Cervical Dumbbell Research Articles

Quantitative Analysis of the Effect of Stereotactic Radiosurgery for Postoperative Residual Cervical Dumbbell Tumors: A Multicenter Retrospective Cohort Study.

Stereotactic radiosurgery (SRS) has been performed for spinal tumors. However, the quantitative effect of SRS on postoperative residual cervical dumbbell tumors remains unknown. This study aimed to quantitatively evaluate the efficacy of SRS for treating postoperative residual cervical dumbbell tumors. We retrospectively reviewed cases of postoperative residual cervical dumbbell tumors from 1995 to 2020 in 2 tertiary institutions. Residual tumors underwent SRS (SRS group) or were observed with clinical and magnetic resonance imaging (MRI) follow-up (observation group). Tumor regrowth rates were compared between the SRS and observation groups. Additionally, risk factors for tumor regrowth were analyzed. A total of 28 cervical dumbbell tumors were incompletely resected. Eight patients were in the SRS group, and 20 in the observation group. The mean regrowth rate was not significantly lower (p = 0.784) in the SRS group (0.18 ± 0.29 mm/mo) than in the observation group (0.33 ± 0.40 mm/mo). In the multivariable Cox regression analysis, SRS was not a significant variable (hazard ratio [HR], 0.57; 95% confidence interval [CI], 0.18-1.79; p = 0.336). SRS did not significantly decrease the tumor regrowth rate in our study. We believe that achieving maximal resection during the initial operation is more important than postoperative adjuvant SRS.

A Novel and Reproducible Classification of Cervical Dumbbell Tumors to Inform Surgical Approach and Reconstruction Techniques.

A retrospective case series. This study developed a novel classification system based on imaging and anatomy to select optimal surgical approaches and reconstruction strategies to achieve total resection of cervical dumbbell tumors and restore spinal stability. Total resection is necessary to decrease the recurrence rate of cervical dumbbell tumors. Previous cervical dumbbell tumor classifications are insufficient for determining surgical strategies; therefore, a practical classification is needed. This study included 295 consecutive patients with cervical dumbbell tumors who underwent total surgical resection. A novel classification of cervical dumbbell tumors was developed based on magnetic resonance imaging and computed tomography. Continuous variables were expressed as mean±SD and were compared using an unpaired two-tailed Student t test. The χ 2 test or the Fisher exact test was used for categorical variables. Kendall's W test assessed three independent raters' inter-rater and intrarater reliabilities on 140 cervical dumbbell tumors. The inter-rater and intrarater consistency coefficient was 0.969 (χ 2 =404.3, P <0.001) and 0.984 (χ 2 =273.7, P <0.001). All patients with type I and II tumors underwent single-posterior surgeries to achieve total resection. Of the patients in this study, 86.1%, 25.9%, 75.9%, and 76.9% underwent posterior surgeries for types IIIa, IIIb, IVa, and V tumors, respectively. All patients with type IVb tumors underwent a combined anterior and posterior approach. Posterior internal fixation was used for all patients in posterior surgery. Anterior reconstruction was applied for patients with type IVb tumors (20/20, 100%) and some with type V tumors (3/13, 23.1%). The mean follow-up duration was 93.6±2.6 months. A recurrence was observed in 19 (6.4%) patients. The authors describe a novel classification system that is of practical use for planning the complete resection of cervical dumbbell tumors.

Cervical Dumbbell Meningioma: case report and literature review

Cervical Dumbbell Meningioma: case report and literature review

Technical nuances for the resection of cervical dumbbell schwannomas.

The majority of spinal nerve sheath tumors are within the intradural/extramedullary compartment. A subset of these tumors develop extraforaminal components that gradually expand into potential spaces. Herein, the authors provide a 2D video demonstrating the technical nuances concerning resection of cervical dumbbell schwannomas with extraspinal extension. Although nerve sheath tumors with large extraforaminal extension are often associated with complications and pose unique challenges to surgeons, circumferential exposure with intradural exploration allows for gross-total resection and nerve root preservation, without need for adjuvant treatments. The use of intraoperative ultrasound, neurophysiological monitoring, Doppler imaging, and meticulous surgical techniques aided to circumvent complications.

