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Yousefi O, Saghebdoust S, Abdollahifard S, Motlagh MA, Farrokhi MR, Motiei-Langroudi R, Mousavi SR. Spinal Ganglioneuroma: A Systematic Review of the Literature. World Neurosurg 2023; 180:163-168.e7. [PMID: 37659751 DOI: 10.1016/j.wneu.2023.08.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 08/11/2023] [Accepted: 08/12/2023] [Indexed: 09/04/2023]
Abstract
OBJECTIVE Spinal ganglioneuromas (GNs) are rare benign tumors that often manifest as symptoms related to the compression of neural elements. The preferred treatment for affected patients is surgical resection, which typically improves symptoms and accompanies a low likelihood of tumor recurrence. We conducted a systematic review of reports of GNs involving the spinal cord and nerve roots, examining their clinical presentation, surgical management, and outcomes. METHODS Using the keywords "ganglioneuroma" and "spinal," we conducted a systematic database review of MEDLINE (PubMed), Scopus, and Embase, querying studies reporting cases of spinal GNs. Patients' demographics, location of the tumors, clinical features, and surgical outcomes were extracted from eligible articles. RESULTS A total of 93 spinal GN cases in 52 case reports/series met our criteria. Data analysis revealed a general male predominance, though thoracic spinal GNs were seen more in females. The mean age of patients with cervical, thoracic, thoracolumbar, and lumbar spinal GNs were 41.28, 27.65, 15.61, and 38.73 years, respectively. Multiple-level GNs were mostly seen in male patients or individuals with neurofibromatosis type 1. In all but 1 case, recurrence and reoperation were not reported in the short-term (months) and long-term (2-10 years) follow-up. CONCLUSIONS We found unique epidemiologic characteristics for patients with GNs of different spinal regions. The treatment of choice is achieving gross total resection, but given the eloquency of the lesions, achieving decompression via subtotal resection can also be associated with improved outcomes. To date, no global postoperative surveillance protocol exists, considering the low recurrence rate and relevant cost-benefit ratios.
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Affiliation(s)
- Omid Yousefi
- Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Saeed Abdollahifard
- Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Majid Reza Farrokhi
- Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran; Shiraz Neuroscience Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Seyed Reza Mousavi
- Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran; Shiraz Neuroscience Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
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Ando K, Machino M, Ito S, Segi N, Tomita H, Koshimizu H, Imagama S. Surgical outcomes in instrumented surgery for dumbbell type spinal cord tumor -the comparison with non-instrumented surgery for spinal cord tumor. J Orthop Sci 2023; 28:1234-1239. [PMID: 36513562 DOI: 10.1016/j.jos.2022.10.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 08/30/2022] [Accepted: 10/14/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND There is little information on outcomes for spinal cord tumor treated surgically with instrumentation. Analysis of surgical outcomes and complications in such cases is needed to develop generalizable conclusions and to help inform patients. METHODS The subjects were 41 patients treated with instrumentation surgery for dumbbell type tumor resection. Demographic data; tumor histology, level, and location; number of fused vertebra; use of a bilateral or hemilateral screw; operative time; EBL; TcMEP monitoring; lumbar subarachnoid drainage; duration of subfascial drainage; postoperative motor and sensory deficits; CSF leakage, implant-related complications; time for union of fused vertebra; salvage surgeries, and pre-/postoperative McCormick scale were obtained from medical records. Significant factors related to postoperative motor deficits were identified. RESULTS Postoperative motor deficit occurred in 9 cases (22.0%) and all recovered in 30 days after surgery. CSF leakage at 7 days and 2 years after surgery was subfascial (n = 31, n = 6) and subcutaneous (n = 3, n = 4). Cases with postoperative motor deficits more commonly had lower cervical lesions; those with CSF leakage had longer operative times; and those with delayed union had more use of hemilateral instrumentation. CONCLUSION In this study in 41 spinal cord tumors treated surgically with instrumentation, the rate of postoperative motor deterioration was 22.0%, and CSF leakage was found in 17.1%.
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Affiliation(s)
- Kei Ando
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine 65, Tsurumai, Showa-ku, Nagoya, Aichi, 466-8550, Japan.
| | - Masaaki Machino
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine 65, Tsurumai, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Sadayuki Ito
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine 65, Tsurumai, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Naoki Segi
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine 65, Tsurumai, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Hiroyuki Tomita
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine 65, Tsurumai, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Hiroyuki Koshimizu
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine 65, Tsurumai, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Shiro Imagama
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine 65, Tsurumai, Showa-ku, Nagoya, Aichi, 466-8550, Japan
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Okubo T, Nagoshi N, Tsuji O, Ozaki M, Suzuki S, Takahashi Y, Matsumoto M, Nakamura M, Watanabe K. Impact of Surgical Resection Without Spinal Fusion for Thoracic Dumbbell Tumors on Postoperative Global Spinal Sagittal Alignment and Clinical Outcomes. Global Spine J 2023:21925682231212724. [PMID: 37899599 DOI: 10.1177/21925682231212724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2023] Open
Abstract
STUDY DESIGN A retrospective comparative study. OBJECTIVES This study investigated radiographical changes in global spinal sagittal alignment (GSSA) and clinical outcomes after tumor resection without spinal fusion in patients with thoracic dumbbell tumors. METHODS Thirty patients with thoracic dumbbell tumors who were followed up for at least 3 years were included in this study. Variations in the outcome variables were analyzed using individual GSSA parameters measured on radiography. Clinical outcomes were assessed using the modified McCormick scale (MMCS), Japan Orthopaedic Association (JOA) score, and visual analog scale (VAS). To assess the impact of the affected levels on these outcomes, we divided the patients into three groups according to the location of the tumor (upper [T1-4], middle [T5-8], or lower [T9-12] thoracic spine). RESULTS The GSSA parameters (cervical lordosis, T1 slope, thoracic kyphosis [global, upper, middle, and lower], thoracolumbar kyphosis, lumbar lordosis, sacral slope, pelvic incidence, and pelvic tilt) of all the patients did not change significantly after surgery. Eleven of thirty patients had preoperative gait disturbances but they could walk without support (MMCS grade I or II) at the final follow-up. The JOA score and VAS showed significant postoperative improvements. No statistically significant differences were observed in each postoperative sagittal profile or clinical outcome between the upper, middle, and lower groups. CONCLUSIONS Tumor resection without spinal fusion did not affect the various GSSA parameters and resulted in satisfactory clinical outcomes, indicating that spinal fusion may not always be necessary when resecting thoracic dumbbell tumors.
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Affiliation(s)
- Toshiki Okubo
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Narihito Nagoshi
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Osahiko Tsuji
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Masahiro Ozaki
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Satoshi Suzuki
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Yohei Takahashi
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Morio Matsumoto
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Masaya Nakamura
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Kota Watanabe
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
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Okubo T, Nagoshi N, Tsuji O, Nishimura S, Suzuki S, Nori S, Yagi M, Matsumoto M, Nakamura M, Watanabe K. Spinous Process-Splitting Laminectomy Approach for Tumor Excision at Conus Medullaris or Cauda Equina Level Results in Satisfactory Clinical Outcomes Without Affecting Global Spinal Sagittal Alignment. Global Spine J 2023; 13:1745-1753. [PMID: 34620008 PMCID: PMC10556912 DOI: 10.1177/21925682211047460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Retrospective comparative study. OBJECTIVES The present study investigated radiographical changes in global spinal sagittal alignment (GSSA) and clinical outcomes following tumor resection using spinous process-splitting laminectomy (SPSL) approach without fixation in patients with conus medullaris (CM) or cauda equina (CE) tumor. METHODS Forty-one patients with CM or CE tumor (19 males, 22 females, mean age at surgery of 52.9 ± 13.0 years) were included in this study. The variations of outcome variables were analyzed in various GSSA profiles using radiographic outcomes. The clinical outcomes were assessed using Japan Orthopaedic Association (JOA) score and JOA back pain evaluation questionnaire (JOABPEQ). RESULTS In all cases, the various GSSA parameters (sagittal vertical axis, C2-7 lordosis, T1 slope, thoracic kyphosis, T10-L2 kyphosis, lumbar lordosis [LL; upper, middle, and lower], sacral slope, pelvic incidence, and pelvic tilt) did not significantly change in the 2-years postoperative period. Moreover, age at surgery, the number of resected laminae, preoperative T12-L2 kyphosis, or LL did not affect the postoperative changes in T12-L2 kyphosis or LL, and had no statistically significant correlation among them. The scores of each postoperative JOA domain and the Visual Analogue Scale included in the JOABPEQ were significantly improved. There was no statistical significant group difference in each sagittal profile or clinical outcomes between CM and CE groups postoperatively. CONCLUSIONS Tumor resection using SPSL approach did not affected the various GSSA parameters examined and resulted in satisfactory clinical outcomes, indicating that SPSL approach is a suitable surgical technique for patients with CM or CE tumor.
