Operative Neurosurgery 28:165–174, 2025
• Objective: The study proposes a surgical strategy for preserving the vertebral artery (VA) during the excision of dumbbell-shaped cervical schwannomas using anatomic layers, specifically the perineurium.
• Methods: A retrospective analysis was conducted on 37 patients who underwent surgery for cervical schwannomas from January 2004 to July 2023.
• Results: The perineurium acted as a protective barrier during surgery, preventing VA injury in most cases. Gross total resection was achieved in 67.6% of patients.
• Complications: VA injury occurred in one patient, but no new neurological deficits were reported post-surgery.
• Subperineurial Dissection: This technique is crucial for safeguarding adjacent structures and preventing VA injury.
• Residual Tumor Management: Residual tumors were observed in some cases, with regrowth occurring near the neural foramen requiring secondary surgery.
• Conclusion: Subperineurium dissection is a vital strategy in preventing VA injury during schwannoma resection.
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