Far lateral approach for dumbbell-shaped C1 schwannomas: how I do it.

Background: Dumbbell-shaped C1 schwannomas are rare lesions that involve both intra- and extradural compartments. Because of the intimate relationships these lesions develop with the third and fourth segments of the vertebral artery, surgical removal of these lesions remains a challenge.

Method: We describe the key steps of the far lateral approach for dumbbell-shaped C1 schwannomas with a video illustration. The surgical anatomy is described along with the techniques for protecting the vertebral artery.

Conclusion: Dumbbell-shaped C1 schwannomas can be safely removed by using the far lateral approach, surgical anatomy expertise, and intraoperative microvascular Doppler.