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Affiliation(s)
- Toshiki Okubo
- Department of Orthopaedic Surgery, National Hospital Organization, Murayama Medical Center, Tokyo, Japan
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Narihito Nagoshi
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Osahiko Tsuji
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Soraya Nishimura
- Department of Orthopaedics Surgery, Kawasaki Municipal Hospital, Kanagawa, Japan
| | - Satoshi Suzuki
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Satoshi Nori
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Mitsuru Yagi
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Morio Matsumoto
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Masaya Nakamura
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Kota Watanabe
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
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Okubo T, Nagoshi N, Tsuji O, Suzuki S, Takahashi Y, Yagi M, Matsumoto M, Nakamura M, Watanabe K. Resection of Cervical Dumbbell-Shaped Schwannoma Using Posterior Unilateral Approach: Impact on Postoperative Cervical Function and Clinical Outcomes. Global Spine J 2023:21925682231178205. [PMID: 37210656 DOI: 10.1177/21925682231178205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/22/2023] Open
Abstract
STUDY DESIGN A retrospective comparative study. OBJECTIVES This study aimed to evaluate the radiographical changes in cervical sagittal alignment (CSA) and clinical outcomes after tumor resection using a posterior unilateral approach without spinal fixation for patients with cervical dumbbell-shaped schwannoma (DS). METHODS Seventy-three patients with DS who were followed up for at least 2 years were included. The Eden classification was used to designate the types of DS. The CSA and range of motion (ROM) were analyzed using radiographs. The clinical outcomes were assessed using the Japanese Orthopaedic Association (JOA) score and JOA cervical myelopathy questionnaire. RESULTS The CSA in the neutral, flexion, and extension position and cervical ROM were not significantly reduced in the follow-up period. The JOA scores showed significant improvement after surgery. The postoperative radiographic parameters and clinical outcomes of Eden type II or III DS, which needed facetectomy for the resection, did not show any statistically significant difference compared with those of Eden type I tumor, which was resected without facetectomy. Fifty-two cases (71.2%) achieved gross total resection, whereas 21 cases (28.8%) remained in partial resection (PR). One case underwent reoperation due to the regrowth of the remnant tumor whose margin was at the entrance of the intervertebral foramen. CONCLUSIONS Tumor resection using the posterior unilateral approach preserved CSA and resulted in favorable clinical outcomes in patients with DS. When the resection ends in PR, the proximal margin of the remnant tumor should be located distally away from the entrance of the foramen to prevent regrowth.
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Affiliation(s)
- Toshiki Okubo
- Department of Orthopaedic Surgery, National Hospital Organization, Murayama Medical Center, Tokyo, Japan
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Narihito Nagoshi
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Osahiko Tsuji
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Satoshi Suzuki
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Yohei Takahashi
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Mitsuru Yagi
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
- Department of Orthopaedic Surgery, International University of Health and Welfare, School of Medicine, Chiba, Japan
| | - Morio Matsumoto
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Masaya Nakamura
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Kota Watanabe
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
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Ishikawa Y, Ohashi M, Hirano T, Matsuda M, Akabane T, Kanno H, Hashimoto K, Handa K, Aizawa T, Suzuki T, Shimamura Y, Watanabe K. Mid- to Long-Term Outcomes After Resection of Thoracic Dumbbell Tumors Managed by Laminectomy and Unilateral Total Facetectomy Without Instrumented Fusion. Global Spine J 2023; 13:771-780. [PMID: 33973481 DOI: 10.1177/21925682211008836] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
STUDY DESIGN Retrospective multicenter study. OBJECTIVE To evaluate mid- to long-term surgical outcomes of thoracic dumbbell tumors managed by laminectomy and unilateral total facetectomy without instrumented fusion. METHODS A total of 15 patients with thoracic dumbbell tumors who underwent primary resection by laminectomy and unilateral total facetectomy without spinal instrumented fusion between 2000 and 2015 were reviewed. Patient characteristics, surgical outcomes (including spinal alignment and stability), disc degeneration, pain, disability, and health-related quality of life were evaluated. Additionally, to analyze the impact of the affected levels on these outcomes, we divided the patients into 2 groups: a middle thoracic group and a thoracolumbar group. RESULTS The mean duration of follow-up was 100.5 months (range, 36-190 months). The affected level was T3-T4 or below in all patients. Although the local kyphosis angle (8.1° to 12.7°), thoracic kyphosis angle (25.6° to 33.9°), and coronal Cobb angle (6.6° to 9.5°) significantly increased from preoperative to the final visit (P ≤ .02), no patient demonstrated spinal instability. From magnetic resonance imaging, no patient had a worse grade of disc degeneration in the affected level than those in the adjacent levels. The percentage of patients who presented with an Oswestry disability index ≤ 22% was 80%. Moreover, the surgical region did not adversely affect the outcomes. No patient required additional surgery due to spinal instability or deformity. CONCLUSIONS Unilateral total facetectomy without fusion to resect thoracic dumbbell tumors caused neither spinal deformity nor instability requiring additional surgery at the mid- to long-term follow-up.
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Affiliation(s)
- Yuya Ishikawa
- Department of Regenerative and Transplant Medicine, Division of Orthopaedic Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Masayuki Ohashi
- Department of Regenerative and Transplant Medicine, Division of Orthopaedic Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Toru Hirano
- Department of Orthopaedic Surgery, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Minami-Uonuma, Niigata, Japan
| | - Michiharu Matsuda
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takeru Akabane
- Department of Orthopaedic Surgery, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Haruo Kanno
- Department of Orthopaedic Surgery, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Ko Hashimoto
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kyoichi Handa
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Toshimi Aizawa
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Tomoto Suzuki
- Department of Orthopaedic Surgery, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Yukihide Shimamura
- Department of Orthopaedic Surgery, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Kei Watanabe
- Department of Regenerative and Transplant Medicine, Division of Orthopaedic Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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Chang CY, Hung CC, Liu JM, Chiu CD. Tension pneumocephalus following endoscopic resection of a mediastinal thoracic spinal tumor: A case report. World J Clin Cases 2022; 10:725-732. [PMID: 35097100 PMCID: PMC8771397 DOI: 10.12998/wjcc.v10.i2.725] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 11/12/2021] [Accepted: 12/08/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Pneumocephalus is a rare complication presenting in the postoperative period of a thoracoscopic operation. We report a case in which tension pneumocephalus occurred after thoracoscopic resection as well as the subsequent approach of surgical management.
CASE SUMMARY A 66-year-old man who received thoracoscopic resection to remove an intrathoracic, posterior mediastinal, dumbbell-shaped, pathology-proven neurogenic tumor. The patient then reported experiencing progressively severe headaches, especially when in an upright position. A brain computed tomography scan at a local hospital disclosed extensive pneumocephalus. Revision surgery for resection of the pseudomeningocele and repair of the cerebrospinal fluid leakage was thus arranged for the patient. During the operation, we traced the cerebrospinal fluid leakage and found that it might have derived from incomplete endoscopic clipping around the tumor stump near the dural sac at the T3 level. After that, we wrapped and sealed all the possible origins of the leakage with autologous fat, tissue glue, gelfoam, and duraseal layer by layer. The patient recovered well, and the computed tomography images showed resolution of the pneumocephalus.
CONCLUSION This report and literature review indicated that the risk of developing a tension pneumocephalus cannot be ignored and should be monitored carefully after thoracoscopic tumor resection.
