Microsurgical treatment of C1-2 intra-extra spinal canal dumbbell-shaped tumor

Objective To summarize the clinical characteristics,operational approaches and microsurgical treatment of C1-2 dumbbell tumors.Methods The clinical data of 22 patients with C1-2 dumbbell tumor from July 2004 to April 2013 were analyzed retrospectively.All of them were comfirmed by MRI before operation.Middline posterior approach was adopted in one-stage operation,and the second stage operation would be 3 months after the first one by lateral approach to remove the remaining tumor,if it was necessary.And at last the patients were reexamined by MRI before they left hospital.Results Tumor tissues were totally removed in 20 cases,subtotally removed in 2 cases.Eighteen patients in total-removed group underwent one-stage operation,and the other 2 patients went through two-stage operations.Pathological types include 18 cases of neurinoma,two cases of meningioma and 2 cases of ganglioneuroma.After operation,all patients achieved alleviation of preoperative symptoms in different levels.Postoperative complications were confirmed in 1 case,and no death occurred in this series.Twenty-one cases were followed up for 3 months to 9 years,while 1 other case was missing.No tumor recurrence,cervical instability or symptoms of posterior circulation were observed.Conclusion The midline posterior approach is appropriate for total resection of one stage to remove most of C1-2 dumbbell tumor. Key words: Atlas; Axis; Spinal canal; Dumbbell tumor; Microsurgical operation