Microsurgical intraneural extracapsular resection of neurinoma around the cervical neuroforamen: a technical note.

Dumb-bell tumours often require extended resection of osseous structures of the spine and subsequent anterior and/or posterior stabilization. Minimally addressed microsurgical intraneural extracapsular resection of a neurinoma originating from around the neuroforamen often provides immediate benefits. We describe our experience with microsurgical intraneural extracapsular resection of four cervical dumb-bell neurinomas in four patients. After a 4- to 7-cm skin incision, a small resection of the laminae and neuroforamen allowed visualisation of the tumour. The procedure was followed by microsurgical intraneural extracapsular complete "enucleation" resection of the tumour, without sacrificing motor funiculi or causing damage to surrounding arteries and radicular veins. One patient had a giant neurinoma at the C5-C6 and C6-C7 foraminal levels that required simultaneous anterior fusion at C5-C6 level only. The average blood loss during surgery was 35 mL (range: 11-59) and all showed neurological improvement immediately after surgery. Minimally addressed microsurgical intraneural extracapsular "enucleating" resection of tumours around the neuroforamen may be beneficial for patients, is not associated with vascular morbidity, and avoids the subsequent need for extensive spinal instrumentation.