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Affiliation(s)
- Chao-Yuan Chang
- Department of Neurosurgery, China Medical University Hospital, Taichung 40447, Taiwan
| | - Cheng-Che Hung
- Department of Neurosurgery, China Medical University Hospital, Taichung 40447, Taiwan
| | - Ju-Mien Liu
- Department of Pathology, Puli Christian Hospital, Nantou 54041, Taiwan
| | - Cheng-Di Chiu
- Department of Neurosurgery, China Medical University Hospital, Taichung 40447, Taiwan
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Harrison OJ, Bakir A, Chamberlain MH, Nader-Sepahi A, Amer KM. Combined minimally invasive resection of thoracic neurogenic dumbbell tumors: A European case series. Thorac Cancer 2021; 12:2767-2772. [PMID: 34423903 PMCID: PMC8520801 DOI: 10.1111/1759-7714.14122] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 08/06/2021] [Accepted: 08/09/2021] [Indexed: 11/29/2022] Open
Abstract
Background Paraspinal tumors are rare neoplasms arising from neurogenic elements of the posterior mediastinum and surgical resection can be challenging. Here, we demonstrate feasibility and outcomes from the first European case series of combined laminectomy and video‐assisted thoracoscopic surgery (VATS) resection of thoracic neurogenic dumbbell tumors. Methods A retrospective review of all combined thoracic dumbbell tumor resections performed at our institution between March 2015 to February 2019 was undertaken. Outcomes included operative time, blood loss, length of stay and recurrence rate. Statistical analysis was performed with SPSS statistics (v26). Values are given as mean ± standard deviation and median ± interquartile range. Results Seven patients were included in the case series and there were no major complications or mortality. Mean tumor size and operative time were 66 (± 35) mm and 171 (± 63) min, respectively. Median blood loss and length of stay were 40 (± 70) ml and four (± 3) days, respectively. One patient required conversion to thoracotomy to remove a tumor of 135 mm in maximal dimension. Histology in all seven cases confirmed schwannoma. There was no disease recurrence at a maximum follow‐up of 54 months. Conclusions Our experience demonstrates favorable operative times, minimal blood loss and short length of stay when dealing with relatively large tumors compared to previous reports. Thoracotomy may be required for tumors exceeding 90 mm and chest drain removal on the operative day can facilitate early mobility and discharge. We advocate a combined, minimally invasive laminectomy and VATS resection as the gold‐standard approach for thoracic neurogenic dumbbell tumors.
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Affiliation(s)
- Oliver J Harrison
- Department of Thoracic Surgery, University Hospital Southampton, Southampton, UK
| | - Adnan Bakir
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Martin H Chamberlain
- Department of Thoracic Surgery, University Hospital Southampton, Southampton, UK
| | - Ali Nader-Sepahi
- Department of Neurosurgery, University Hospital Southampton, Southampton, UK
| | - Khalid M Amer
- Department of Thoracic Surgery, University Hospital Southampton, Southampton, UK
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Podobed AV, Malkevich VT, Obad NT, Bambiza AV, Savchenko OG. [Outcomes of minimally invasive surgery for mediastinal neurogenic tumors]. Khirurgiia (Mosk) 2021:25-31. [PMID: 33977695 DOI: 10.17116/hirurgia202105125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To improve postoperative outcomes in patients with mediastinal neurogenic tumors by using of minimally invasive surgical approaches. MATERIAL AND METHODS A retrospective analysis included 108 patients who underwent surgery for mediastinal neurogenic tumors for the period 2001-2019. Short-term outcomes of conventional and minimally invasive (VATS, supraclavicular approach and their combination with laminectomy) surgeries were analyzed. RESULTS Paravertebral tumor in posterior mediastinum was diagnosed in 71 patients, apical neoplasm - 34 patients, anterior mediastinal tumor - in 3 patients. Thirteen patients had dumbbell tumors. VATS was applied in 61 (56.5%) patients, thoracotomy - 22 (20.4%) cases, supraclavicular approach - 4 (3.7%) patients, combination of VATS and supraclavicular approach - 2 (1.9%) patients, cervicosternotomy - 10 (9.3%) cases, combination of VATS and laminectomy - 2 (1.9%) patients, thoracotomy and laminectomy - 3 (2.8%) cases, supraclavicular approach and laminectomy - 1 (0.9%) patient, cervicosternotomy and laminectomy - 3 (2.8%) patients. Regardless location of tumor, minimally invasive surgery reduced blood loss, perioperative morbidity, duration of drainage and hospital-stay. CONCLUSION Most posterior neurogenic tumors can be resected via VATS. Supraclavicular approach is recommended for tumors extending in cervical region. Combination of laminectomy and VATS or supraclavicular approach are appropriate for patients with dumbbell tumors.
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Affiliation(s)
- A V Podobed
- Aleksandrov National Center of Oncology and Medical Radiology, Lesnoy, Belarus
| | - V T Malkevich
- Aleksandrov National Center of Oncology and Medical Radiology, Lesnoy, Belarus
| | - N T Obad
- Aleksandrov National Center of Oncology and Medical Radiology, Lesnoy, Belarus
| | - A V Bambiza
- Aleksandrov National Center of Oncology and Medical Radiology, Lesnoy, Belarus
| | - O G Savchenko
- Aleksandrov National Center of Oncology and Medical Radiology, Lesnoy, Belarus
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Wang R, Chen Y, Liang Z, Yang W, Chen C. Efficacy of One-stage Paravertebral Approach using a Micro-Tubular Technique in Treating Thoracic Dumbbell Tumors. Orthop Surg 2021; 13:1227-1235. [PMID: 33943013 PMCID: PMC8274168 DOI: 10.1111/os.12991] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 01/24/2021] [Accepted: 02/21/2021] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE The aim of the present study was to investigate the feasibility and efficacy of one-stage surgical resection of thoracic dumbbell tumors using a paravertebral approach and a micro-tubular technique. METHODS Clinical data of thoracic dumbbell tumors resected using a paravertebral approach and a micro-tubular technique (14 mm, non-expandable type) in the Department of Neurosurgery at our hospital from July 2014 to July 2019 were retrospectively analyzed. Tumors were found between T1 and T12 vertebrae. Operation time, blood loss, hospitalization, recovery of neurological function, complications, the Japanese Orthopaedic Association (JOA) score, and the visual analogue scale (VAS) score were used to evaluate clinical efficacy. RESULTS In all 31 cases, tumors were completely resected in one operation, with a mean blood loss of 53.23 ± 33.08 mL (20-150 mL) and a mean operation time of 95.16 ± 20.31 min (60-180 min). According to the Eden classification, there were four type II cases, 16 type III cases, and 11 type IV cases. The incidence of tumors in the lower thoracic segment (T8-T12) was 51.6% (16/31 cases), while the incidences in the upper thoracic segment (T1-T4) and middle segment (T5-T8) were 25.8% (8/31 cases) and 22.6% (7/31 cases), respectively. Pathological diagnoses were schwannoma (n = 22), gangliocytoma (n = 4), metastatic tumor (n = 2), neurofibroma (n = 1), granuloma (n = 1), and lipoma (n = 1). After surgery, symptoms were relieved in all patients. VAS and JOA scores significantly improved (P < 0.001). There was no pleural or lung injury, and there were no complications, such as cerebrospinal fluid leakage. The average follow-up duration was 29 months (13-59 months), during which time no tumor recurrence or spinal instability occurred. The group of Eden type II tumors had lower JOA scores at 12 months postoperatively, longer operation times, and more estimated blood loss compared with other groups (P < 0.05). There were no significant influences on VAS scores at 12 months postoperatively and postoperative hospital stay from the different types of tumors. CONCLUSION The paravertebral approach with a micro-tubular technique is a safe and effective minimally invasive surgical approach for thoracic dumbbell tumors that allows one-stage tumor resection using a single incision. Using this approach significantly reduces intraoperative blood loss and postoperative complications, shortens hospital stay, and reduces the rates of postoperative spinal instability.
