The patient came to the clinic 26-July-2020 complaining of limitation of neck movement for all directions due to huge mass in the left posterior aspect of the neck a the craniovertebral junction. He noticed it 6 months ago and it is growing by time. MRI done 22-July-2020 showing a huge left paravertbral mass with intradural compartment at the level of C3 shifting the spinal cord to the right.

On examination: The patient has limitation of neck movement to all directions except flexion of the neck. The mass is firm unmovable, residing under the base of the skull posterior to the mastoid. Inspection of area for presence of abnormal veins, which could be a clue for malignancy is absent. The patient was neurologically free.

The patient was sent for investigations and MRI with MRA and MRV of the area was done confirming the presence of neurofibroma, originating from the left C3 root, pushing the spinal cord to the right, expanding the left C2-3 foramen, pushing the left vertebral artery anterior and upward. ICA and jugular veins are normal. The huge extravertebral part is multicompartment with several consistency, reaching the C5 level.  

Midline incision with laminectomy C2,3 more to the left. The dura was opened above the tumor and radical removal of the intradural part of the tumor with involved roots was achieved. The left extraforaminal huge part of the tumor was of multiple consistency with one huge stony consistency rounded mass were removed. The tumor was severely vascularized, that it needs 5 units packed cells and 10 units FFP during surgery. All the visible parts of the tumor were removed.   Routine closure of the wound with Ready-Vac drain inside the wound.

Smooth postoperative recovery. He was sent to the ICU since the operation took around 10 hours with massive intraoperative bleeding.

The final histologic result was that of malignant peripheral nerve sheath tumor. The tumor cells show, in the better differentiated area, focal reaction to S 100. Proliferative index by Ki 67 shows hot areas with increase to levels exceeding 15% especially in perivascular zones and less differentiated component. Tumor cells were non-reactive to Sox 10 (positive in only 2/3 of such tumors). The report was received 27-August-2020. The report was issued by Prof. Yahia F. Dajani.
The patient came 10 days after surgery. He was neurologically free with normal healing of the wound.
The report was given upon family request 27-August-2020 to be re-evaluated by Hussein Cancer Center for possible radio, chemotherapy or both.

The patient is in need for surgery to prevent spinal cord damage and to make the patient able to move his head.