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. 2017 Dec 15:3:17092.
doi: 10.1038/s41394-017-0017-8. eCollection 2017.

Excision of a centrally based ventral intradural extramedullary tumor of the cervical spine through a direct posterior approach

Alexander Ghasem  1 , Joseph P Gjolaj  1 , Dylan N Greif  1 , Barth A Green  2
Affiliations

Excision of a centrally based ventral intradural extramedullary tumor of the cervical spine through a direct posterior approach

Alexander Ghasem et al. Spinal Cord Ser Cases. .

Abstract

Introduction: Intradural extramedullary (IDEM) tumors of the cervical spine are removed through an assortment of surgical approaches including: dorsolateral, ventrolateral, and anterior or transoral. Historically, midline ventral IDEM tumors are ostensibly thought to be unfavorable candidates for removal through a direct posterior approach. A case report of a patient with a ventrally based centrally located meningioma in the upper cervical spine (C2/C3) that was removed with direct posterior approach is described.

Case presentation: A 51-year-old male presented with cervicalgia and radiating scapular pain following a remote motor vehicle collision. A ventrally located meningioma in relation to the C2 body was noted on MRI. Management of this patient included obtaining adequate exposure through a posterior approach, complete tumor excision, and maintenance of cervical spine stability. Cervical stability was maintained following total unilateral facetectomy and application of instrumentation from C1-C3.

Discussion: Subsequent to tumor removal, the patient had complete resolution of his cervicalgia, headaches, and scapular pain by his two month follow-up appointment. Although adhesions can make total resection difficult, a posterior approach can grant adequate access to midline ventral meningiomas. Cervical spine stability, tumor location, infection risk, and surgeon familiarity with the approach should all be weighed in decision-making.

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Conflict of interest statement

Compliance with ethical standardsEach author certifies that he or she has no commercial associations (e.g., consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article. No copyrighted information was presented in this case report.

Figures

Fig. 1 Sagittal MRI of Intradural Mass
Fig. 1 Sagittal MRI of Intradural Mass
Sagittal T2 magnetic resonance imaging of the patient’s cervical spine identifying a hypointense intradural extramedullary mass with severe radiographic cord compression
Fig. 2 Postoperative Cervical Radiographs
Fig. 2 Postoperative Cervical Radiographs
PA (a) and lateral (b) radiographs of the patient’s cervical spine following unilateral C2 facetectomy and partial laminectomy of C1 and C3 with implemented cervical instrumentation at levels C1–C3
See this image and copyright information in PMC

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