Jan 1;29(1):E10-4. PubMed PMID: 14699292.
)).
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Cervical dumbbell [[spinal schwannoma]]s with an extraspinal extension through the [[intervertebral foramina]] pose significant challenges for complete [[resection]] while avoiding injury to the [[vertebral artery]] and preserving the integrity of the [[cervical spine]]. Posterior approaches may require an extensive soft-tissue dissection and bone removal with potential spinal instability. Moreover, they offer only a limited access to an extraspinal tumor component that entails an additional anterior approach for complete resection of a dumbbell-shaped lesion. 

Goga et al., used an [[anterolateral transforaminal approach]] that preserves the bony elements of the intervertebral foramen and offers a comprehensive access to the extraspinal, foraminal and intraspinal/intradural components of a cervical dumbbell tumor
((Goga C, Türe U. The Anterolateral Transforaminal Approach to a Dumbbell
Schwannoma of the C3 Nerve Root. A 3-Dimensional Operative Video. Neurosurgery.
2014 Sep 24. [Epub ahead of print] PubMed PMID: 25255264.)).