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Affiliation(s)
- Rui Wang
- Department of Neurosurgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Yan Chen
- Department of Neurosurgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Zeyan Liang
- Department of Neurosurgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Weizhong Yang
- Department of Neurosurgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Chunmei Chen
- Department of Neurosurgery, Fujian Medical University Union Hospital, Fuzhou, China
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11
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Tang J, Zhang D, Xu YY, Xu XK, Wang FH, Zeng JH, Liang JH, Liu W, Li L. Clinical characteristics and therapeutic outcomes of mediastinal neuroblastoma with intraspinal extension: a retrospective study. Transl Pediatr 2021; 10:715-722. [PMID: 34012821 PMCID: PMC8107862 DOI: 10.21037/tp-20-268] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Mediastinal neuroblastoma (NB) can invade the spinal canal and result in spinal cord compression. Some patients go on to develop severe spinal deformities after decompression of the spinal cord. The optimal therapeutic strategy for mediastinal NB with intraspinal extension is still unclear. Our study is to assess the therapeutic strategies for such patients. METHODS A total of 77 patients suffered mediastinal tumors with intraspinal extension between March 2015 and Aug 2019 were enrolled in the study. According to the primary therapy, NB were classified into 4 groups: chemotherapy, video-assisted thoracoscopic surgery (VATS)/thoracotomy, neurosurgical decompression, and a combined thoracic-neurosurgical approach. Clinical features, including patient demographics, neurologic recovery and survival rate, were assessed. RESULTS Among the 77 patients suffered mediastinal tumors with intraspinal extension, neurological symptoms were present in 44 patients. Neurological deficits improved in 76.5% of patients who underwent neurosurgical intervention and 50% of the other patients (P=0.094). Compression manifestations of ≤4 weeks duration showed an improved outcome compared to a longer compression time, with complete recovery of neurological function in 60% of patients versus 28.6% for patients with a longer symptom duration (P=0.04). NB constituted 49.4% of the 77 patients. An overall survival rate of 90.0%±9.5% was achieved for patients in the combined thoracic-neurosurgical group, 59.5%±15.0% in the thoracotomy group, 40.0%±29.7% in laminectomy group, and 37.0%±20.2% in the chemotherapy group. Complete regression of the tumor was demonstrated in 80% of combined group, which was greater than that of patients in the other groups (P=0.001). CONCLUSIONS Neurological recovery was correlated with the type of initial treatment and the duration of neurological symptoms. Mediastinal NB with intraspinal extension can be effectively managed with a combined neurosurgical and thoracic surgical approach.
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Affiliation(s)
- Jue Tang
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Dan Zhang
- Reproductive Medicine Center, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Ying-Yi Xu
- Department of Anesthesia, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Xin-Ke Xu
- Department of Neurosurgery, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Feng-Hua Wang
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Jia-Hang Zeng
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Jiang-Hua Liang
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Wei Liu
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Le Li
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou, China
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12
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An Hourglass-Type Spinal Schwannoma Spreading to the Chest Treated with One-Stage Total Removal through Posterior Paravertebral Approach without Opening the Pleural Cavity (Clinical Observation). ACTA BIOMEDICA SCIENTIFICA 2021. [DOI: 10.29413/abs.2020-5.6.18] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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13
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Hashimoto M, Arizumi F, Yamamoto A, Kusuyama K, Nakamura A, Tachibana T, Hasegawa S. One-Stage Robotic Resection for Thoracic Dumbbell Tumor Without Repositioning. Ann Thorac Surg 2021; 112:e83-e85. [PMID: 33482167 DOI: 10.1016/j.athoracsur.2020.12.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 12/02/2020] [Indexed: 11/30/2022]
Abstract
A 67-year-old woman presented with a thoracic dumbbell-shaped tumor at the left T3-4 level. One-staged surgical resection using the spinal and robotic-assisted thoracic approach without repositioning was planned. The patient was placed in the prone position under general anesthesia. First the tumor was dissected from the dura after T3 left hemilaminectomy and T3/4 left facetectomy. Then posterior spinal fixation was performed. Second 3 ports were placed in her left thoracic cavity without repositioning, and the tumor was resected using a robotic-assisted thoracic approach. The tumor was a schwannoma without malignant potential. Convalescence was uneventful, and she was discharged 14 days postoperatively.
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Affiliation(s)
- Masaki Hashimoto
- Department of Thoracic Surgery, Hyogo College of Medicine, Nishinomiya, Japan.
| | - Fumihiro Arizumi
- Department of Orthopedic Surgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Aya Yamamoto
- Department of Thoracic Surgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Kazuki Kusuyama
- Department of Orthopedic Surgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Akifumi Nakamura
- Department of Thoracic Surgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Toshiya Tachibana
- Department of Orthopedic Surgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Seiki Hasegawa
- Department of Thoracic Surgery, Hyogo College of Medicine, Nishinomiya, Japan
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14
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Ando K, Kobayashi K, Nakashima H, Machino M, Ito S, Kanbara S, Inoue T, Segi N, Koshimizu H, Imagama S. Surgical outcomes and factors related to postoperative motor and sensory deficits in resection for 244 cases of spinal schwannoma. J Clin Neurosci 2020; 81:6-11. [PMID: 33222969 DOI: 10.1016/j.jocn.2020.09.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 09/07/2020] [Indexed: 11/25/2022]
Abstract
In a large cohort the clinical presentation, management and outcomes of spinal schwannoma and factors related to postoperative motor and sensory deficits were invesgtigated. In 244 patients (males: 126, females: 118, average age 51.8 y) at one center, significant factors related to postoperative motor and sensory deficits were identified. Tumors were in the cervical (n = 79, 32.4%), lumbar (n = 66), thoracolumbar (T11-L1) (n = 55), and thoracic (n = 39) regions, and 5 patients had sacrum tumors. The rates of postoperative motor and sensory deterioration were 13.1% and 20.5%, respectively. The risk factors for motor deterioration were preoperative motor weakness, preoperative gait disturbance, dumbbell Eden type II, subtotal resection, and operative time, and those for postoperative sensory deficit were preoperative gait disturbance and subtotal resection. Of 12 patients with significant TcMEP changes, 11 had a new motor deficit after surgery; and of 216 patients with stable TcMEP data, 196 were neurologically intact after surgery (true negative) and 20 (11.0%) had deficits in the immediate postoperative stage (false negative). These deficits resolved during hospitalization for most patients. Of 15 patients with TcMEP deterioration and recovery, 11 (93.3%) had no motor deficits after surgery (p < 0.01).
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Affiliation(s)
- Kei Ando
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa-ku, Nagoya, Aichi 466-8550, Japan
| | - Kazuyoshi Kobayashi
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa-ku, Nagoya, Aichi 466-8550, Japan
| | - Hiroaki Nakashima
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa-ku, Nagoya, Aichi 466-8550, Japan
| | - Masaaki Machino
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa-ku, Nagoya, Aichi 466-8550, Japan
| | - Sadayuki Ito
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa-ku, Nagoya, Aichi 466-8550, Japan
| | - Shunsuke Kanbara
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa-ku, Nagoya, Aichi 466-8550, Japan
| | - Taro Inoue
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa-ku, Nagoya, Aichi 466-8550, Japan
| | - Naoki Segi
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa-ku, Nagoya, Aichi 466-8550, Japan
| | - Hiroyuki Koshimizu
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa-ku, Nagoya, Aichi 466-8550, Japan
| | - Shiro Imagama
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa-ku, Nagoya, Aichi 466-8550, Japan.
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15
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Wewel JT, Kasliwal MK, Chmielewski GW, O'Toole JE. Complete anterior-posterior minimally invasive thoracoscopic robotic-assisted and posterior tubular approach for resection of thoracic dumbbell tumor. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2020; 11:148-151. [PMID: 32905059 PMCID: PMC7462138 DOI: 10.4103/jcvjs.jcvjs_52_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 05/02/2020] [Indexed: 11/29/2022] Open
Abstract
Thoracic dumbbell tumors are relatively uncommon neoplasms that arise from the neurogenic elements. Surgical resection can be challenging as the tumor involves both the spinal canal and thoracic cavity. Historically, thoracotomy and laminectomy were utilized for the resection of these tumors. Although single-stage removal of such tumors has been described recently, there is no prior description of a total minimally invasive single-stage resection of a thoracic dumbbell ganglioneuroma. The current report describes a completely minimally invasive surgical resection for such a tumor performed using the posterior minimally invasive tubular approach to resect the intraspinal component with ligation of the T2 nerve root in conjunction with robotic-assisted thoracoscopic resection of the extraforaminal, intrathoracic component of the tumor. This report illustrates the safety and utility of a completely minimally invasive endoscopic resection of a thoracic dumbbell tumor that can potentially obviate the morbidity associated with open surgical resections for such tumors.
