CERVICAL NEUROMAS WITH EXTRADURAL COMPONENTS - SURGICAL-MANAGEMENT INA SERIES OF 57 PATIENTS

OBJECTIVE: Cervical neuromas with extradural components (intraextradur al or strictly extradural forms) are rare. Their resection raises the problems of nerve root preservation, vertebral artery (VA) control, an d spinal stability. METHODS: A series of 57 patients with neuromas (29 neurofibromas, 23 schwannomas, 4 neurofibrosarcomas, and 1 plexiform neurofibroma) was treated during the period of 1980 to 1995, using one of the lateral approaches (antero-or posterolateral approach). The VA was always controlled before resection of the tumor. In cases of intr aextradural forms, the intradural component was removed by a complemen tary laminectomy (three patients) in the early period and then by an o blique corpectomy through the same lateral approach (five patients) in the late period. A laminectomy had been performed in 15 other patient s (11 patients with intraextradural neuromas) before they were referre d to us. These patients included seven with recurrent neuromas, occurr ing after an average period of 4.1 years (1-9 yr). RESULTS: Complete r esection was achieved in all except two patients, in whom the nerve ro ot reacted positively to intraoperative stimulation and could not be s eparated from the tumor. One of the patients was subsequently operated on after 2 years. Another recurrence was observed in another patient at 1 year. The four patients with sarcomas died from recurrence within 2 years. The rate of root preservation included an average of 28%, in cluding 43.5% for schwannomas, 18% for neurofibromas, 44% for lower ce rvical neuromas (C4-C8), and 4.5% for upper cervical neuromas (C1-C3). Worsening of preoperative neurological deficits was observed in only two patients. The VA was always preserved, except in one patient with a sarcoma that was preoperatively occluded. No instability was observe d in any of the patients. CONCLUSION: Complete resection with good neu rological results can be achieved in most patients harboring cervical neuromas each with an extradural component by using a lateral approach and VA control. If the root cannot be separated from the tumor, espec ially in patients with neurofibromas, intraoperative stimulation can h elp decide whether the root may be divided without incurring postopera tive deficit. The lateral approach permits the resection of the extrad ural as well as the intradural component by a complementary oblique co rpectomy. There was no morbidity in relation to VA control as well as no postoperative instability.