Abstract

Rationale: Giant spinal schwannomas located at the C1-C2 level pose significant surgical challenges because of their proximity to the brainstem, cervical spinal cord, and vertebral arteries. This case provides insight into the surgical management of giant spinal schwannomas at the C1-C2 level. Patient Concerns: A 40-year-old female presented with a 2-year history of progressive limb numbness, weakness, and gait instability. She reported a sensation of stepping on cotton and tightness in the chest and abdomen with worsening symptoms over time. Diagnoses: Physical examination revealed limited cervical spine movement, increased muscle tone in the limbs, and Hoffmann and Babinski signs. Imaging, including CT, CTA and MRI, identified a large schwannoma at the C1-C2 level, with compression of the spinal cord and proximity to the vertebral artery. Interventions: The patient underwent surgical excision of the tumor using full laminectomy approach under intravenous anesthesia. Outcomes: The surgery was successfully completed, and the patient’s neurological symptoms, including numbness and weakness, were significantly relieved. Conclusion: Strict enucleation within the capsule can effectively protect the vertebral artery and nearby nerves. When functional nerve roots or the spinal cord are involved, leaving the residual capsule may be safer than risking permanent deficits.