Single stage transforaminal retrojugular tumor resection: The spinal keyhole for dumbbell tumors in the cervical spine.

John Michael Duff,Lukas Bobinski,Yves Henchoz,Kishore Sandu

doi:10.4103/2152-7806.154453

John Michael Duff, Lukas Bobinski + Show 2 more

Open Access

https://doi.org/10.4103/2152-7806.154453

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Abstract

Background:Dumbbell tumors are defined as having an intradural and extradural component with an intermediate component within an expanded neural foramen. Complete resection of these lesions in the subaxial cervical spine is a challenge, and it has been achieved through a combined posterior/anterior or anterolateral approach. This study describes a single stage transforaminal retrojugular (TFR) approach for dumbbell tumors resection in the cervical spine.Methods:This is a retrospective review of a series of 17 patients treated for cervical benign tumors, 4 of which were “true” cervical dumbbell tumors operated by a simplified retrojugular approach. The TFR approach allows a single stage gross total resection of both the extraspinal and intraspinal/intradural components of the tumor, taking advantage of the expanded neural foramen. All patients were followed clinically and radiologically with magnetic resonance imaging (MRI).Results:Gross total resection was confirmed in all four patients by postoperative MRI. Minimal to no bone resection was performed. No fusion procedure was performed and no delayed instability was seen. At follow up, one patient had a persistent mild hand weakness and Horners syndrome following resection of a hemangioblastoma of the C8 nerve root. The other three patients were neurologically normal.Conclusions:The TFR approach appears to be a feasible surgical option for single stage resection in selective cases of dumbbell tumors of the cervical spine.

Highlights

Dumbbell tumors are defined as having an intradural and extradural component with an intermediate component within an expanded neural foramen
The term “dumbbell” tumor was used to describe an intraextraspinal tumor of neural origin growing across a constricting anatomical space confined by the boundaries of the bony neural foramen and investing dural nerve root sleeve.[6,11]
Surgical Neurology International 2015, 6:53 component connected across an expanded neural foramen

Summary

Methods

This is a retrospective review of a series of 17 patients treated for cervical benign tumors, 4 of which were “true” cervical dumbbell tumors operated by a simplified retrojugular approach. The TFR approach allows a single stage gross total resection of both the extraspinal and intraspinal/intradural components of the tumor, taking advantage of the expanded neural foramen. All patients were followed clinically and radiologically with magnetic resonance imaging (MRI). Between 2007 and 2013, 17 patients underwent retrojugular resection of laterally placed cervical spinal tumors. Among these were four “true” dumbbell tumors resected using a transforaminal retrojugular (TFR) approach. The index neural foramen was expanded in all four patients [Table 1]. All patients were followed up clinically and radiologically [Table 2]

Results

Discussion

Conclusion