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Resection of an Occipital-Cervical Junction Schwannoma through a modified minimally invasive approach: Technical Note
Michael Feldman1, Kristopher T Kimmell1, Robert E Replogle1
1Department of Neurosurgery, University of Rochester Medical Center, Rochester, NY, USA.
Background:
Minimally invasive spine (MIS) techniques have been available for many years, but their application has been largely limited to degenerative spine diseases. There are few reports in the literature of using MIS techniques for removal of neoplasms. We report our experience using a modified MIS technique for removal of an occipital-cervical junction (OCJ) schwannoma with attention to technical aspects of this approach.
Case Description:
A 64-year-old male presented with several months of neck pain radiating to the shoulder with bilateral hand numbness. The patient had evidence of early myelopathy on examination. Magnetic resonance imaging (MRI) demonstrated enhancing intradural lesion with significant mass effect on the spinal cord. The mass extended extradurally through the right C1 neural foramen. Imaging characteristics were suggestive of a schwannoma. The patient underwent a minimally invasive far lateral approach to the OCJ for resection of the lesion. A Depuy Pipeline™ expandable retractor was used for visualization. Surgical resection was performed with microscopic visualization. Somatosensory evolved potentials (SSEP) monitoring was used. The patient tolerated the procedure well. Postoperative imaging demonstrated gross total resection. No intra- or postoperative complications were noted. The patient was discharged home on postoperative day 2. At 1-month follow-up, his preoperative symptoms were resolved and his wound healed excellently.
Conclusion:
In properly selected patients, minimally invasive approaches to the OCJ for resection of mass lesions are feasible, provide adequate visualization of tumor and surrounding structures, and may even be preferable given the lower morbidity of a smaller incision and minimal soft tissue dissection.
Insights
Minimally invasive spine surgery effectively removed an occipital-cervical junction schwannoma, offering a less invasive option for spinal tumors. This approach may reduce patient morbidity compared to traditional open surgeries.
Area of Science:
- Neurosurgery
- Spinal Surgery
- Oncology
Background:
- Minimally invasive spine (MIS) techniques are underutilized for tumor removal, primarily applied to degenerative conditions.
- Limited literature exists on MIS approaches for spinal neoplasms.
Purpose of the Study:
- To describe a modified MIS technique for occipital-cervical junction (OCJ) schwannoma resection.
- To evaluate the feasibility and technical aspects of MIS for OCJ tumors.
Main Methods:
- A 64-year-old male with neck pain and myelopathy underwent MIS resection of an OCJ schwannoma.
- A minimally invasive far lateral approach with an expandable retractor and microscopic visualization was employed.
- Intraoperative somatosensory evoked potentials (SSEP) monitoring was utilized.
Main Results:
- The procedure resulted in gross total resection of the schwannoma.
- The patient experienced no intra- or postoperative complications and was discharged on postoperative day 2.
- Preoperative symptoms resolved at 1-month follow-up with excellent wound healing.
Conclusions:
- MIS approaches are feasible for OCJ mass resection in selected patients.
- These techniques provide adequate visualization for tumor removal.
- MIS may offer lower morbidity due to smaller incisions and minimal soft tissue dissection.
