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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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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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Jiang YW, Xu XJ, Wang R, Chen CM. Tubular minimally invasive resection of McCormick type II paraspinal schwannoma: preliminary experience. Br J Neurosurg 2023; 37:193-198. [PMID: 35379043 DOI: 10.1080/02688697.2022.2057433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
PURPOSE Complete removal of paraspinal schwannomas is generally required for full patient recovery. However, traditional open approaches to surgery are often extensive and may lead to more postoperative complications. Herein, we present our preliminary experience with tubular minimally invasive resection of McCormick type II paraspinal schwannomas and describe the technique by specifically reviewing two patient cases. MATERIALS AND METHODS Type of study: Retrospective: Level of evidence: Level III: A total of 15 patients (six men; nine women; median age, 45 years) who underwent minimally invasive resection of McCormick type II paraspinal schwannomas were retrospectively analysed. Preoperative characteristics, including age, location of tumour, Visual Analog Scale score, Modified McCormick Scale score, and intraoperative findings and complications were analysed. Furthermore, postoperative outcomes using imaging, such as magnetic resonance imaging (MRI) and thin-slice computed tomography, and postoperative neural status using the Modified McCormick and Visual Analog Scales were also assessed. RESULTS The mean operation time was 134.72 ± 34.21 min. The estimated mean blood loss and mean hospital stay were 25.33 ± 17.27 ml and 7.67 ± 1.88 days, respectively. Regarding complications, one of the patients had a local wound infection, which improved after antibiotic treatment. The total resection in all cases was verified using postoperative MRI. CONCLUSION The tubular minimally invasive approach is a feasible technique for the total resection of McCormick type II paraspinal schwannomas. Using this technique, surgeons can resect paraspinal schwannomas while maintaining spinal stability.
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Affiliation(s)
- Yan-Wei Jiang
- Department of Neurosurgery, Fujian Medical University Union Hospital, Fuzhou City, China
| | - Xiong-Jie Xu
- Department of Neurosurgery, Fujian Medical University Union Hospital, Fuzhou City, China
| | - Rui Wang
- Department of Neurosurgery, Fujian Medical University Union Hospital, Fuzhou City, China
| | - Chun-Mei Chen
- Department of Neurosurgery, Fujian Medical University Union Hospital, Fuzhou City, China
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Kurland DB, Lau D, Dalle Ore CL, Haddad A, Deviren V, Ames CP. Combined retropleural thoracotomy and posterior spinal approach for thoracic dumbbell Schwannoma: Case series and review of the literature. J Clin Neurosci 2022; 106:173-179. [DOI: 10.1016/j.jocn.2022.10.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 10/18/2022] [Accepted: 10/28/2022] [Indexed: 11/07/2022]
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Gagliardi F, Snider S, Roncelli F, Piloni M, Pompeo E, Caputy AJ, Mortini P. Combined, Rib-Sparing, Bilateral Approach to the Ventral Mid and Low Thoracic Spine: Study on Comparative Anatomy and Surgical Feasibility. World Neurosurg 2021; 150:e117-e126. [PMID: 33677087 DOI: 10.1016/j.wneu.2021.02.105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 02/20/2021] [Accepted: 02/21/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Pathologies of the ventral thoracic spine represent a challenge, igniting arguments about which should be the ideal surgical approach to access this area. Anterior transthoracic thoracotomy and a number of posterolateral routes have been developed. Among the latter, costotransversectomy has demonstrated to provide good ventral exposure with a lower, but not negligible, morbidity. The optimal approach should be the one minimizing surgical morbidity on both neural and extraneural structures while optimizing exposure. METHODS The authors described the combined, rib-sparing, bilateral approach (CRBA) to the ventral mid/low-thoracic spine. The technique combines a transfacet pedicle partially sparing approach on one side and a transpedicular with transverse process resection on the contralateral one. A laboratory investigation was conducted. The technique was applied in a surgical setting, and a case was reported. RESULTS CRBA is rib-sparing, completely extracavitary, and does not require pleural exposure and paraspinal muscle splitting, thus minimizing potential morbidity. The combination of 2 corridors ensures the greatest exposure compared with standard posterolateral approaches. The only blind corner is limited to a small area just in front of the dural sac. A bimanual approach optimizes control during surgical manipulation, even if the area of maneuverability and cross-section areas of surgical corridors are slightly limited compared to traditional costotransversectomy due to the minimally invasive nature of the procedure. CONCLUSIONS CRBA represents a safe and effective option to access the ventral mid/low thoracic spine. It provides great exposure and bimanual manipulation of the surgical target, minimizes potential morbidity, and avoids entrance into the thoracic cavity and paraspinal muscle splitting.