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Affiliation(s)
- Joshua T Wewel
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | - Manish K Kasliwal
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA.,Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Gary W Chmielewski
- Department of Thoracic and Cardiac Surgery, Rush University Medical Center, Chicago, IL, USA
| | - John E O'Toole
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
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16
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Galetta D, Spaggiari L. Primary Intrathoracic Neurogenic Tumors: Clinical, Pathological, and Long-Term Outcomes. Thorac Cardiovasc Surg 2020; 69:749-755. [PMID: 32652524 DOI: 10.1055/s-0040-1712499] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Intrathoracic neurogenic tumors (INTs) are uncommon neoplasms arising from nerve tissues. We report our single-center experience in treating these rare INTs. METHODS Using a prospective institutional database, clinical, surgical, and pathological records of patients receiving resection of INT between May 1998 and June 2018 were analyzed. Survival was calculated by Kaplan-Meier method. RESULTS There were 82 patients (24 females) with an average age of 53 years (29-75 years). Mean diameter was 32 mm (range, 12-68 mm). Histology included 49 schwannomas (11 malignant), 15 neurinomas (2 malignant), 14 neurilemmomas, and 4 paragangliomas. Tumor was located in the posterior mediastinum in 52 patients, in the thoracic inlet in 12, in the anterior mediastinum in 7, in the lung parenchyma in 5, and in the chest wall in 3. In three (3.6%) patients, the tumor showed an intraspinal extension. Symptoms were reported in 51 patients (62.2%) and included cough in 23, dyspnea in 15, neurologic symptoms in 11, and wheezing in 2. Operation was performed by thoracotomy in 42 (51.2%) cases and less invasive technique in 40 (48.8%) cases. Resection was completed in 80 patients (97.6%). Postoperative radiotherapy was administered in two cases. Intraoperative and postoperative mortalities were nil. Morbidity occurred in four patients (4.8%) including two prolonged air leaks, one hemothorax, and one chylothorax. Five-year survival was 97% (mean follow-up, 4.9 years). Malignant tumors had a worse prognosis (p = 0.02). No recurrence occurred during the follow-up neither for malignant nor for benign tumors. CONCLUSION The treatment of choice for INTs is complete resection which will be tailored to tumor size, location, and extension. Long-term prognosis is favorable for benign neurogenic tumors.
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Affiliation(s)
- Domenico Galetta
- Division of Thoracic Surgery, European Institute of Oncology, IRCCS, Milan, Italy
| | - Lorenzo Spaggiari
- Division of Thoracic Surgery, European Institute of Oncology, IRCCS, Milan, Italy.,Department of Oncology and Hematology-Oncology-DIPO, University of Milan, Milan, Italy
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17
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Case report: Mini-invasive surgery assisted by Da Vinci® robot for a recurrent paravertebral schwannoma. Neurochirurgie 2020; 66:179-182. [DOI: 10.1016/j.neuchi.2020.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 01/13/2020] [Accepted: 01/25/2020] [Indexed: 11/20/2022]
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18
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Moses ZB, Barzilai O, O'Toole JE. Benign Intradural and Paraspinal Nerve Sheath Tumors: Advanced Surgical Techniques. Neurosurg Clin N Am 2020; 31:221-229. [PMID: 32147013 DOI: 10.1016/j.nec.2019.11.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Traditional surgical techniques for benign intradural and paraspinal nerve sheath tumors often consisted of open posterior approaches. However, these were limited by the morbidity of open surgery. In addition, iatrogenic instability is often required for total resection of larger or laterally located tumors, thus necessitating the use of additional hardware for spinal fusion. Advances in surgical techniques and technologies have allowed for a plethora of minimally invasive approaches throughout the cervical, thoracic, and lumbar regions. These approaches and their particular applications for the resection of benign peripheral nerve sheath tumors are described, with special attention to modern surgical strategies.
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Affiliation(s)
- Ziev B Moses
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL 60612, USA
| | - Ori Barzilai
- Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - John E O'Toole
- Department of Neurosurgery, Coleman Foundation Comprehensive Spine Tumor Clinic, Rush University Medical Center, 1725 West Harrison Street, Suite 855, Chicago, IL 60612, USA.
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19
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Sweeney J, Zyck S, Crye M, Galgano M. Novel Single-Staged Posterior Retropleural Approach with Thoracoscopic Guidance for Resection of a Thoracic Dumbbell Schwannoma. Cureus 2020; 12:e6548. [PMID: 32042523 PMCID: PMC6996463 DOI: 10.7759/cureus.6548] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Dumbbell spinal cord tumors are infrequent pathologic entities. The optimal approach to safe surgical resection is ill-defined and must often be individualized. This is assisted with multiple tumor classification systems. Here, we describe a novel technique used to safely and successfully resect a large thoracic dumbbell schwannoma originating from the left T3 spinal nerve root with extension into the posterior mediastinum adjacent to the parietal pleura and thoracic aorta. A review of the literature was performed to study described surgical approaches to primary spinal dumbbell tumors. The decision-making process and preoperative imaging for operative planning are included. A detailed description of the procedure follows with intraoperative images. Gross total resection with no neurologic sequelae was achieved. Previously described operative techniques for resection of primary spinal dumbbell tumors with advantages and limitations of each are then reviewed. Gross total resection was safely achieved utilizing a single-staged posterior retropleural approach with anterior thoracoscopic guidance. The tumor was removed en bloc through a large posterior window. The prone position was utilized for the entire case with no intraoperative repositioning required. No intraoperative or immediate postoperative complications occurred. We report a novel approach to resecting a large primary spinal dumbbell tumor. A single-stage retropleural approach with anterior thoracoscopic guidance facilitated safe and successful gross total resection. Maintenance of the prone position throughout surgery allowed for reduced operative time, excellent anterior, and posterior visualization and no added patient morbidity. Repositioning to the lateral decubitus position may not be required in select cases.
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Affiliation(s)
- Jared Sweeney
- Neurosurgery, State University of New York Upstate Medical University, Syracuse, USA
| | - Stephanie Zyck
- Neurosurgery, State University of New York Upstate Medical University, Syracuse, USA
| | - Mark Crye
- Thoracic Surgery, State University of New York Upstate Medical University, Syracuse, USA
| | - Michael Galgano
- Neurosurgery, State University of New York Upstate Medical University, Syracuse, USA
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20
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Cabrera JP, Torche E, Luna F, Alarcón E, Spencer ML, López E, Valdés G, Arévalo A. Upper thoracic dumbbell-shaped tumor resected in one stage posterior approach: case report. AME Case Rep 2019; 3:25. [PMID: 31463430 DOI: 10.21037/acr.2019.07.01] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 06/26/2019] [Indexed: 11/06/2022]
Abstract
Upper thoracic tumors may develop spinal cord compression. By surgery at the time of diagnosis, a neurological deficit can be avoided. However, this particular localization requires a double approach to decompress the spinal cord and thoracic structures. The posterior extracavitary approach results in resection of the spinal canal, the foraminal component, and the extraspinal fragment, but is not routinely used by most neurosurgeons. A 56-year-old woman with a two-month history of axial thoracic pain and cough. The patient has a normal neurological examination. Thoracic computed tomography (CT) scan with contrast agent was performed, evincing a dumbbell-shaped tumor on the left T3-T4. Magnetic resonance imaging (MRI) confirms the diagnosis, showing a 4 cm diameter tumor that compresses the spinal cord without myelopathy. The surgery was performed posteriorly, with costotransversectomy, allowing complete resection under intraoperative neurophysiological monitoring. The patient developed no thoracic or neurological complications. One-stage posterior approach is possible and effective during the treatment of the upper thoracic dumbbell-shaped tumors, avoiding a change in surgical position, thoracic morbidity, and dependence on assisting surgeons.
