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Intradural Extramedullary Tumor: Cervical

  • Kyle L. McCormick
  • Paul C. McCormickEmail author
Chapter

Abstract

Intradural extramedullary tumors of the cervical spine are located within the dural sheath and outside the spinal cord. Nerve sheath tumors, including the subset of dumbbell tumors, and meningiomas make up the vast majority of these tumors. Using standard exposures and microsurgical techniques, it is possible to completely resect these tumors while preserving neurological function in most cases. Timely treatment on appropriate selected patients, combined with a well-developed plan for an operative approach, can lead to gratifying outcomes for both patient and surgeon. While benign, noninvasive, and biologically indolent, these tumors are subject to so many variables that each case must be considered unique. Key considerations of the tumors, including size, axial and sagittal location, origin, attachments, vascularity and consistency, as well as patient conditions and co-morbidities and surgeon preferences and experience, must all be incorporated into the treatment plan. In this chapter, we aim to describe the initial approach, surgical techniques, as well as modifications and pearls in order to optimize surgical management of these tumors.

Keywords

Intradural extramedullary tumor Cervical spine Microsurgical resection Nerve sheath tumor Dumbbell tumor Meningioma Standard laminectomy Osteoplastic laminectomy Nerve roots Simpson grade 

References

  1. 1.
    Agrawal BMBB, McCormick PC, Resnick DK. Intradural extramedullary spinal lesions. In: Benzel EC, editor. Spine surgery – techniques, complication avoidance, and management. 3rd ed. New York: Churchill Livingstone; 2012. p. 991–8.Google Scholar
  2. 2.
    McCormick PC. Surgical management of dumbbell tumors of the cervical spine. Neurosurgery. 1996;38:294–300.CrossRefGoogle Scholar
  3. 3.
    Safavi-Abbasi S, Senoglu M, Theodore N, Workman RK, Gharabaghi A, Feiz-Erfan I, et al. Microsurgical management of spinal schwannomas: evaluation of 128 cases. J Neurosurg Spine. 2008;9:40–7.  https://doi.org/10.3171/spi/2008/9/7/040.CrossRefPubMedGoogle Scholar
  4. 4.
    Setzer M, Vatter H, Marquardt G, Seifert V, Vrionis FD. Management of spinal meningiomas: surgical results and a review of the literature. Neurosurg Focus. 2007;23:E14.  https://doi.org/10.3171/foc-07/10/e14.CrossRefPubMedGoogle Scholar
  5. 5.
    Zhu YJ, Ying GY, Chen AQ, Wang LL, Yu DF, Zhu LL, et al. Minimally invasive removal of lumbar intradural extramedullary lesions using the interlaminar approach. Neurosurg Focus. 2015;39:E10.  https://doi.org/10.3171/2015.5.focus15182.CrossRefPubMedGoogle Scholar
  6. 6.
    Angevine PD, Kellner C, Haque RM, McCormick PC. Surgical management of ventral intradural spinal lesions. J Neurosurg Spine. 2011;15:28–37.  https://doi.org/10.3171/2011.3.spine1095.CrossRefPubMedGoogle Scholar
  7. 7.
    O'Toole JE, McCormick PC. Midline ventral intradural schwannoma of the cervical spinal cord resected via anterior corpectomy with reconstruction: technical case report and review of the literature. Neurosurgery. 2003;52:1482–5. discussion 1485-1486.CrossRefGoogle Scholar
  8. 8.
    McCormick PC. Resection of a cervical dumbbell schwannoma with stabilization through a single stage extended posterior approach. Neurosurg Focus. 2014;37:Video 2.  https://doi.org/10.3171/2014.v3.focus14257.
  9. 9.
    Celli P. Treatment of relevant nerve roots involved in nerve sheath tumors: removal or preservation? Neurosurgery. 2002;51:684–92. discussion 692.CrossRefGoogle Scholar
  10. 10.
    Klekamp J, Samii M. Surgical results for spinal meningiomas. Surg Neurol. 1999;52:552–62.CrossRefGoogle Scholar
  11. 11.
    Lot G, George B. Cervical neuromas with extradural components: surgical management in a series of 57 patients. Neurosurgery. 1997;41:813–20. discussion 820-812.CrossRefGoogle Scholar
  12. 12.
    Seppala MT, Haltia MJ, Sankila RJ, Jaaskelainen JE, Heiskanen O. Long-term outcome after removal of spinal schwannoma: a clinicopathological study of 187 cases. J Neurosurg. 1995;83:621–6.  https://doi.org/10.3171/jns.1995.83.4.0621.CrossRefPubMedGoogle Scholar
  13. 13.
    Solero CL, Fornari M, Giombini S, Lasio G, Oliveri G, Cimino C, Pluchino F. Spinal meningiomas: review of 174 operated cases. Neurosurgery. 1989;25:153–60.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Neurosurgery DepartmentColumbia University Medical CenterNew YorkUSA

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