Dorsal root entry zone approach in ventral and eccentric intramedullary tumors: A report of 2 cases

Intramedullary tumors constitute 2-4% of all the tumors affecting the central nervous system. They include low-grade astrocytomas and ependymomas in majority. Earlier, only biopsy or decompression used to be the best available options for these tumors, but with the upcoming technology and newer techniques, gross total excision with the aim of achieving complete removal has been the preferred treatment for these tumors. Usually, nearly all intramedullary tumors are approached from posterior midline myelotomy as this is the safest corridor to approach under neurophysiologic monitoring. But sometimes, if the tumor is exophytic, eccentric, or ventral to the cord, other routes of access may also be useful. These approaches are less frequently used these days and actually may be found useful in certain cases. Hence, they should not be termed "obsolete" and must be kept in mind for tumors in specific location. We describe a similar less commonly used dorsal root entry zone approach for near total excision of ventral and eccentric cervical pilocytic astrocytomas in two patients.