Abstract：
Schwannomas overall account for approximately 8% of primary brain tumors, with the majority of them arising from the vestibular nerves.1,2 Non-vestibular schwannomas are considered rare, particularly ones arising from the accessory nerve, constituting only around 4% of craniovertebral junction schwannomas.3,4 The far lateral approach and its variations is an important tool in the armamentarium of skull base neurosurgeons. It allows adequate exposure for accessing ventral and ventrolateral lesions of the craniocervical junction.5-13 A 60-year-old female patient presented with a 3-month history of difficulty walking and progressive right-sided weakness. Magnetic resonance imaging demonstrated an extra-axial solid lesion at the craniocervical junction with significant enhancement on post-contrast imaging. The lesion was ventrolateral to the medulla, causing compression, displacement, and peritumoral edema. The patient consented to the procedure and underwent a far lateral suboccipital craniotomy with C1 hemilaminectomy in a lateral position. Tumor origins were identified at the left accessory nerve rootlet. The patient\'s postoperative course was uneventful. Follow-up magnetic resonance imaging revealed gross total resection and complete resolution of hemiparesis 3 months after the surgery. Microsurgical resection of tumors at the craniocervical junction is challenging. Preoperative planning and tailoring the approach are essential in the decision-making process to safely perform surgery. This video demonstrates, in detail, the steps, relevant anatomy, and technical nuances for accessory nerve schwannoma ressmoval. To the best of our knowledge, this is the first operative video showing the resection of a pure accessory nerve schwannoma with compression of the medulla. Under our institutional ethical review board regulations, approval was not necessary.
摘要：
神经鞘瘤约占原发性脑肿瘤的8%。其中大部分来自前庭神经1,2非前庭神经鞘瘤被认为是罕见的,特别是由副神经产生的，仅占颅骨交界处的4％左右。3,4远外侧入路及其变异是颅底神经外科医生的重要工具。5-13一名60岁的女性，有3个月的行走困难和进行性右侧无力病史，可以充分暴露于颅颈交界处的腹侧和腹外侧病变。MR成像显示颅颈交界处有轴外实性病变，对比后成像显着增强。病变位于延髓腹外侧,导致压缩，位移,和瘤周水肿。患者同意该程序，并在侧卧位进行了C1半椎板切除术的枕骨下外侧开颅术。在左副神经根处确定肿瘤起源。患者术后病程顺利。随访MR成像显示手术后3个月完全切除，偏瘫完全消退。颅颈交界处肿瘤的显微手术切除具有挑战性。术前计划和定制方法在安全执行手术的决策过程中至关重要。这个视频演示了,在细节上,的步骤，相关解剖学,以及切除副神经神经鞘瘤的技术细微差别.据我们所知,这是第一个手术视频，显示了单纯的副神经神经鞘瘤切除并压迫髓质。根据我们的机构道德审查委员会的规定，批准是不必要的。
