Abstract
Introduction
The treatment of hourglass-shaped neurinomas of the C2 root is surgical, using various approaches such as the posterior, posterolateral, anterior, or combined ones. There are controversies in the literature regarding the choice of the best surgical access aiming to remove the tumor completely and safely and maintaining the stability of the spine. This study reports the authors' experience with 14 hourglass-shaped neurinomas of the C2 root, comparing the posterior and anterolateral approaches.
Patients and Methods
A total of 14 patients with hourglass-shaped neurinoma of the cervical root of C2 were surgically treated. The analysis involved symptoms, radiological diagnosis, information about surgery, and postoperative outcome. The posterior approach was used to remove the tumors in nine patients, and the anterolateral one in five patients. The 10 steps and tips/tricks for safe surgical removal are identified and reported.
Results
Females predominated in this sample (n = 8) and the mean age was 52 ± 4.16 years. The time from onset of the symptoms to diagnosis was 17.8 months ( ± 7.8 months). The mean surgical time was 180 minutes ( ± 39.15 minutes) in the posterior approach and 192 minutes ( ± 22.17 minutes) in the anterolateral approach (p = 0.52). There was no statistically significant difference in the volume of intrasurgical bleeding among the groups (posterior approach: 70.71 ± 16.93; anterolateral approach: 65.00 ± 24.15; p = 0.64). The tumor was completely resected in all the patients. A complication occurred with the posterior access, which was the presence of a cerebrospinal fluid fistula, and it was necessary to reoperate, reconstructing the duramater with fascia lata.
Conclusion
The tumor was completely resected with both surgical approaches, but the posterior approach has the advantage of being more familiar to the surgeon.