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Affiliation(s)
- Filippo Gagliardi
- Department of Neurosurgery and Gamma Knife Radiosurgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy.
| | - Silvia Snider
- Department of Neurosurgery and Gamma Knife Radiosurgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Francesca Roncelli
- Department of Neurosurgery and Gamma Knife Radiosurgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Martina Piloni
- Department of Neurosurgery and Gamma Knife Radiosurgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Edoardo Pompeo
- Department of Neurosurgery and Gamma Knife Radiosurgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Anthony J Caputy
- Department of Neurological Surgery, The George Washington University, Washington, District of Columbia, USA
| | - Pietro Mortini
- Department of Neurosurgery and Gamma Knife Radiosurgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
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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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Smith JL, Christopher AN, Evans NR. Novel Two-Stage Open Spine and Robotic Thoracic Approach to Resection of a Mediastinal Tumor. Ann Thorac Surg 2021; 111:e27-e29. [DOI: 10.1016/j.athoracsur.2020.05.043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 05/01/2020] [Indexed: 12/12/2022]
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8
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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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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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Marhx Bracho A, Muñoz Montoya JE, Peña Rosas NP, Carrillo Marhx G, Ramírez Ferrer E. Costotransversectomy plus hemilaminectomy as alternative surgical approach for extramedullary intradural thoracic schwannoma resection with and without extradural extension in pediatric population three cases and literature review. JOURNAL OF SPINE SURGERY 2019; 5:285-290. [PMID: 31380483 DOI: 10.21037/jss.2019.05.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Extramedullary intradural tumors constitute up to 25% of the spinal tumors. Commonly, schwannomas that presents with extradural and intradural compromise are called dumbbell-shaped tumor. The thoracic spine is a common localization for these tumors, especially in pediatric population. Given this surgically difficult localization, some classic approaches for spine tumors can be mixed with modified approaches like the costotransversectomy. The main objective of this report is expose three different pediatric cases in which mixed approach (costotransversectomy plus hemilaminectomy) was implemented for thoracic spine dumbbell-shaped schwannoma resection. It was achieved complete surgical resection without major perioperative complications in the three cases.
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Affiliation(s)
- Alfonso Marhx Bracho
- Pediatric Neurosurgery Department, Instituto Nacional de Pediatría, Mexico City, Mexico
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Sebai MA, Kerezoudis P, Alvi MA, Yoon JW, Spinner RJ, Bydon M. Need for arthrodesis following facetectomy for spinal peripheral nerve sheath tumors: an institutional experience and review of the current literature. J Neurosurg Spine 2019; 31:112-122. [PMID: 30952137 DOI: 10.3171/2019.1.spine181057] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 01/08/2019] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Spinal peripheral nerve sheath tumors (PNSTs) are a group of rare tumors originating from the nerve and its supporting structures. Standard surgical management typically entails laminectomy with or without facetectomy to gain adequate tumor exposure. Arthrodesis is occasionally performed to maintain spinal stability and mitigate the risk of postoperative deformity, pain, or neurological deficit. However, the factors associated with the need for instrumentation in addition to PNST resection in the same setting remain unclear. METHODS An institutional tumor registry at a tertiary care center was queried for patients treated surgically for a primary diagnosis of spinal PNST between 2002 and 2016. An analysis focused on patients in whom a facetectomy was performed during the resection. The addition of arthrodesis at the index procedure comprised the primary outcome. The authors also recorded baseline demographics, tumor characteristics, and surgery-related variables. Logistic regression was used to identify factors associated with increased risk of fusion surgery. RESULTS A total of 163 patients were identified, of which 56 (32 had facetectomy with fusion, 24 had facetectomy alone) were analyzed. The median age was 48 years, and 50% of the cohort was female. Age, sex, and race, as well as tumor histology and size, were evenly distributed between patients who received facetectomy alone and those who had facetectomy and fusion. On univariate analysis, total versus subtotal facetectomy (OR 9.0, 95% CI 2.01-64.2; p = 0.009) and cervicothoracic versus other spinal region (OR 9.0, 95% CI 1.51-172.9; p = 0.048) were significantly associated with increased odds of performing immediate fusion. On multivariable analysis, only the effect of total facetectomy remained statistically significant (OR 6.75, 95% CI 1.47-48.8; p = 0.025). CONCLUSIONS The authors found that total facetectomy and cervicothoracic involvement may be highly associated with the need for concomitant arthrodesis at the time of index surgery. These findings may help surgeons to determine the best surgical planning for patients with PNST.
