Dural contact in a high cervical paraspinal spindle cell neoplasm

Background: Paraspinal spindle cell mesenchymal neoplasms of myofibroblastic origin are extremely rare, particularly in the high cervical region. Radiologic differentiation between dural contact and true invasion is often challenging. Case Description: A 52-year-old female presented with posterior neck pain and a palpable upper cervical mass. The magnetic resonance demonstrated a 6 × 4 cm paraspinal lesion at the C1–C2 level with suspected dural involvement. Surgical exploration revealed a well-encapsulated tumor extending to the dura without true invasion; this allowed for gross total resection with dural preservation. Histopathology confirmed a benign myofibroblastic spindle cell neoplasm with a low Ki-67 index (1%). The patient experienced complete postoperative symptom resolution, and at 13 months postoperatively, had no radiologic evidence of recurrence. Conclusion: Radiologic dural contact should not be assumed to represent true dural invasion. In these benign lesions, intraoperative assessment allows for safe gross total resection with full dural preservation and the avoidance of a cerebrospinal fluid leak.