Resection of cervical extra-intraspinal neuromas through the enlarged intervertebral foramen: Results in 34 case series patients.

The purpose of this study was to analyze the techniques used to resection cervical extra-intraspinal neuromas (also known as cervical dumbbell neuromas) through the enlarged intervertebral foramen. A total of 34 consecutive patients (19 male, 15 female) with cervical dumbbell neuromas reviewed retrospectively between April 2008 and May 2020. Sixteen tumors were found in the intervertebral foramen of C1-C3, four in C3-C4, and 14 in C4-T1. The approach in all cases was to expose the tumors by intermuscular dissection and to remove them through the enlarged intervertebral foramen without excision of any bony structures. However, to expose tumors at different locations, the incisions shall be made accordingly. In this case series, the incisions were made along the posterior border of the sternocleidomastoid muscle for the C1-C3 tumors and along the anterior border of the muscle for the C3-C4 tumors. Transverse incisions were required for the C4-T1 tumors. Following the mentioned incising approach, all 34 tumors were completely exposed. 31 were completely removed in one stage, and 3 tumors underwent subtotal resection because of brachial plexus nerve adhesion. The vertebral artery and spinal cord were undamaged for all cases. The patients who had total tumor resection showed no sign of recurrence on enhanced magnetic resonance imaging during follow-ups. The status of patients who underwent subtotal resection was stable after radiation therapy. None of the patients developed spinal instability. Cervical dumbbell neuromas can be exposed and removed through the enlarged intervertebral foramen without causing spinal instability or injury to the spinal cord or vertebral artery. This operative approach can retain the integrity of the structures of spine and should be considered the ideal approach for cervical dumbbell neuromas.

Surgical considerations for maximal safe excision of subaxial cervical dumbbell Schwannoma in a single approach

Surgical considerations for maximal safe excision of subaxial cervical dumbbell Schwannoma in a single approach

Complete Resection of a Recurrent Cervical Dumbbell Schwannoma After Initial Subtotal Resection and Radiotherapy: 2-Dimensional Operative Video.

Complete Resection of a Recurrent Cervical Dumbbell Schwannoma After Initial Subtotal Resection and Radiotherapy: 2-Dimensional Operative Video.

Subaxial Lateral Mass Prosthesis for Posterior Reconstruction of Cervical Spine.

Posterior facetectomy or lateral mass resection is often used during cervical dumbbell tumor resection, jeopardizing the stability of cervical spine. The space after resection of one or more lateral masses, if left unfilled might hamper bone fusion and structural support. There were the aims to obtain the relevant morphometry of the lateral mass of the subaxial cervical spine (C3-C7) and to design a lateral mass prosthesis for the posterior reconstruction of the cervical spine. The computed tomography (CT) scans of healthy volunteers were obtained. RadiAnt DICOM Viewer software (Version 2020.1, Medixant, Poland) was used to measure the parameters of lateral mass, such as height, anteroposterior dimension (APD), mediolateral dimension (MLD), and facet joint angle. According to the parameters, a series of cervical lateral mass prostheses were designed. Cadaver experiment was conducted to demonstrate its feasibility. Twenty-three volunteers with an average age of 30.1 ± 7.1 years were enrolled in this study. The height of the lateral mass was 14.1 mm on average. The facet joint angle, APD, and MLD of the lateral mass averaged 40.1 degrees, 11.2 mm, and 12.2 mm, respectively. With these key data, a lateral mass prosthesis consisting of a column and a posterior fixation plate was designed. The column has a 4.0-mm radius, 41-degree surface angle, and adjustable height of 13, 15, or 17 mm. In the cadaver experiment, the column could function as a supporting structure between adjacent facets, and it would not violate the exiting nerve root or the vertebral artery. This study provided a detailed morphology of the lateral mass of the subaxial cervical spine. A series of subaxial cervical lateral mass prostheses were designed awaiting further clinical application.

