Surgery of spinal nerve sheath tumors originating from C1 or C2 of high cervical spine.

Spinal nerve sheath tumors (NSTs) originating from the C1 or C2 level are unique from both anatomical and clinical perspectives. Surgical technique to accomplish radical but safe resection of these tumors is described in 8 cases treated during the past 5 years. Surgical measures included positioning the patient in the lateral oblique position, unilateral posterior approach, exposure of the tumor along the surgical plane of the dural or perineural boundary, and proximal and distal amputation of the tumor with resection of dural penetration. Excessive bone resection and soft tissue manipulation were unnecessary. Microscopic complete removal of the tumor was accomplished in seven of eight cases. Subtotal resection was done in one case where the tumor extended beyond the vertebral artery. Functional assessment demonstrated satisfactory improvement after surgery in all cases. Surgery-related complications were not encountered in any case. Exposure of the tumor along the surgical plane of the dural or perineural boundary may be the key procedure required to accomplish radical but safe resection of spinal NSTs originating from the C1 or C2 level.