One-stage microsurgical excision for intra- and extra-spinal dumbbell-shaped tumors in cervical spine: a report of 11 cases

Objective To investigate the clinical characteristics and surgical treatment strategy of intra- and extra-spinal dumbbell-shaped tumors in cervical spine. Methods Clinical data of 11 patients with intra- and extra-spinal dumbbell-shaped tumors in cervical spine were retrospectively studied. Male was in 7 cases, female in 4 cases. The tumors were in stageⅠin 4 cases, Ⅱ in 2 cases, Ⅲ in 4 cases and Ⅳ in one case. The tumors were resected via posterior midline approach alone in 9 cases, among whom unilateral hemilaminectomy was performed in 4 cases (screw fixation via posterior approach was performed for fusion of lesion segments after tumor resection in 2 cases, one was stage Ⅳ tumor, another one was stage Ⅲ tumor in cervicothoracic junction), total laminotomy and reduction by titanium miniplates and screws in 2 cases, and via interlaminar approach in 3 cases. Posterior midline approach combined with anterior lateral approach was performed in the rest 2 cases. Results Tumors were one-stage totally resected in all of the cases. Histological types of the tumors included schwannoma in 10 cases, and ganglioneuroma in one case. The numbness area was enlarged in one case, and the motor function improved in other cases. All of the patients were followed-up from 8 months to 3.50 years with an average of 21 months. No tumor relapse and spinal deformity were found. Conclusion Most cases of intra- and extra-spinal dumbbell-shaped tumors can be treated with one-stage microsurgery. The surgical treatment strategy can be reached according to the location and surgical staging of tumors. Unilateral hemilaminectomy technique is useful to maintain the stability of the cervical spine for most of tumors. Combined approach is needed in some of the tumors and fixation should be implemented in the case of stability of cervical spine damaged after tumor resection.