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C1-C2 Schwannoma

May 11, 2015


Resection of compressive cervical spinal cord schwannomas is one of the most satisfying procedures in neurosurgery. This is a 50 year old male who presented with myelopathy. MRI evaluation revealed a heterogeneously enhancing mass filling the right aspect of the spinal canal at the level of C1 and C2. This tumor also appeared to be infiltrating into the foramen at this level. A schwannoma was suspected. Patient underwent a C1 and C2 laminectomies. The intervening ligaments were also removed using standard techniques. Here C1 that has been drilled. Kerrison rongeurs remove the bone while protecting the dura. You can see the canal is relatively tight at the level of C1. Additional removal of the bone superiorly was completed. And the posterior lip of the foramen magnum was also decompressed slightly as well. Here's the extent of boney removal along the rim of foramen magnum the adherent ligaments were also resected. Here you can see the extent of our boney removal. The dura was opened in the midline all the way to the level of the craniocervical junction. Retention sutures retract the dura especially on the right side. The tumor is clearly evident. Arachnoid layers were incised. CSF was drained and the tumor was dedressed. Also placed a suture within the dentate ligament just to gently rotate and mobilize this spinal cord along with it, dura. The poster capsule of the tumor was coagulated, devascularized followed by internal decompression of the tumor. This tumor was relatively non-adherent to the pial surface of the spinal cord. This finding made its resection very straightforward. You can see one of the red nerve roots, very small one that was potentially involved with the tumor. Here is another small rootlet that is being disconnected so that the tumor capsule can be extracted. The C2 nerve roots appear intact, at least the majority of them. No residual tumor into the frame and is apparent. Spinal cord appears very well decompressed. There was no changes in our somatosensory or motor evoked potentials during the procedure and the dura was closed in a watertight fashion, primarily. Thank you.

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