Microsurgical resection of a cervical dumbbell melanocytic tumor with a large extraforaminal component: surgical video

Abstract

Cervical dumbbell tumors with foraminal and extraforaminal extension can introduce technical challenges because of their proximity to critical structures such as the spinal cord, nerve roots, and the vertebral artery. Most cervical dumbbell tumors arise from Schwann cells making up peripheral nerve sheaths but, while uncommon, can be other pathologies. We present the operative video of a 50-year-old male with progressive cervical myelopathy caused by a C4-C5 Asazuma type IIIA dumbbell tumor with intradural, foraminal, and large extraforaminal components. The lesion was resected through a posterior approach consisting of C3-5 laminectomies and a left C4-5 facetectomy with a microsurgical tumor resection. A C3-6 posterior instrumented fusion was also performed. This report highlights technical considerations when resecting tumors of this nature. Gross total resection was achieved, and the final pathology report established the diagnosis of a primary circumscribed central nervous system (CNS) melanocytic tumor. This video illustrates operative nuances relevant to resection of cervical dumbbell lesions with significant extraforaminal extension.