Intradural Extramedullary Cervical Spine Tumors (IECST)

Abstract

The most common neoplasms in intradural extramedullary compartment of cervical spine are meningiomas and peripheral nerve sheath tumors (NST)—schwannomas and neurofibromas. Magnetic resonance imaging with contrast administration is the gold standard method that distinguishes lesions in the intradural extramedullary space from tumors in the other spinal compartments. The goal of the treatment for both mentioned groups of neoplasms is to complete resection that gives excellent long-term prognosis and provides hope for improvement of neurological dysfunctions. The vast majority of IECST can be removed via the posterior approach involving a laminectomy or hemilaminectomy. For large dumbbell-shaped NSTs in subaxial region, the anterolateral approach is advantageous (better VA control). The anterior approach is preferred for purely ventrally located tumors in subaxial region. In ventral and ventrolateral IECST of the upper cervical spine and foramen magnum, far lateral suboccipital approach and lateral atlantoaxial approach are recommended. All these approaches and surgical strategy are described in this capture.