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Affiliation(s)
- Mohammed Adeeb Sebai
- 1Mayo Clinic Neuro-Informatics Laboratory, and
- 2Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota; and
| | - Panagiotis Kerezoudis
- 1Mayo Clinic Neuro-Informatics Laboratory, and
- 2Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota; and
| | - Mohammed Ali Alvi
- 1Mayo Clinic Neuro-Informatics Laboratory, and
- 2Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota; and
| | - Jang Won Yoon
- 1Mayo Clinic Neuro-Informatics Laboratory, and
- 3Department of Neurologic Surgery, Mayo Clinic, Jacksonville, Florida
| | - Robert J Spinner
- 1Mayo Clinic Neuro-Informatics Laboratory, and
- 2Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota; and
| | - Mohamad Bydon
- 1Mayo Clinic Neuro-Informatics Laboratory, and
- 2Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota; and
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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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13
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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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Fernandes RL, Lynch JC, Welling L, Gonçalves M, Tragante R, Temponi V, Pereira C. Complete removal of the spinal nerve sheath tumors. Surgical technics and results from a series of 30 patients. ARQUIVOS DE NEURO-PSIQUIATRIA 2014; 72:312-7. [PMID: 24760097 DOI: 10.1590/0004-282x20140008] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Accepted: 01/06/2014] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Observe whether a microsurgical gross total removal (GTR) of a spinal nerve sheath tumors (SNSTs) is safe and decreases the tumor recurrence. METHOD We identify 30 patients with 44 SNSTs. RESULTS We operated upon 15 males and 15 females patients; mean age 40 years. GTR was achieved in 29 (96.6%) instances. Surgical mortality was 3.3% and the recurrence rate was 3.3%. The median follow-up time was 6.2 years. CONCLUSION The surgical approach used in this group of patients afford that the great majority of tumors could be totally removed with low mortality and low recurrence rates, proving to be safe and effective.
