Schwannoma of the upper cervical spine--a case report

Upper cervical schwannoma is rare, and belongs to benign tumors that is usually asymptomatic. It accounted for only ten percent of schwannomas cases and mostly occurs in 40-50 years old patients. Aggressive and total resection is the treatment of choice for this tumor. Preoperative diagnosis is difficult, relying on clinical suspicion, and confirmed by surgical pathology. We report a 54-year-old male patient with chief complain of progressive weakness and numbness of his right arm for four months. He had a history of lymph node tumor in 2007 and excised in 2011. Neurological decrease was found on the right arm. The radiographic examination showed lytic lesion on the second, third, and fourth cervical spine. Computed tomography scan showed destruction extending to the first cervical vertebra. Capsulated extradural and extramedullary mass and compression to the spinal cord was found from the magnetic resonance imaging. Two-stage operation was performed. The first stage was posterior decompression with occipitocervical fusion and instrumentation, while the second was anterior decompression and iliac strut graft. Both operations performed using the surgical ultrasonic dissector. During three months' follow-up, it showed neurological improving. Neurological deficit appears when there is compression on the spinal cord. Total resection is the treatment of choice for these tumors. Preoperative imaging should be performed to exclude malignant tumor and found tumor extension.