Intermittent vertebral artery compression caused by C1-root schwannoma: Case Report

Extradural schwannomas of the C1-root are extremely rare. As the tumor grow s in size, it may compress surrounding neurovascular structures and cause s ymptoms. In the present case report, the left vertebral artery (VA) was sev erely compressed by the tumor, eliciting severe vertigo on turning the head to the right side and with neck extension. We report a 52-year-old man who presented with a history of intermittent episodes of severe vertigo on hea d movement that was caused by a C1-root schwannoma. The lesion was exposed through an extreme lateral transcondylar approach. At exposure the lesion w as yellowish in color and was extradural in location lying between the mark edly eroded C1-posterior arch and the compressed vertebral artery (V3) on t he left side. The medial portion of the tumor was attached to the C1-nerve root. The tumor was excised enbloc with decompression of the VA. The patien t's symptoms completely resolved immediately following surgery, with no rec urrence of the symptoms at one year follow up. The vertebral artery may fre quently be compressed by osteophytes in cervical spondylosis or due to othe r causes in the cervical spinal canal, but compression of the artery by CI extradural schwannoma with vascular insufficiency is rare. Removal of the t umor and the resultant decompression of the artery can be facilitated by th e extreme lateral approach as demonstrated by this case.