Kalavakonda C, Sekhar L N, Jones R V, Rehaman A B
Mid Atlantic Brain and Spine Institutes, Fairfax, VA, USA.
Neurol Res. 2000 Oct;22(7):679-84. doi: 10.1080/01616412.2000.11740739.
Extradural schwannomas of the C1-root are extremely rare. As the tumor grows in size, it may compress surrounding neurovascular structures and cause symptoms. In the present case report, the left vertebral artery (VA) was severely 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 head movement that was caused by a C1-root schwannoma. The lesion was exposed through an extreme lateral transcondylar approach. At exposure the lesion was yellowish in color and was extradural in location lying between the markedly eroded C1-posterior arch and the compressed vertebral artery (V3) on the 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 patient's symptoms completely resolved immediately following surgery, with no recurrence of the symptoms at one year follow up. The vertebral artery may frequently be compressed by osteophytes in cervical spondylosis or due to other causes in the cervical spinal canal, but compression of the artery by C1 extradural schwannoma with vascular insufficiency is rare. Removel of the tumor and the resultant decompression of the artery can be facilitated by the extreme lateral approach as demonstrated by this case.
C1神经根的硬膜外神经鞘瘤极为罕见。随着肿瘤体积增大，它可能会压迫周围神经血管结构并引发症状。在本病例报告中，肿瘤严重压迫左侧椎动脉，导致向右侧转头及颈部伸展时出现严重眩晕。我们报告了一名52岁男性，他因C1神经根神经鞘瘤出现头部运动时间歇性严重眩晕病史。通过极外侧经髁入路暴露病变。暴露时病变呈淡黄色，位于硬膜外，介于明显侵蚀的C1后弓和左侧受压的椎动脉（V3）之间。肿瘤内侧部分附着于C1神经根。肿瘤被整块切除并解除了椎动脉受压。患者术后症状立即完全缓解，随访一年症状无复发。椎动脉在颈椎病中可能经常被骨赘压迫，或因颈椎管内其他原因受压，但C1硬膜外神经鞘瘤伴血管功能不全压迫动脉的情况罕见。如本病例所示，极外侧入路有助于切除肿瘤并解除动脉受压。
