[Surgical approach for cervical dumbbell type neurinoma: posterior approach by partial hemilaminectomy with preservation of a facet joint].

We report on a case harboring a cervical dumbbell type neurinoma. The tumor was completely removed by a modified posterior approach, consisting of partial hemilaminectomies of C2 and C3 with preservation of the facet joint. The operative field under microscope was limited by the preserved facet joint of C2/3. However, sufficient bulk reduction of the epidural and paravertebral mass enabled us to obtain a good operative field. The paravertebral mass, which extended anteriorly to just beside the posterior aspect of the carotid sheath, was removed through the lateral space. The operative field was easily widened beside the right facet joint of C2/3 with partial removal of the posterior part of the transverse process of C2 and C3. The transit portion of the tumor to the normal nerve fiber was also identified through this space. The intracanalicular mass was removed by the partial hemilaminectomies of C2 and C3 without compressing the dural sac. Following sufficient reduction of the bulk, the right vertebral artery was identified at the anteromedial margin of the enlarged intervertebral foramen. Finally the intradural part of the tumor was removed through this space. Our modified posterior approach is a less invasive method to the bony elements of the cervical vertebrae and may minimize the incidence of postoperative instability and angular deformity. This approach also eliminates the necessity of long postoperative immobilization using a rigid cervicothoracic brace.