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Affiliation(s)
- Rudi Lenck Fernandes
- Departamento de Neurocirurgia, Hospital Federal dos Servidores do Estado, Rio de Janeiro, RJ, Brazil
| | - José Carlos Lynch
- Departamento de Neurocirurgia, Hospital Federal dos Servidores do Estado, Rio de Janeiro, RJ, Brazil
| | - Leonardo Welling
- Departamento de Neurocirurgia, Hospital Federal dos Servidores do Estado, Rio de Janeiro, RJ, Brazil
| | | | - Rodrigo Tragante
- Departamento de Neurocirurgia, Hospital Federal dos Servidores do Estado, Rio de Janeiro, RJ, Brazil
| | - Vicente Temponi
- Departamento de Neurocirurgia, Hospital Federal dos Servidores do Estado, Rio de Janeiro, RJ, Brazil
| | - Celestino Pereira
- Departamento de Neurocirurgia, Hospital Federal dos Servidores do Estado, Rio de Janeiro, RJ, Brazil
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Lateral extracavitary, costotransversectomy, and transthoracic thoracotomy approaches to the thoracic spine: review of techniques and complications. ACTA ACUST UNITED AC 2014; 26:222-32. [PMID: 22143047 DOI: 10.1097/bsd.0b013e31823f3139] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
STUDY DESIGN Systematic review. OBJECTIVE The authors review complications, as reported in the literature, associated with ventral and posterolateral approaches to the thoracic spine. SUMMARY OF BACKGROUND The lateral extracavitary, costotransversectomy, and transthoracic thoracotomy techniques allow surgeons to access the ventral thoracic spine for a wide range of spinal disorders including tumor, degeneration, trauma, and infection. Although the transthoracic thoracotomy has been used traditionally to reach the ventral thoracic spine when access to the vertebral body is required, modifications to the various dorsal approaches have enabled surgeons to achieve goals of decompression, reconstruction, and stabilization through a single approach. METHODS A systematic Medline search from 1991 to 2011 was performed to identify series reporting clinical data related to these surgical approaches. The morbidity associated with each approach is reviewed and strategies for complications avoidance are discussed. RESULTS Four thousand six hundred seventy-seven articles that assessed outcomes of the approaches to the thoracic spine were identified; of these 31 studies that consisted of 774 patients were selected for inclusion. A mean complication rate of 39%, 17%, and 15% for thoracotomy, lateral extracavitary, and costotransversectomy, respectively, was determined. The thoracotomy approach had the highest reoperation (3.5%) and mortality rates (1.5%). The specific complications and neurological outcomes were categorized. CONCLUSIONS Outcomes of the surgical approaches to the thoracic spine have been reported with great detail in the literature. There are limited studies comparing the respective advantages and disadvantages and the differences in technique and outcome between these approaches. The present review suggests that in contrast to the historical experience of the laminectomy for thoracic spine disorders, these alternative approaches are safe and rarely associated with neurological deterioration. The differences between these approaches are based on their complication profiles. A thorough understanding of the regional anatomy will help avoid approach-related complications.
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Ando K, Imagama S, Ito Z, Tauchi R, Muramoto A, Matsui H, Matsumoto T, Ishiguro N. Removal of thoracic dumbbell tumors through a single-stage posterior approach: its usefulness and limitations. J Orthop Sci 2013; 18:380-7. [PMID: 23512015 DOI: 10.1007/s00776-013-0370-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2012] [Accepted: 02/13/2013] [Indexed: 12/28/2022]
Abstract
BACKGROUND The purpose of this study was to evaluate the surgical results of the single-stage surgery only from posterior approach for the management of thoracic dumbbell tumor and to discuss its usefulness and limitations. METHODS Sixteen cases of large thoracic dumbbell tumor (11 men and 5 woman, mean age, 44 years) were analyzed retrospectively. Pathologic findings included schwannoma in 10 patients, neurofibroma in 2 patients (Recklinghausen in 1 patient), meningioma in 2 patients, myxolipoma in 1 and ganglioneuroma in 1. They underwent single-stage removal of dumbbell tumor using the posterior approach followed by laminectomy and often costotransversectomy combined with instrumentation. Clinical and radiologic outcomes are reviewed. RESULTS The mean follow-up period for clinical and radiographic outcome variables was 66 months (range, 24-120 months). Operative time ranged from 185 to 420 min (mean, 320 min), with estimated blood loss ranging from 71 to 1830 ml (mean, 540 ml). Postoperative complications were pleural injury during the enucleation of paravertebral tumors, which could be repaired, and the chest tube was detained to prevent postoperative pneumothorax. Postoperative complications included atelectasis in one case. All patients had tumors successfully removed with no neurological deterioration. One patient underwent both posterior and anterior surgery because of attachment to and compression of an artery. We were not able to diagnose this case preoperatively, although a biopsy had been performed. CONCLUSIONS Single-stage surgery may be a useful method for removing thoracic dumbbell tumors without the combined anterior approach, unless they are attached to and compressing the artery and the diagnosis cannot be made preoperatively.