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Affiliation(s)
- Juan P Cabrera
- Department of Neurosurgery, Regional Clinical Hospital of Concepción, Concepción, Chile.,Department of Surgery, University of Concepción, Concepción, Chile
| | - Esteban Torche
- Department of Neurosurgery, Regional Clinical Hospital of Concepción, Concepción, Chile.,Department of Surgery, University of Concepción, Concepción, Chile
| | - Francisco Luna
- Department of Neurosurgery, Regional Clinical Hospital of Concepción, Concepción, Chile.,Department of Surgery, University of Concepción, Concepción, Chile
| | - Emilio Alarcón
- Department of Surgery, University of Concepción, Concepción, Chile.,Department of Thoracic Surgery, Regional Clinical Hospital of Concepción, Concepción, Chile
| | - M Loreto Spencer
- Department of Pathology, Regional Clinical Hospital of Concepción, Concepción, Chile
| | - Eduardo López
- Department of Surgery, University of Concepción, Concepción, Chile
| | - Guillermo Valdés
- Department of Neurosurgery, Regional Clinical Hospital of Concepción, Concepción, Chile
| | - Antonela Arévalo
- Department of Surgery, University of Concepción, Concepción, Chile
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21
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Tessitore E, Schonauer C. Commentary: Minimally Invasive Single-Stage Removal of a Thoracic Dumbbell Tumor From a Posterior Approach. Oper Neurosurg (Hagerstown) 2019; 16:E142-E143. [DOI: 10.1093/ons/opy285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 12/13/2018] [Indexed: 11/13/2022] Open
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22
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Surgical treatment of thoracic dumbbell tumors. Eur J Surg Oncol 2019; 45:851-856. [DOI: 10.1016/j.ejso.2018.10.536] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 10/24/2018] [Accepted: 10/25/2018] [Indexed: 11/19/2022] Open
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23
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Lee MT, Panbehchi S, Sinha P, Rao J, Chiverton N, Ivanov M. Giant spinal nerve sheath tumours - Surgical challenges: case series and literature review. Br J Neurosurg 2019; 33:541-549. [PMID: 30836023 DOI: 10.1080/02688697.2019.1567678] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: Giant nerve sheath tumours (GNST) are rare and literature on their management is scant. Spinal GNST present as a surgical challenge due to the involvement of anatomical regions often outside the "comfort zone" of a spinal surgeon. This case series aims to identify challenges in the surgical management of GNSTs. Methods: Retrospective case note review of all spinal GNST cases from 2010 to 2016 managed in Sheffield Teaching Hospitals identified 8 patients, 3 of whom were incidental findings (kept under surveillance) and were excluded. 5 cases were treated surgically. Data collected included patient demographic, presenting symptom(s), radiological data, surgical approach to the tumour and challenges encountered, histopathology report and follow up. Results: Our cohort consisted entirely of females (N = 5) with a mean age of 56.4 years (range 45-70). Imaging studies and histopathological diagnoses confirmed 5 GNSTs (four benign schwannomas and one ganglioneuroma). A Single-stage anterior approach was adopted for three patients while a combined anterior-posterior approach was adopted for the remaining two. In one patient, a posterior approach was initially planned, but this was abandoned and converted to an anterior approach following onset of acute superior vena cava (SVC) syndrome secondary to SVC compression by the giant tumour on prone positioning of the patient. PET imaging of case 3 showed intense tracer uptake consistent with malignancy, however histology confirmed WHO grade 1 Schwannoma. The other three non-operated GNSTs are kept under yearly radiological and clinical surveillance. Conclusions: GNSTs are surgically challenging as they often invade territories that are beyond the comfort zone of one single specialty. A multidisciplinary approach with careful pre-operative surgical planning is recommended. Patients in whom a posterior approach is planned should have a trial of prone positioning pre-operatively. Careful interpretation of FDG-PET imaging is recommended due to the possibility of false positive result.
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Affiliation(s)
- Ming-Te Lee
- Foundation House Officer, Leeds General Infirmary , Leeds , UK
| | - Sasan Panbehchi
- Foundation House Officer, Southend University Hospital , Southend-on-Sea , UK
| | - Priyank Sinha
- Department of Spinal Surgery, Royal Victoria Hospital , Newcastle , UK
| | - Jagan Rao
- Consultant Cardiothoracic Surgeon, Northern General Hospital , Sheffield , UK
| | - Neil Chiverton
- Consultant Orthopedic Spinal Surgeon, Northern General Hospital , Sheffield , UK
| | - Marcel Ivanov
- Consultant Neurosurgeon and Spinal Surgeon, Royal Hallamshire Hospital , Sheffield , UK
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24
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Chen X, Ma Q, Wang S, Zhang H, Huang D. Surgical treatment of posterior mediastinal neurogenic tumors. J Surg Oncol 2019; 119:807-813. [PMID: 30653663 DOI: 10.1002/jso.25381] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 01/03/2019] [Indexed: 12/18/2022]
Affiliation(s)
- Xiaofeng Chen
- Department of Cardiothoracic SurgeryHuashan Hospital, Fudan UniversityShanghai China
| | - Qinyun Ma
- Department of Cardiothoracic SurgeryHuashan Hospital, Fudan UniversityShanghai China
| | - Shaohua Wang
- Department of Cardiothoracic SurgeryHuashan Hospital, Fudan UniversityShanghai China
| | - Huijun Zhang
- Department of Cardiothoracic SurgeryHuashan Hospital, Fudan UniversityShanghai China
| | - Dayu Huang
- Department of Cardiothoracic SurgeryHuashan Hospital, Fudan UniversityShanghai China
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25
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Pojskić M, Zbytek B, Mutrie CJ, Arnautović KI. SPINAL DUMBBELL EPIDURAL HEMANGIOMA: TWO STAGE/SAME SITTING/SAME POSITION POSTERIOR MICROSURGICAL AND TRANSTHORACIC ENDOSCOPIC RESECTION - CASE REPORT AND REVIEW OF THE LITERATURE. Acta Clin Croat 2018; 57:797-808. [PMID: 31168222 PMCID: PMC6544093 DOI: 10.20471/acc.2018.57.04.27] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 11/20/2018] [Indexed: 12/16/2022] Open
Abstract
- Spinal dumbbell tumors are defined by a narrowing at the point where they penetrate the intervertebral foramina or dura mater, assuming an hourglass or dumbbell shape. Dumbbell-shaped spinal hemangiomas are extremely rare. We describe a dumbbell spinal tumor (epidural cavernous hemangioma) resected by a 2-stage single-sitting combined approach. We also conduct a substantial literature review of the subject. We present a case of a 78-year-old male who was found to have a homogeneously enhancing, dumbbell-shaped, intraspinal, extradural tumor mass extending into the left chest cavity. The tumor was resected with a single-sitting 2-stage posterior technique: a microsurgical approach, followed by endoscopic resection via a thoracoscopic approach. There are several reports in the literature on the combined approach for dumbbell tumors of the spinal cord. Our case is the first to describe 2-stage combined surgery in 1 sitting for dumbbell hemangioma with the patient in the lateral decubitus position for the thoracoscopic part of the surgery; and the use of a fat pad, which was applied in the neuroforamen via the posterior route, as a marker for resection during the transthoracic procedure.
