Posterior Approach Resection of Giant Schwannomas at the Craniovertebral Junction: A Case Series

Abstract

Tumors of the craniovertebral junction (CVJ) are rare and present a major surgical challenge due to the anatomical complexity of the region. We report three cases that were admitted and operated on in our department. All three patients presented with motor deficits and bladder-sphincter dysfunction. In the first case, MRI revealed a grossly ovoid tumor measuring 30 x 28 mm, located anterolaterally to the right of the cervical spinal cord at the level of the C2 vertebral body, extending anteriorly beyond the arch of C1. The second patient's contrast-enhanced MRI showed an intradural extramedullary lesion measuring 31 x 27 mm at the C2-C3 level. In the third case, imaging demonstrated spinal cord compression at the C1-C2 level due to a mass measuring 35 x 26 mm in the extradural and extramedullary space, with spontaneous signal located anterior to the dural sac. All patients underwent posterior decompression. Tumor excision was performed under a neurosurgical microscope following C2 laminectomy and partial resection of the posterior arch of C1 in all three cases. Histopathological examination of the resected specimens confirmed the diagnosis of schwannomas. Postoperative outcomes were uneventful, and all patients showed improvement following physiotherapy sessions. This case series highlights the surgical complexity of the posterior approach to CVJ tumors, particularly giant schwannomas, and demonstrates the favorable postoperative course following complete resection.