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Affiliation(s)
- Kei Ando
- Department of Orthopaedic Surgery, Nagoya Graduate University School of Medicine, 65 Tsurumai Showa-ward, Aichi, 466-8550, Japan.
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Missori P, Pandolfi S, Antonelli M, Domenicucci M. Epidural neural fibrolipoma of the thoracic vertebral canal. J Neurosurg Spine 2012; 17:449-52. [DOI: 10.3171/2012.8.spine11971] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Neural fibrolipoma is a benign tumor that most frequently infiltrates the median nerve. The authors describe a patient with spinal cord compression syndrome caused by a neural fibrolipoma. The tumor originated in the thoracic nerve at the T6–7 extradural level in the left conjugate foramen and extended into the thoracic cavity. Total removal was achieved by a combined posterior and costotransversectomy approach. Postoperatively, the patient's spinal cord compression syndrome resolved. No tumor recurrence has been observed in medium-term follow-up. This is the second case of an extradural spinal neural fibrolipoma to be reported in the literature.
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Affiliation(s)
- Paolo Missori
- 1Department of Neurology and Psychiatry, Division of Neurosurgery, and
| | - Sergio Pandolfi
- 1Department of Neurology and Psychiatry, Division of Neurosurgery, and
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Lubelski D, Abdullah KG, Mroz TE, Shin JH, Alvin MD, Benzel EC, Steinmetz MP. Lateral Extracavitary vs Costotransversectomy Approaches to the Thoracic Spine. Neurosurgery 2012; 71:1096-102. [DOI: 10.1227/neu.0b013e3182706102] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
ABSTRACT
BACKGROUND:
The lateral extracavitary approach (LECA) and costotransversectomy (CTE) are 2 dorsolateral approaches that avoid entrance into the pleural cavity and facilitate ventral decompression. The indications and outcomes of each of these approaches have not been fully defined in the literature.
OBJECTIVE:
To assess the techniques, indications, and complications associated with the LECA and CTE approaches to the thoracic spine.
METHODS:
A retrospective analysis was performed on all patients who underwent LECA and CTE between 2000 and 2009 at our institution.
RESULTS:
A total of 54 patient charts were reviewed (19 LECA, 35 CTE). Indications for operation included disk herniation, trauma, tumor, osteomyelitis, and scoliosis/kyphosis. Osteomyelitis was treated significantly more often with LECA (47%) than with CTE (9%; P = .002). Mean blood loss was 2134 mL and 1556 mL (P = .3) in LECA and CTE, respectively, and hospital stay was 17.2 days for LECA and 9.8 days for CTE (P = .07). Thirteen LECA patients (68%) and 19 CTE patients (54%; P = 1.0) had preoperative or postoperative complications.
CONCLUSION:
LECA was used more often to treat complex pathologies such as osteomyelitis and trended toward significance for more frequent use in extensive procedures involving 1- or 2-level corpectomies. As can be expected, CTE was associated with slightly less blood loss and a shorter hospital stay compared with the more extensive LECA operation. Adverse outcomes occurred with similar frequency for CTE and LECA.
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Affiliation(s)
- Daniel Lubelski
- Cleveland Clinic Center for Spine Health and Cleveland Clinic, Cleveland, Ohio
- Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
- Department of Neurological Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Kalil G. Abdullah
- Cleveland Clinic Center for Spine Health and Cleveland Clinic, Cleveland, Ohio
- Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
- Department of Neurological Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Thomas E. Mroz
- Cleveland Clinic Center for Spine Health and Cleveland Clinic, Cleveland, Ohio
- Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
- Department of Neurological Surgery, Cleveland Clinic, Cleveland, Ohio
| | - John H. Shin
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Matthew D. Alvin
- Cleveland Clinic Center for Spine Health and Cleveland Clinic, Cleveland, Ohio
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Edward C. Benzel
- Cleveland Clinic Center for Spine Health and Cleveland Clinic, Cleveland, Ohio
- Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
- Department of Neurological Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Michael P. Steinmetz
- Case Western Reserve University School of Medicine, Cleveland, Ohio
- Department of Neurosciences, MetroHealth Medical Center, Cleveland, Ohio
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