Lateral Transtumoral Transforaminal Removal of Cervical Dumbbell Tumors

Abstract Background Cervical dumbbell tumors constitute 15% of cervical nerve sheath tumors. These tumors occupy intraspinal, foraminal, and extraspinal compartments. Laminectomy, laminectomy and facetectomy and anterolateral partial vertebrectomy are the approaches used to address these multicompartment tumors. Laminectomy leads to incomplete tumor removal. Other approaches ensure complete tumor excision but involve more extensive bone work. Objective We describe our surgical technique and clinical experiences of six patients treated through single lateral approach, addressing all compartments (transforaminal approach) with minimal or no bony resection. Methods Six patients with cervical dumbbell tumors underwent minimally invasive transforaminal approach and tumor excision. The cohort consisted of four women and two men. All patients underwent complete tumor excision Technique Intraoperative X-ray and ultrasound are used to localize the respective foramen. Skin is entered from the lateral side and sequential dilatation is done through muscles. The dilators and port are docked to the lateral surface of articular facets. Standard technique of capsule dissection, internal decompression and capsule mobilization is done to remove the tumor. Arachnoid is seen at the end. Tumor cavity is obliterated with fat graft. Results Total excision of tumor was documented in all patients with postoperative MRI scan. The mean blood loss was 100 mL. The patients could be discharged on second or third postoperative day. Mean follow-up is of 48 months (18–70 months) and all patients had resolution in features of myelopathy. Conclusions Endoportal transforaminal approach is technically feasible and minimally invasive option to remove the dumbbell schwannomas.

Application of posterior arch of the atlasrch resection for high-level cervical dumbbell schwannoma surgery

To investigate the feasibility and clinical effect of hemi-resection of posterior arch of atlas in the upper cervical spinal dumbbell-shaped schwannomas. A retrospective analysis was performed on 13 patients with high level cervical dumbbell schwannomas from January 2005 to December 2018, including 10 males and 3 females, aged 19 to 67 years old. The occipital foramen to the C1 were 4 cases and 9 cases of C1,2. Tumors were removed by posterior arch of the atlas resection without internal fixation. The clinical efficacy was evaluated by visual analogue pain scale (VAS), Japanese Orthopaedic Association (JOA) scores, and American Spinal Injury Association(ASIA) ratings. The operation was successfully completed in 13 cases of this group. No vertebral artery injury or spinal cord injury occurred during the operation. All 13 patients were followed up for more than 12 months. No local recurrence was found. Both the VAS and the JOA score were significantly improved compared with those before surgery. The ASIA classification before operation was:1 case of grade C, 6 cases of grade D, 6 cases of grade E;the latest follow up was 3 cases of ASIA grade D and 10 cases of E. The posterior arch of the atlas hemisection can remove the upper cervical dumbbell schwannoma in one stage. The short-term clinical effect is good, and there are no complications such as cervical instability.

Microsurgical Resection of a C1-C2 Dumbbell and Ventral Cervical Schwannoma: 2-Dimensional Operative Video.

