Extradural C1-C2 Dumbbell Schwannoma Mimicking an Intradural Lesion on MRI: A Case Report

Cervical dumbbell schwannomas are benign nerve sheath tumors that may present diagnostic challenges when preoperative imaging suggests intradural involvement despite an extradural origin. We report the case of a 43‑year‑old African male with a three‑year history of right‑sided cervicobrachialgia and two years of progressive quadriparesis, sensory loss, and mixed reflex abnormalities consistent with cervical myelopathy. MRI demonstrated a 31 × 21 mm C1-C2 mass initially interpreted as intradural‑extramedullary. However, intraoperative findings revealed a purely extradural schwannoma arising from the nerve root, producing significant spinal cord compression through a classic dumbbell configuration. A posterior midline approach with C2 laminectomy allowed safe microsurgical resection, achieving gross total removal without cerebrospinal fluid leakage, without neurological deterioration, and with progressive improvement of quadriparesis. Postoperative MRI confirmed complete resection with expected inflammatory changes and no residual tumor. This case underscores the importance of correlating radiological and intraoperative findings, as cervical schwannomas may mimic intradural lesions on MRI. Accurate classification and tailored surgical planning are essential for optimal outcomes, particularly in resource‑limited settings.