Umana Giuseppe Emmanuele, Passanisi Maurizio, Chaurasia Bipin, Scalia Gianluca
Department of Neurosurgery, Trauma Center, Gamma Knife Center Cannizzaro Hospital Catania Italy.
Department of Neurosurgery Neurosurgery Clinic Birgunj Nepal.
Clin Case Rep. 2023 Jun 26;11(6):e7616. doi: 10.1002/ccr3.7616. eCollection 2023 Jun.
Craniovertebral junction (CVJ) schwannomas are rare tumors, showing direct involvement of the atlanto-occipital and atlanto-axial joints. Microsurgical removal is the standard of care to improve symptoms and local control, but stereotactic radiosurgery (SRS) is an option. Both, surgery, and SRS, may show risks of severe complications. A 41-year-old male was referred to our department after incidental finding of a right-sided C1 tumor. A CT angiogram with 3D reconstructions showed the close relationship between the tumor and the right vertebral artery (VA). A post-contrast enhancement MRI revealed the presence of an extradural mass, sited at the level of the CVJ, mainly at the level of the right articular mass of C1. After multidisciplinary assessment, involving the gamma-knife and neurosurgical teams, we performed a microsurgical resection of the tumor. Histology confirmed the diagnosis of schwannoma. At 1 year follow-up the patient is stable, with no recurrence of the tumor. CVJ schwannoma's current standard of care is surgical resection, but longitudinal studies are required, and should promoted promptly since the recent introduction of the new version of GKSRS that allow the treatment of CVJ's lesions.
颅颈交界区（CVJ）神经鞘瘤是罕见肿瘤，可直接累及枕寰关节和寰枢关节。显微手术切除是改善症状和局部控制的标准治疗方法，但立体定向放射外科（SRS）也是一种选择。手术和SRS都可能有严重并发症的风险。一名41岁男性在偶然发现右侧C1区肿瘤后转诊至我科。带有三维重建的CT血管造影显示肿瘤与右侧椎动脉（VA）关系密切。增强后MRI显示硬膜外肿块存在，位于CVJ水平处，主要在C1右侧关节块水平。经过包括伽马刀和神经外科团队的多学科评估后，我们对肿瘤进行了显微手术切除。组织学确诊为神经鞘瘤。在1年随访时患者情况稳定，肿瘤无复发。CVJ神经鞘瘤目前的标准治疗方法是手术切除，但需要进行纵向研究，并且由于新版GKSRS的近期推出允许治疗CVJ病变，应立即推动相关研究。