Dumbbell schwannoma of the cervical spine is a known entity,1-5 and should be radically resected with the preservation or improvement of neurological function. However, to our knowledge, an operative video of a C1-C2 cervical dumbbell schwannoma with ventral extension and dorsal spinal cord compression has not been reported previously. This tumor resection video performed by the senior author (KIA) includes details of dural opening, and techniques for microsurgical resection and for postoperative closure to avoid cerebrospinal fluid (CSF) leak and pseudomeningocele formation.Fat grafting was performed through a small paraumbilical incision. The patient was prone in MAYFIELD 3-point pin fixation (Integra LifeSciences, Plainsboro Township, New Jersey). Intraoperative neurophysiological electrodes were placed for somatosensory evoked potential (SSEP) and motor evoked potential (MEP) monitoring. Stealth neuronavigation was used to aid in tumor localization. A small suboccipital craniectomy and C1 laminectomy were performed before opening the dura. Using a microsurgical technique, the dura was opened in the form of the letter “Y.” The right-sided dentate ligament was cut to aid in the mobilization of the tumor away from the spinal cord. After dividing the tumor at the dumbbell isthmus, the ventral tumor component was removed, with attention paid to the division of a perforator coming from the vertebral artery. Intraforaminal tumor debulking was performed with a cavitron ultrasonic surgical aspirator (CUSA) and resected.High cervical dumbbell schwannoma should be radically resected while preserving and improving preoperative neurological function. Avoidance of CSF leak and formation of pseudomeningocele should be planned at the beginning, utilizing fascia and fat graft to avoid this feared complication.The patient provided written consent and permission to publish her image.

Revisiting the surgical corridors for cervical Type IIb-c dumbbell neurofibroma: A series of two unconventional approaches and review of literature.

Background:Cervical sub-axial dumbbell neurofibromas (NFs) account for nearly 20% of all NFs, with prognosis depending on the extent of excision. When majority of tumor is extra-foraminal (Tomaya's Type IIb and c), certain unconventional anterolateral or posterolateral neck approaches are used for maximum safe excision. In our article, we provide a brief review of the literature regarding various surgical approaches, emphasizing the utility of posterolateral or combined anterior and posterior neck approaches for such giant NF.Methods:We performed a retrospective analysis of prospectively maintained surgical databases, from our hospital discharge codes, for all cervical Type IIb-c dumbbell NF patients, who underwent surgery at our institution between 2015 and 2019. Clinical variables included age at admission, clinical presentation, and surgical difficulties, and the outcome was analyzed.Results:Four patients of age ranging from 22 to 45 years (M:F 3:1) were operated by posterolateral (n = 3) and combined anteroposterior (n = 1) approach. Three patients underwent near-total excision and one patient had total excision. One patient with tumor capsule attached to roots of upper brachial plexus had motor deficit, who was re-admitted for neurotization. There was no intraoperative complication.Conclusion:Posterolateral approach for cervical dumbbell giant NFs is safe, effective, and promises maximum safe excision. The major blood vessels including carotid artery or jugular veins in neck and vertebral artery at foraminal portion are directly under vision and control of surgeon. Despite near-total excision, wherein small part of adhered capsule is left, recurrence rate is low.

Surgical Resection of a Cervical Dumbbell Tumor: 2-Dimensional Operative Video.

We demonstrate the surgical resection of a cervical dumbbell tumor in a patient who presented with progressive weakness over 3 mo. He was found to have a large C2-C3 dumbbell-shaped lesion with bony destruction on preoperative imaging. The patient subsequently underwent successful gross total resection of the tumor and had dramatic improvement in neurological status following surgery. Pathology confirmed the diagnosis of a World Health Organization grade I schwannoma. Detailed surgical techniques of the tumor resection and posterior fusion are presented in high-definition video with narration.Watch now at https://academic.oup.com/ons/article-lookup/doi/10.1093/ons/opy033 {"href":"Single Video Player","role":"media-player-id","content-type":"play-in-place","position":"float","orientation":"portrait","label":"Surgical Resection of a Cervical Dumbbell Tumor: 2-Dimensional Operative Video","caption":"","object-id":[{"pub-id-type":"doi","id":""},{"pub-id-type":"other","content-type":"media-stream-id","id":"1_cil69l26"},{"pub-id-type":"other","content-type":"media-source","id":"Kaltura"}]} There is no identifying information in this video. A patient consent was obtained for publishing of the material included in the video Disclosures Dr Traynelis is a consultant and patent holder for Medtronic and receives fellowship funding from Globus. Dr Fontes is a consultant for Stryker and Medtronic. The authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article.

