Cervical Spine Nerve Sheath Tumor: Surgical Experience of a Clinical Case Series

Abstract

Background Data: Cervical spine nerve sheath tumors (SNTSs) represent a special location of interest and challenge for neurosurgeons because the lesion in this region tend more to have extradural and extraspinal component (dumb-bell tumors) than dorsal or lumbar region. These tumors extension is most likely because of short intraduradural root in thecervical region. Dumb-bell tumors require special surgical strategy and approaches to allow complete removal of these tumors from both intraspinal and extraspinal components without traction on the spinal cord. Purpose: to evaluate our experience in management of cervical spinal nerve sheath tumors with special consideration for dumb-bell tumors that operated by multidisciplinary team and discussing our result. Study Design: A prospective descriptive clinical case study.Patients and Methods: This was a prospective study including nine patients suffering from cervical spinal nerve sheath tumors who were treated from January 2006 to December 2012. Each case was analyzed according to sex, age, clinical presentation, magnetic resonance imaging (MRI) of the brain and whole spine, surgical intervention, pathology and outcomes. The patients were followed in our outpatient clinic, where they were assessed clinically and functionally by VAS score and JOA score as well as radiologically by MRI of the cervical spine. Results: There were nine cases in this study with cervical SNTSs with age ranged from 30 to 56 years in eight cases with one case reported at 6 years. There were 5 females and 4 males. Five cases in this study (56%) were dumb-bell tumors and four cases were only intraspinal.All dumb-bell tumors were operated by combined posterior and anterior approach at the same session. Six cases (67%) were schwannoma, two cases (22%) were neurofibromas and one case was malignant nerve sheath tumor. The results were generally good. 80% of patients with preoperative pain (78%) had moderate to complete pain relive. All cases withpreoperative cord related motor deficit (56%) had improvement to satisfying degree. Conclusion: SNTSs are uncommon lesions and tend to have extradural component in the cervical region. Proper clinical and radiological evaluation should be performed to exclude Neurofibromatosis 1 or 2 with associated spinal and /or intracranial tumors.Multidisciplinary team management provides optimum result for removal of dumb-bell tumors but the posterior approach should be performed first to prevent neurological manipulation. The incidence for recurrence and reoperation of small residual tumor are generally low. (2013ESJ059)