Transforaminal Retrojugular Approach (TFRA) for Resection of Dumbbell Nerve Sheath Tumors in the Cervical Spine

Abstract

Aims: Based on modern MR imaging, we consider the true dumbbell spinal tumors to have an intradural component within the spinal canal, expanding through the neural foramen and forming an extradural component paraspinally. Surgical treatment of these tumors is challenging in the subaxial cervical spine. In standard posterior approach the resection of extradural component integrity of the facet joint must be sacrifice with risk for instability. Additionally, the proximal control of the adjacent vertebral artery is impossible in event of a vessel injury. We describe a simplification of retrojugular technique which enables one stage gross total resection of the dumbbell tumors as described above with neither mobilization of vertebral artery (VA) nor spinal stabilization. Dural reconstruction was performed using mobilized local vascularized muscle flap.