Matthieu Peyre
Cervical dumbbell schwannomas are rare and heterogeneous tumors with complex surgical management. This single-center retrospective study aimed at evaluating the results of a standardized surgical approach and included patients who underwent surgery for a cervical dumbbell schwannoma between 2013 and 2026. All patients underwent initial posterior extradural intra-radicular surgery without instrumentation. The mean postoperative follow-up was 23.6 months (range: 2-90 months). Among the 26 patients included in the study, 12 had Schwannomatosis. The mean age at surgery was 61 years for sporadic and 37 years for Schwannomatosis patients (p = 0.02, unpaired t-test). The mean tumor volume was 11.9 cm³ (range: 1.5 - 80 cm³). The main indication for surgery was spinal cord compression (19 cases, 73%). Resection via exclusive intraradicular approach was possible in 94% of sporadic and 33% of Schwannomatosis patients (p = 0.03, Fisher's exact test), including 4 cases in which intradural resection was necessary due to a concomitant intradural tumor. Most patients reported an improvement in pain, sensory, and spinal cord compression symptoms, with two cases of worsening symptoms (8.3%). The complete resection rate was 84.6%. Of the four cases with incomplete resection, only one, in a Schwannomatosis patient, required early reoperation. Two cases (8%) of postoperative spinal instability were identified in the series, both in Schwannomatosis patients. Uninstrumented intraradicular resection of dumbbell schwannomas yields satisfactory functional and oncological outcomes in most cases, except for Schwannomatosis patients, diagnosed at a younger age and potentially requiring additional intradural approach for concomitant intracanalar tumors.