Subtotal Resection of Cervical Dumbbell Schwannomas: Radiographic Predictors for Surgical Considerations

Currently, radiologic predictors for the resectability of cervical dumbbell schwannomas remain unknown. To identify radiologic predictors for resectability, we retrospectively reviewed data from 72 patients. From January 1995 to June 2017, 72 patients who underwent surgical treatment for cervical dumbbell schwannomas were enrolled. We focused on the relationship between preoperative magnetic resonance imaging (MRI) features and the extent of tumor removal. The MRI features evaluated were tumor size, tumor level, Eden classification, degree of vertebral artery (VA) involvement, and signal intensity (SI) on T2-weighted images (WIs). Among the 72 patients, gross total resection (GTR) and subtotal resection (STR) were achieved in 37 (51.4%) and 35 (48.6%) patients, respectively. Mean maximal tumor size (P= 0.011), mean size of foraminal and extraforaminal portion (P= 0.017), tumor level (P < 0.001), VA involvement (P < 0.001), and SI on T2-WIs (P= 0.006) were significantly different between the GTR and STR groups. Univariate analyses demonstrated that maximal tumor size (odds ratio [OR]: 0.93, P= 0.012), high cervical level (OR: 11.37, P < 0.001), pushed VA (OR: 0.11, P= 0.002), encased VA (OR: 0.02, P < 0.001), and hyper-SI on T2-WIs (OR: 12.46, P= 0.020) were significant predictors for GTR. In the multivariate analysis, only high cervical level (OR: 5.48, P= 0.033) and encased VA (OR: 0.07, P= 0.014) were significant predictors for GTR. The resectability of cervical dumbbell schwannomas may be predicted by MRI features, including tumor size, tumor level, and degree of VA involvement.

Surgical Strategy for Spinal Dumbbell Tumors: A New Classification and Surgical Outcomes.

One hundred twenty-four patients with spinal dumbbell tumors were analyzed retrospectively using a new classification. To recommend a novel classification of spinal dumbbell tumors based on the characteristics of surgical approach. Current classifications of cervical dumbbell tumor are excessively convoluted with an impractical number of variables or lack of quantitative indicators for the choice of surgical approach, and there are few classifications described in the literature which related to thoracic or lumbar dumbbell tumors. An ideal classification must be simple and reproducible based on commonly identified clinical and radiographic parameters. The clinical records of a series of 124 patients with spinal dumbbell tumors were analyzed retrospectively using a new classification. We divided the largest transverse section of the tumor into four areas, and different areas need different surgical procedures. Ninety-two patients were treated using the posterior approach alone, 13 patients underwent surgery by lateral cervical approach, and 19 cases were excised using combined anterior and posterior approach. Tumors total removal was 123 cases, with partial resection in one patient. Concomitant spinal fixation and fusion was performed in 18 patients. A total of 97 cases had follow-up with clinical and radiographic outcome variables ranged from 12 to 52 months (mean, 46.3 months). Eighty-eight patients (90.7%) had clinical improvement, whereas clinical status was the same in seven (7.2%), two patients (2.1%) demonstrated neurologic deterioration, and magnetic resonance imaging at last follow-up revealed no recurrence in any patient. The new classification of spinal dumbbell tumors is a simple way of identifying patients who require a different surgical approach. 4.

An independent evaluation on the interobserver reliability and intraobserver reproducibility of Toyama classification system for cervical dumbbell tumors.

Dumbbell tumors can not only cause the compression of cervical cord and nerve root, but also invade the important structures and the surrounding organs, causing great harm to the patient. Toyama classification that is commonly used has not been evaluated and still requires independent validation.The objectives of this study were to evaluate and analyze the interobserver reliability and intraobserver reproducibility of Toyama classification system, explore the differences, discover the shortages, and evaluate the clinical value for diagnosis.One hundred sixty-five consecutive patients of a cervical dumbbell tumor with complete clinical and radiologic data were enrolled. Six surgeons determined the classification according to Toyama system. The classification was repeated 12 weeks later. Correlation coefficient (ICC) and kappa coefficient (κ) test were used to determine interobserver reliability and intraobserver reproducibility.The interobserver reliability for Toyama classification was moderate with a value of 0.432. The interobserver reproducibility for Toyama classification was moderate with a value of 0.608.The Toyama classification has landmark value in clinical practice, but it is a relatively cumbersome system. This study shows that it has low reliability and reproducibility. Accordingly, surgical management of the resection of dumbbell cervical tumors raises several problems, including preservation of the cervical nerve root, control of the vertebral artery, and maintenance of spine. There is a need to optimize the classification in the future.

