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%). 1).
Cervical dumbbell spinal schwannomas 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 2).