The far lateral approach for microsurgical management of dumbbell C2 schwannomas.

Background: C2 nerve root schwannomas are rare and may be hourglass or dumbbell-shaped at the craniocervical junction. We describe the clinical/radiological features and treatment outcomes of patients with dumbbell C2 schwannomas operated through a far lateral approach and the technical details of this approach. Methods: Between 2019 and 2024, seven consecutive patients underwent surgery for dumbbell C2 schwannomas at the Hospital de Especialidades del Centro Médico Nacional Siglo XXI in Mexico City, Mexico. Data regarding clinical presentation, tumor location, and surgical results were investigated retrospectively in institutional databases. Results: There were 5 males (71.4%) and 2 females (28.5%); the mean age was 50.4 years (range 36-75). The average duration of symptoms before surgery was 16.7 months (range 8-35). Motor deficit (85.7%) and headache (57.1%) were the most frequent symptoms. In all cases, gross total resection (GTR) was successfully achieved. There were no post-surgical complications reported. The mean follow-up time was 21.4 months (range 1-54). Six patients (85.7%) referred completely recovered from their symptoms. Conclusion: Dumbbell C2 schwannomas pose a surgical challenge due to the adjacent anatomical structures involved. The far lateral approach enables GTR of these tumors with minimal neurovascular manipulation and excellent functional outcomes.