Anterolateral Transforaminal Approach for a Large Cervical Dumbbell Neurinoma

概要

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The generally accepted procedure for the removal of a large cervical dumbbell-shaped neurinoma is that a posterior approach is carried out first for the removal of the intraspinal tumor and then the remaining extraspinal tumor is explored through an anterior approach. We have achieved total resection of these tumors at one-stage operation by an anterolateral transforaminal approach. In the supine position, a linear skin incision along the anterior margin of the sternocleidomastoid muscle is made. This muscle and external jugular vein are retracted laterally and the longus capitis muscles medially. This step gives exposure of the extraspinal portion of the tumor as well as cervical nerves distal to the tumor just above the scalenus muscular groups. After an intracapsular decompression of the tumor, these two muscular layers are dissected and retracted medially to identify the vertebral artery, which is mobilized upward to expose the intraforaminal portin of the tumor. The intradural part of the tumor is then removed through this enlarged foramen. After the removal of tumor, the dura is closed and no bone graft is required. This approach dealt with a series of 11 cases. Satisfactory surgical results were achieved in 10 cases. In discussion, we compare this transforaminal approach with other anterolateral approaches such as transuncodiscal and oblique transcorporeal ones.
日本脊髄外科学会の論文
1998-11-30