Transforaminal Resection of Cervical Dumbbell Schwannomas in Patients with Additional Tumors

It is rare for 2 primary tumors to occur simultaneously in a patient. Management of cervical dumbbell schwannomas (CDSs) with concurrent tumors (CTs) requires a specific neurosurgical strategy. The primary objective of this study is to investigate surgical strategies for CDSs with CTs while preserving as much of the mechanically relevant bone structures as possible. Twelve patients with concurrent CTs and CDSs were identified from 3 medical centers. Surgical strategies for CDSs were based on accurate preoperative images and subsequent treatment considerations for CTs. All patients received surgical treatment for CDSs and CTs. Clinical features, surgical considerations for a transforaminal approach (TA), and ultimate outcome were studied retrospectively. Gross total resection of CDSs was achieved with endoscopic and microscopic assistance in 9 cases, and subtotal resection was achieved in 3 cases after the head and neck surgeons exposed and removed the extraforaminal anatomy. One patient required an additional hemilaminectomy for the resection of the intraspinal segment. After wound healing, patients were transferred to the appropriate surgical department for surgery on CTs with cervical spine stabilization after a transforaminal approach. In most patients, the stability of the cervical spine can be preserved with low invasive microsurgical or endoscopic transforaminal resection. CTs could be surgically treated sequentially after microscopic- and endoscopic-assisted resection of CDSs.

A Rare Case of Cervical Dumbbell Meningioma with the C2 Spinous Process Preservation

Dumbbell growth is often observed in schwannoma but rarely in meningioma. In particular, the occurrence of dumbbell meningioma at the cervical cord level in Japan is markedly rare. We reported an elderly case with symptomatic meningioma that developed in a dumbbell shape from cervical spine and was treated successfully by surgery.

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

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.

Differences between Cervical Schwannomas of the Anterior and Posterior Nerve Roots in Relation to the Incidence of Postoperative Radicular Dysfunction.

Study DesignA retrospective study.PurposeTo assess the case files of patients who underwent surgery for cervical dumbbell schwannoma for determining the differences between schwannomas of the anterior and posterior nerve roots with respect to the incidence of postoperative radicular dysfunction.Overview of LiteratureThe spinal roots giving origin to schwannoma are frequently nonfunctional, but there is a risk of postoperative neurological deficit once these roots are resected during surgery.MethodsFifteen patients with cervical dumbbell schwannomas were treated surgically. Ten men and 5 women, who were 35-79 years old (mean age, 61.5 years), presented with neck pain (n=6), radiculopathy (n=10), and myelopathy (n=11).ResultsFourteen patients underwent gross total resection and exhibited no recurrence. Follow-ups were performed for a period of 6-66 months (mean, 28 months). Preoperative symptoms resolved in 11 patients (73.3%) but they persisted partially in 4 patients (26.7%). Six patients had tumors of anterior nerve root origin, and 9 patients had tumors of posterior nerve root origin. Two patients who underwent total resection of anterior nerve root tumors (33.3%) displayed minor postoperative motor weakness. One patient who underwent total resection of a posterior nerve root tumor (11.1%) showed postoperative numbness.ConclusionsAppropriate tumor removal improved the neurological symptoms. In this study, the incidence of radicular dysfunction was higher in patients who underwent resection of anterior nerve root tumors than in patients who underwent resection of posterior nerve root tumors.