2025 Proffered Presentations
S200: OPERATIVE APPROACHES TO C2 SCHWANNOMAS
Petr Vachata, PhD; Jan Lodin; Martin Sames, PhD; Dpt of Neurosurgery Masaryk Hospital UJEP
Introduction: Schwannomas in the C2 region are rare intradural-extramedullary tumors. Anatomical conditions in the spinal canal in the area of the craniocervical junction predispose to long-term asymptomatic growth and diagnosis of the pathology only at an advanced stage with manifestations of cervical myelopathy. The classic generally accepted surgical choice is the posterior approach with C1 and C2 hemi/laminectomy.
Material and methodology: From 2010–2023, we operated on 12 schwannomas in the C2 upper cervical spine region. There were five women and seven men, with an average age of 51 (3-76). Tumors were predominantly on the left in 8 cases (67%). The leading clinical symptomatology was myelopathy in 9 cases (75%). From the whole group, five patients were operated on by a classic posterior approach with skeletonization and partial or complete hemilaminectomy of the adjacent vertebrae. In comparison, seven patients were operated on by a lateral-axial approach concerning the direction of the access trajectory to the affected foramen, preservation of the paraspinal muscles, and use of the natural corridor created by the tumor.
Results: In the group of classic approaches, a complication in the form of a clinically asymptomatic occlusion of the ipsilateral vertebral artery was recorded in one case, and in one case, we are monitoring the progression of the residual tumor embedded in the foramen. There were no complications or incomplete resections in the group of axial and lateral approaches. The average operating time in the classic approach was four hours and 27 minutes, and in the case of the lateral-axial approach, it was one hour and 32 minutes. There was clinical improvement in both groups, regardless of the chosen approach.
Conclusion: Based on our first experiences, we can state that the lateral axial approach to schwannomas of the upper cervical spine represents a full-fledged alternative to classical posterior approaches with the benefit of preserving the paraspinal muscles, reducing the resection of bony structures and significantly reducing the operating time while maintaining the radical resection, including extra/intraforaminal/intradural portion of the tumor.