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Affiliation(s)
- Mirza Pojskić
- 1Department of Neurosurgery, University of Marburg, Marburg, Germany; 2Pathology Group of Midsouth, Memphis, TN, USA; 3Baptist Memorial Group Thoracic Surgery, Memphis, TN, USA; 4Semmes Murphey Neurologic & Spine Institute and Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Blazej Zbytek
- 1Department of Neurosurgery, University of Marburg, Marburg, Germany; 2Pathology Group of Midsouth, Memphis, TN, USA; 3Baptist Memorial Group Thoracic Surgery, Memphis, TN, USA; 4Semmes Murphey Neurologic & Spine Institute and Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Christopher J Mutrie
- 1Department of Neurosurgery, University of Marburg, Marburg, Germany; 2Pathology Group of Midsouth, Memphis, TN, USA; 3Baptist Memorial Group Thoracic Surgery, Memphis, TN, USA; 4Semmes Murphey Neurologic & Spine Institute and Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Kenan I Arnautović
- 1Department of Neurosurgery, University of Marburg, Marburg, Germany; 2Pathology Group of Midsouth, Memphis, TN, USA; 3Baptist Memorial Group Thoracic Surgery, Memphis, TN, USA; 4Semmes Murphey Neurologic & Spine Institute and Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, TN, USA
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Rong HT, Fan YS, Li SP, Zhang ZS, Liu H, Liu T, Zhu T, Zhang JN. Management of Dumbbell and Paraspinal Tumors of the Thoracic Spine Using a Single-stage Posterolateral Approach: Case Series. Orthop Surg 2018; 10:343-349. [PMID: 30406971 DOI: 10.1111/os.12405] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 06/10/2018] [Indexed: 12/19/2022] Open
Abstract
This study investigated the surgical results of a single-stage posterolateral approach with arc incision, unilateral laminectomy, and costotransversectomy for the management of dumbbell tumors and paraspinal tumors of the thoracic spine. From January 2010 to March 2017, 14 patients with dumbbell tumors or paraspinal tumors of the thoracic spine who underwent resection with single-stage posterolateral approach were followed up and analyzed retrospectively. The operations were performed using a single-stage posterolateral approach with arc incision, unilateral laminectomy, and costotransversectomy without any instrumentation. We reviewed the scores of clinical symptoms and imaging results, including postoperative MRI and reconstructed 3D-CT images. Gross total removal was achieved in 13 patients, and subtotal removal was achieved in 1 case. Histopathology revealed schwannoma in 9 patients, angiolipoma in 1 patient, and paraganglioma and mixed hemangioma in 2 patients each. No significant operative or postoperative complications occurred in any patient. The 14 patients were followed up for 14-68 months (mean 39.4 months). At the final follow-up, no obvious spinal deformity or tumor recurrence was found in any patient except one with paraganglioma. Single-stage posterolateral approach is a good alternative surgical method for removing dumbbell tumors and paraspinal tumors of the thoracic spine without necessitating a subsequent anterior operation.
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Affiliation(s)
- Hong-Tao Rong
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Yue-Shan Fan
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Si-Peng Li
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Zheng-Shan Zhang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Hui Liu
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Tong Liu
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Tao Zhu
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Jian-Ning Zhang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
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Li Y, Wang B, Li L, Lü G. Posterior surgery versus combined laminectomy and thoracoscopic surgery for treatment of dumbbell-type thoracic cord tumor: A long-term follow-up. Clin Neurol Neurosurg 2018; 166:31-35. [DOI: 10.1016/j.clineuro.2018.01.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 01/06/2018] [Accepted: 01/15/2018] [Indexed: 12/28/2022]
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Zabalo G, de Frutos D, García JC, Ortega R, Guelbenzu JJ, Zazpe I. Dumbbell malignant dorsal schwannoma embolized and operated by single posterior approach. Neurocirugia (Astur) 2018; 30:28-32. [PMID: 29472158 DOI: 10.1016/j.neucir.2018.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 12/03/2017] [Accepted: 01/23/2018] [Indexed: 11/30/2022]
Abstract
We report a case of a 41 years old patient complaining of chronic dorsalgia. MRI showed a well defined intradural extramedular dumbbell-shaped lesion, associated to a left paravertebral tumor at D5-D6 level. The tumor was embolizated prior to surgery. Following she underwent a D4-D6 laminotomy, left D5-D6 costotransversectomy and resection of the intracanal extradural part of the lesion with section of the left D5 nerve. Posteriorly, complete resection of the extracanal portion of the tumor was performed by a postero-lateral approach. The anatomopathologic diagnosis was a malignant schwannoma. After the surgery, the patient required adyuvant radiotherapic treatment. Malignant schwannoma is a very uncommon tumor which belongs to the malignant peripheral nerve sheath tumors (MPNST). It develops from Schwann cells. It is frequently associated with type 1 neurofibromatosis. MPNST usually present local recurrence and can metastatize.
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Affiliation(s)
- Gorka Zabalo
- Servicio de Neurocirugía, Complejo Hospitalario de Navarra, Pamplona, España; Servicio de Cirugía Torácica, Complejo Hospitalario de Navarra, Pamplona, España.
| | - Daniel de Frutos
- Servicio de Neurocirugía, Complejo Hospitalario de Navarra, Pamplona, España; Servicio de Cirugía Torácica, Complejo Hospitalario de Navarra, Pamplona, España
| | - Juan Carlos García
- Servicio de Neurocirugía, Complejo Hospitalario de Navarra, Pamplona, España; Servicio de Cirugía Torácica, Complejo Hospitalario de Navarra, Pamplona, España
| | - Rodrigo Ortega
- Servicio de Neurocirugía, Complejo Hospitalario de Navarra, Pamplona, España; Servicio de Cirugía Torácica, Complejo Hospitalario de Navarra, Pamplona, España
| | - Juan José Guelbenzu
- Servicio de Neurocirugía, Complejo Hospitalario de Navarra, Pamplona, España; Servicio de Cirugía Torácica, Complejo Hospitalario de Navarra, Pamplona, España
| | - Idoya Zazpe
- Servicio de Neurocirugía, Complejo Hospitalario de Navarra, Pamplona, España; Servicio de Cirugía Torácica, Complejo Hospitalario de Navarra, Pamplona, España
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Proposal of a new radiological classification system for spinal meningiomas as a descriptive tool and surgical guide. Clin Neurol Neurosurg 2017; 162:118-126. [DOI: 10.1016/j.clineuro.2017.10.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 09/18/2017] [Accepted: 10/01/2017] [Indexed: 12/25/2022]
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Abstract
STUDY DESIGN One hundred twenty-four patients with spinal dumbbell tumors were analyzed retrospectively using a new classification. OBJECTIVE To recommend a novel classification of spinal dumbbell tumors based on the characteristics of surgical approach. SUMMARY OF BACKGROUND DATA Current classifications of cervical dumbbell tumor are excessively convoluted with an impractical number of variables or lack of quantitative indicators for the choice of surgical approach, and there are few classifications described in the literature which related to thoracic or lumbar dumbbell tumors. An ideal classification must be simple and reproducible based on commonly identified clinical and radiographic parameters. METHODS The clinical records of a series of 124 patients with spinal dumbbell tumors were analyzed retrospectively using a new classification. We divided the largest transverse section of the tumor into four areas, and different areas need different surgical procedures. RESULT Ninety-two patients were treated using the posterior approach alone, 13 patients underwent surgery by lateral cervical approach, and 19 cases were excised using combined anterior and posterior approach. Tumors total removal was 123 cases, with partial resection in one patient. Concomitant spinal fixation and fusion was performed in 18 patients. A total of 97 cases had follow-up with clinical and radiographic outcome variables ranged from 12 to 52 months (mean, 46.3 months). Eighty-eight patients (90.7%) had clinical improvement, whereas clinical status was the same in seven (7.2%), two patients (2.1%) demonstrated neurologic deterioration, and magnetic resonance imaging at last follow-up revealed no recurrence in any patient. CONCLUSION The new classification of spinal dumbbell tumors is a simple way of identifying patients who require a different surgical approach. LEVEL OF EVIDENCE 4.
