High cervical spinal schwannoma; microneurosurgical management: an experience of 15 cases.

Purpose: Schwannoma arising from high cervical spinal root are common among the spinal schwannomas.Here, we prospectively recorded the clinical features, radiological features, surgical approaches & findings,postoperative follow up & ultimate neurological outcome of high cervical spinal schwannomas and then we evaluated the records retrospectively.

Method: Here, schwannomas arising from C1, C2 and C3 spinal nerve roots were regarded as high cervical spinal schwannoma. All patients with high cervical spinal schwannomas that were consecutively operated micro-neurosurgically from 2006-2010 were included in the study. Postoperatively all patients were followed up regularly both clinically and neuro-radiologically (MRI of cervical spine).

Results: Average follow up was 31.5 months. The mean age of the series was 35.8 years (range 10-61 years). There were 8 male and 7 female patients. The mean duration of symptoms at the time of presentation was 32 months (range 06 months-5 years). Two schwannomas were completely extradural, seven were intradural and rest six were interdural or hourglass type (both extra and intradural) as identified during surgery. The standard midline posterior approach was used in all patients. A C2 hemilaminectomyor C2 laminectomy with or without cutting of posterior arch of atlas was used for most intradural and large interdural C2 schwannomas. Tumor removal was complete in all cases. Preservation of the nerve root fibers was not possible in 9 cases and was possible only in 3 cases. In two patients CSF leak developed after operation. One patient who had severe myelopathic features with bed sore failed toimprove and expired 5 months after operation. Rest of the patients showed postoperative improvement in their preoperative symptoms and returned to their normal life by the end of sixth month. There was no tumor recurrence in any patient till last follow up.

Conclusion: Proper 3-D anatomical orientation & physiological knowledge, deep neuro-radiological observation,pathological appreciations and micro-neurosurgical skill and expertization can make the surgical management of these tumors ( in a surgically complex site) simple with gratifying result (i.e.neurological outcome) without extensive bone removal or soft tissue manipulation through a standard midline posterior approach.