Surgical nuances on the treatment of giant dumbbell cervical spine schwannomas: description of a challenging case and review of the literature.

We report a case of a giant intra and extradural cervical schwannoma in a patient affected by a severe myelo-radiculopathy. Clinical features, diagnosis and the issues concerning the surgical management of this benign tumor are discussed. We also review similar cases previously reported in the literature. A 50-year old caucasian woman was complaining of a 1 year of neck pain and worsening motor impairment in all four limbs causing the inability to walk. Neuroradiological assessment revealed a suspected schwannoma involving the nerve roots from C3 to C5, compressing and deviating the spinal cord. The vertebral artery was also encased within the lesion, but still patent. A posterior cervical laminectomy with a microsurgical extradural resection of the lesion was performed. Moreover, an accurate dissection of the lesion from the vertebral artery and the resection of the intraspinal component was achieved. Vertebral fixation with screws on the lateral masses of C3, C5 and C6 and a hook on C1 was performed. The procedure was secured using electroneurophysiological monitoring. A progressive improvement of the motor functions was achieved. A cervical post-contrast MRI revealed optimal medullary decompression and a gross-total resection of the lesion. Schwannomas are benign, slowly growing lesions which may cause serious neurological deficit. Early diagnosis is necessary and it maybe aided by imaging studies such as MRI or CT. The accepted treatment for these tumors is surgical resection and, when indicated, vertebral fixation.