Technique Note for Staged Resection of Giant Invasive High-Cervical Schwannoma and Reconstruction of C2—C4 with 3D Printing Technique

Abstract

A schwannoma is a relatively common benign spinal cord tumour; however, giant schwannomas with extensive cervical vertebral erosion are rare, and the treatment strategy, especially the reconstruction of the upper cervical vertebra, remains a challenge for spine surgeons. Here, we present a rare case of giant invasive high-cervical schwannoma with extensive erosion of the C2—C4 vertebral bodies and tumour-encased left vertebral artery. The surgical strategy and the reconstruction of C2—C4 with 3D printing techniques were discussed and performed. A 32-year-old man presented to our department with complaints of gait disturbance and weakness in both upper and lower extremities. His limb muscle strength was grade 2 or 3/5, and he exhibited severe bladder and bowel dysfunction on admission. X-ray and computed tomography of the cervical spine showed an extremely large erosive lesion at the C2—C4 vertebral bodies and lateral masses. Magnetic resonance imaging of the cervical spine showed a large soft-tissue mass on the left aspect of the C2—C5 vertebra and in the spinal canal at the C3—C4 level. A staged schwannoma resection, instrumented fixation, and reconstruction of C2—C4 with 3D metal printing technique were performed. The patient achieved good postoperative outcomes and returned to normal daily life with no recurrence of schwannoma during follow-up for four and a half years. The 3D-printed implant achieved solid fusion with the remaining cervical spine. We performed staged resection of the giant invasive high-cervical schwannoma and reconstructed the erosive C2—C4 vertebra with the assistance of a 3D printing technique. 3D printing technology has facilitated the design and manufacture of customised implants for complex surgical procedures.