Foramen magnum schwannoma with an unusual clinical presentation: case report

Intradural Extramedullary Capillary Hemangioma in the Upper Cervical Spine: First Report

BACKGROUND

The occurrence of intradural extramedullary capillary hemangiomas is exceedingly rare. To date, only 39 cases of intradural extramedullary capillary hemangiomas have been reported in the English literature, and all of these cases have been described at the lumbar and thoracic spinal levels. To our knowledge, this report is the first case of capillary hemangiomas of the cervical spine in the literature. In general, this entity is misdiagnosed preoperatively as a neoplasm.

CASE DESCRIPTION

A 29-year-old man presented with neck pain and progressive gait disturbance, and was diagnosed with an intradural extramedullary capillary hemangioma in the cervical region.

CONCLUSIONS

Although rare, our case demonstrates that capillary hemangioma should be considered in the differential diagnosis of intradural extramedullary tumor of the cervical spine.

Retrospective analysis of peripheral nerve sheath tumors of the second cervical nerve root in 60 surgically treated patients

Object

This study is a retrospective analysis of 60 surgically treated patients with 64 peripheral nerve sheath tumors (PNSTs) at the second cervical (C-2) nerve root. The anatomical subtleties of these tumors and their implications for surgical strategy when compared with other spinal PNSTs and other tumors in the foramen magnum region are reviewed.

Methods

Sixty patients with C-2 PNSTs treated surgically in the Department of Neurosurgery at King Edward VII Memorial Hospital and Seth Gordhandas Sunderdas Medical College between 1992 and 2006 were studied. All patients underwent magnetic resonance imaging. Tumors were divided into 3 groups depending on their anatomical location identified during surgery. Those tumors located within or extending into the spinal dural tube were called Type A, those located within the dural tube of the C-2 ganglion were labeled as Type B, and tumors extending laterally into the paraspinal region were labeled as Type C. Follow-up durations ranged from 6 months to 15 years (mean 64 months).

Results

There were 38 male and 22 female patients in the study, who ranged in age from 6 to 62 years (mean 28 years). Nine patients had clinical features indicative of neurofibromatosis (NF). The mean duration of symptoms at the time of presentation was 27 months (range 4 days–5 years). Two patients had no specific symptoms related to the C-2 PNST, 6 patients had only local symptoms such as neck pain or stiffness, and 52 patients had symptoms of varying degrees of myelopathy. There were 5 solely Type A tumors, 7 Type A + B tumors, 31 Type B tumors, and 21 Type B + C tumors. All Type A, A + B, and B tumors were totally resected. Seven of 21 Type B + C tumors were partially resected, and the remainder were completely resected. All patients postoperatively reported varying improvement in their preoperative symptoms. Except for patients with NF who were disabled by other tumors, the rest of the patients resumed their normal life style. There have been no cases of symptomatic tumor recurrence.

Conclusions

The majority of PNSTs located at the C-2 level in these patients probably arose from the large C-2 ganglion and are limited within the dural confines or are interdural in location. In contrast to other spinal PNSTs, the location of C-2 PNSTs is in most cases posterior to the lateral mass of the atlas and axis and the atlantoaxial joint and is exposed to the posterior without any bone cover. Radical tumor resection is safe, resolution of clinical symptoms is rapid, and recurrence rates are extremely low. In a selected number of cases, bone work for tumor exposure and resection can be entirely avoided.

Spinal extradural schwannoma

OBJECT

The authors endeavor to define the clinical and surgery-related profile of spinal nerve sheath tumors located in the extradural space outside both the dural sac and, apparently, the nerve roots' sleeve.

METHODS

A series of 24 extradural schwannomas was retrospectively selected after reviewing the notes of spinal nerve sheath tumors surgically treated at La Sapienza University of Rome. Clinical data, tumor-related characteristics, and outcome were analyzed. Women predominantly harbored these tumors. On admission sensory nerve root dysfunction was infrequently reported, whereas pyramidal tract deficits were often present. The tumor, generally large, was most frequently located in the intermediate thoracic segments and high cervical region; only one was reported in the lumbosacral region. Considerable erosion of vertebral bodies was reported in almost one third of the cases. In four patients eloquent nerve roots, that of C-5 in three and that of S-1 in one, were involved with the tumor. Radical tumor resection, with preservation of the nerve roots, was possible in several cases, whereas in two patients manipulation and resection of the C-5 root produced transient and permanent, respectively, root palsy. At follow-up examination patients for whom walking was impossible before surgery were now able to walk.

CONCLUSIONS

Extradural schwannomas can be distinguished from other nerve sheath tumors growing inside the spinal canal by their clinicoradiological features and unlikely nerve root origin. After surgery, recovery from pyramidal tract deficits, even severe, is noteworthy; in the authors' experience, however, resection of an involved appendicular root is more likely to result in a permanent and significant radicular deficit.

Navigated dorsolateral suboccipital transcondylar (NADOSTA) approach for treatment of hypoglossal schwannoma

Hypoglossal schwannoma is a rare skull base neoplasm, which lies in the midst of extremely complex anatomical structures. We report a 39-year-old man who presented with a history of right glossal hemiatrophy, dysesthesia and weakness of the left extremities. These symptoms were caused by a unilateral hypoglossal schwannoma located at the cranial base. This lesion was exposed through a dorsolateral suboccipital transcondylar approach, which was navigated with the frameless stereotaxy (NADOSTA). We also describe the epidemiology, symptomatology and the diagnosis of hypoglossal schwannoma as well as literature review of the operative approach. By introducing this minimally invasive dorsal surgical approach with neuronavigation in treating hypoglossal schwannoma, we believe that safe exposure and complete tumor resection can be achieved with minimal rate of morbidity.