OBJECTIVE;
Cervical neuromas with extradural components (intraextradural or strictly extradural forms) are rare. Their resection raises the problems of nerve root preservation, vertebral artery (VA) control, and spinal stability.

METHODS;
A series of 57 patiens with neuromas (29 nerofibromas, 23 schwannomas, 4 neurofibrosarcomas, and 1 plexiform neurofibroma) was treated during the period of 1980 to 1995, using one of the lateral approaches (antero- or posterolateral approach). The VA was always controlled before resection of the tumor. In cases of intraextradural forms, the intradural component was removed by a complementary laminectomy (3 patients) in the early period and then by an oblique corpectomy through the same lateral approach (5 patients) in the late period. A laminectomy had been performed in 15 other patients (11 patients with intraextradural neuromas) before they were refered for us. These patients included seven with recurrent neuromas, occurring after an average period of 4.1 years (1-9 yr).

RESULTS;
Complete resection was achieved in all except two patients, in whom the nerve root reacted positively to intraoperative stimulation and could not be separated from the tumor. One of the patients was subsequently operated on after 2 years. Another recurrence was observed in another patient at 1 year. The four patients with sarcomas died from recurrence within 2 years. The rate of root preservation included an average of 28%, including 43.5% for schwannomas, 18% for neurofibromas, 44% for lower cervical neuromas (C4-C8), and 4.5% for upper cervical neuromas (C1-C3). Worsenig of preoperative neurological deficits was observed in only two patients. The VA was always preserved, except in one patients with a sarcoma that was preoperatively occluded. No instability was observed in any of the patients.

CONCLUSION;
Complete resection with good neurological results can be achieved in most patients harvoring cervical neuromas each with an extradural component by using a lateral approach and VA control. If the root cannot be separated from the tumor, especially in patients with neurofibromas, intraoperative stimulation can help decide whether the root may be divided without incurring postoperative deficit. The lateral approach permits the resection of the extradural as well as the intradural component by a complementary oblique corpectomy. There was no morbidity in relation to VA control as well as no postoperative instability.