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Nam KH, Ahn HY, Cho JS, Kim YD, Choi BK, Han IH. One Stage Posterior Minimal Laminectomy and Video-Assisted Thoracoscopic Surgery (VATS) for Removal of Thoracic Dumbbell Tumor. J Korean Neurosurg Soc 2017; 60:257-261. [PMID: 28264248 PMCID: PMC5365298 DOI: 10.3340/jkns.2016.0909.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 12/09/2016] [Accepted: 12/23/2016] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE This study was conducted to assess the surgical results of one-stage posterior minimal laminectomy and video-assisted thoracoscopic surgery (VATS) for the treatment of thoracic dumbbell tumor and to describe its precise technique. In addition, we investigated the technique's usefulness and limitations. METHODS Seven cases of thoracic dumbbell tumor (two men and five women, mean age, 43 years) were analyzed retrospectively. Pathological findings included schwannoma in four patients, neurofibroma in two patients, and hemangioma in one patient. The location of tumors varied from T2/3 to T12/L1. Dumbbell tumors were resected by one-stage operation using posterior laminectomy followed by VATS without instrumentation. Clinical data were reviewed. RESULTS The mean follow-up period was 25 months (range, 3-58 months), and the operative time ranged from 255 to 385 min (mean, 331 min), with estimated blood loss ranging from 110 to 930 mL (mean, 348 mL). The tumor was completely resected without instrumentation and postoperative instability in all cases. Postoperative complications included atelectasis and facial anhydrosis in one case each. CONCLUSION One-stage posterior minimal laminectomy and VATS may be a safe and less invasive technique for removal of thoracic dumbbell tumor without instability. This method has the advantage of early ambulation and rapid recovery because it reduces blood loss and postoperative pain.
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Affiliation(s)
- Kyoung Hyup Nam
- Department of Neurosurgery, Medical Research Institute, Pusan National University Hosptial, Busan, Korea
| | - Hyo Yeoung Ahn
- Department of Thoracic and Cardiovascular surgery, Medical Research Institute, Pusan National University Hosptial, Busan, Korea
| | - Jeong Su Cho
- Department of Thoracic and Cardiovascular surgery, Medical Research Institute, Pusan National University Hosptial, Busan, Korea
| | - Yeoung Dae Kim
- Department of Thoracic and Cardiovascular surgery, Medical Research Institute, Pusan National University Hosptial, Busan, Korea
| | - Byung Kwan Choi
- Department of Neurosurgery, Medical Research Institute, Pusan National University Hosptial, Busan, Korea
| | - In Ho Han
- Department of Neurosurgery, Medical Research Institute, Pusan National University Hosptial, Busan, Korea
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Peter S, Matevž S, Borut P. Spinal dumbbell lipoblastoma: a case-based update. Childs Nerv Syst 2016; 32:2069-2073. [PMID: 27444294 DOI: 10.1007/s00381-016-3184-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 07/07/2016] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Lipoblastomas are benign tumors that arise from the proliferation of fetal adipose tissue. They are frequently found in the extremities, in the head, and in the neck. Dumbbell conformation (which refers to epidural tumors with extraspinal extension) has been described in only seven lipoblastoma cases so far. CASE REPORT We describe an 11-month-old patient with a large mediastinal dumbbell lipoblastoma. The mass was excised, but it recurred 1 year later when the MRI showed also multiple pleural lipoblastomatous lesions, thus establishing the diagnosis of lipoblastomatosis. The tumor has been removed with a second surgical procedure. CONCLUSION Radical excision of lipoblastomas is the gold standard but is not always possible to achieve. Residual lesions can be managed conservatively, on the basis of the benign nature of the tumor and of its potential maturation to normal fat. Recurrence of lipoblastoma appears in 15 % of non-radical excisions but has not yet been described in the form of lipoblastomatosis. A second surgery is indicated if the tumor mass reaches large dimensions, if it increases in size, and if it threatens the functionality of vital organs such as the spinal cord.
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Affiliation(s)
- Spazzapan Peter
- Department of Neurosurgery, University Medical Centre Ljubljana, Zaloška 7, 1000, Ljubljana, Slovenia.
| | - Srpčič Matevž
- Department of Thoracic Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Prestor Borut
- Department of Neurosurgery, University Medical Centre Ljubljana, Zaloška 7, 1000, Ljubljana, Slovenia
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Zairi F, Nzokou A, Sunna T, Obaid S, Weil AG, Bojanowski M, Shedid D. Minimally invasive costotransversectomy for the resection of large thoracic dumbbell tumors. Br J Neurosurg 2016; 31:179-183. [DOI: 10.1080/02688697.2016.1233317] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Fahed Zairi
- Department of neurosurgery, Lille University Hospital, Lille, France
- Division of neurosurgery, Hôpital Notre-Dame, University of Montreal, Montreal, QC, Canada
| | - Andre Nzokou
- Division of neurosurgery, Hôpital Notre-Dame, University of Montreal, Montreal, QC, Canada
| | - Tarek Sunna
- Division of neurosurgery, Hôpital Notre-Dame, University of Montreal, Montreal, QC, Canada
| | - Sami Obaid
- Division of neurosurgery, Hôpital Notre-Dame, University of Montreal, Montreal, QC, Canada
| | - Alexander G. Weil
- Division of neurosurgery, Hôpital Notre-Dame, University of Montreal, Montreal, QC, Canada
| | - Michel Bojanowski
- Division of neurosurgery, Hôpital Notre-Dame, University of Montreal, Montreal, QC, Canada
| | - Daniel Shedid
- Division of neurosurgery, Hôpital Notre-Dame, University of Montreal, Montreal, QC, Canada
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Wang Z, Wang X, Jian F, Chen L. Single stage complete resection of giant dumbbell lumbar ganglioneuroma: a case report and review of the literature. Chin Neurosurg J 2016. [DOI: 10.1186/s41016-016-0051-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Combined Video-Assisted Thoracic Surgery and Posterior Spinal Surgery for the Treatment of Dumbbell Tumor of the First Thoracic Nerve Root. Asian Spine J 2015; 9:595-9. [PMID: 26240720 PMCID: PMC4522451 DOI: 10.4184/asj.2015.9.4.595] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Revised: 11/13/2014] [Accepted: 12/01/2014] [Indexed: 02/07/2023] Open
Abstract
Although several cases of a dumbbell tumor of thoracic nerve roots have been reported, reports on the surgical procedures for a dumbbell tumor of the first thoracic (T1) nerve root are rare. Surgeons should be cautious, especially when performing a surgical procedure for a dumbbell tumor of the T1 nerve root because the tumor is anatomically located adjacent to important organs and because the T1 nerve root composes the lower trunk of the brachial plexus with the eighth cervical nerve root. We present cases with dumbbell tumors of the T1 nerve root that were treated with combined surgical treatment to remove the tumor. We first performed video-assisted thoracic surgery (VATS) to release the organs anteriorly and then performed posterior spinal surgery in the prone position. The combined VATS and posterior spinal surgery may become a standard surgical procedure for the treatment of dumbbell tumors of the T1 nerve root.
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Krätzig T, Dreimann M, Klingenhöfer M, Floeth FW, Krajewski K, Eicker SO. Treatment of large thoracic and lumbar paraspinal schwannoma. Acta Neurochir (Wien) 2015; 157:531-8. [PMID: 25577451 DOI: 10.1007/s00701-014-2320-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 12/17/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Paraspinal neurogenic tumors usually expand into the mediastinum and retroperitoneum and can reach a considerable size before they become symptomatic. Such large tumors are rare. We describe 14 cases of large schwannomas (>2.5 cm ø) with mild and late onset of symptoms, which were treated with total surgical resection through a single-approach surgery. METHODS In 2013 14 patients with paraspinal large schwannomas were treated in our institutions. Data were analyzed retrospectively. Magnetic resonance imaging (MRI) showed lesions suspicious for a paraspinal schwannoma with partial intraforaminal growth. In case of ambiguity regarding tumor dignity, a needle biopsy was performed before final treatment. Three different approaches and their indications were discussed. RESULTS Fourteen patients (7 female and 7 male, ages 18-58 years, mean: 39.8 years) requiring surgical exploration because of a thoracic (6) or lumbar/lumbosacral (8) lesion were treated in our institutions. Two patients received CT-guided needle biopsy preoperatively. Complete resection of the schwannoma was possible through a mini-thoracotomy in 1 case (7 %), a retroperitoneal approach in 2 cases (14 %), and dorsal interlaminar and intercostal fenestration in 11 cases (79 %). Histological examination revealed the diagnosis of schwannoma (WHO grade I) in all cases except one with neurofibroma (WHO grade I). There were no major complications in any case. CONCLUSION Large benign schwannomas are rare. They need a tailored treatment, which in most cases works through one surgical approach. Usually it is possible to perform a complete resection with a good postoperative prognosis.
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Affiliation(s)
- Theresa Krätzig
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
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