Clinical characteristics and surgical treatment of upper cervical intra- and extraspinal dumbbell-shaped schwannoma

English Keywords:Upper cervical vertebra  Dumbbell-shaped schwannoma  Clinical characteristics  Operation plan

English Abstract:

  【Abstract】 Objectives: To analyze the clinical characteristics of upper cervical vertebrae with dumbbell schwannoma, and to explore its clinical symptoms, imaging features, and treatment plans. Methods: A retrospective analysis was performed on 14 patients with upper cervical intra- and extraspinal dumbbell-shaped schwannoma admitted to the Spinal Surgery Department of Southern Theater General Hospital from January 2022 to June 2024, including 9 males and 5 females, aged 43.64±11.96 years(25-61 years). According to the location, size, scope of the tumor, and relationship with the surrounding important tissue structure in upper cervical spine, the relevant clinical treatment data were analyzed and the surgical treatment plan was discussed. Cervical X-ray, CT and MRI examinations were regularly performed after surgery to evaluate the conditions of complete resection of tumor and recurrence, the stability of the upper cervical spine and whether the internal fixation was loose or broken. The recovery of spinal nerve function and pain improvement were evaluated by the Japanese Orthopaedic Association(JOA) and visual analogue scale(VAS) scores. Results: All the patients underwent complete tumor resection in one stage, and the postoperative JOA score(10.14±1.55 vs 13.86±1.06, P=0.005) and VAS score(2.42±1.29 vs 0.64±0.71, P=0.000) were statistically different from those before surgery. Postoperative tumor histopathology was confirmed as schwannoma in all the 14 patients. The follow-up time was 6 months to 2 years. No recurrence of tumor was found, neurological symptoms were significantly improved, and no upper cervical instability appeared. Conclusions: For patients with intra- and extra-spinal dumbbell-shaped schwannoma in the upper cervical spine, complete resection of the tumor in one stage of posterior approach can be given priority. If the important stable tissue structure of the upper cervical spine is destroyed, upper cervical spine fixation and fusion should be performed to ensure the stability of upper cervical spine after tumor resection.