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Pan J, Gu Y, Zhang F. One step excision combined with unilateral transforaminal intervertebral fusion via minimally invasive technique in the surgical treatment of spinal dumbbell-shaped tumors: A retrospective study with a minimum of 5 years’ follow-up. Front Surg 2022; 9:939505. [PMID: 36176344 PMCID: PMC9513348 DOI: 10.3389/fsurg.2022.939505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 08/17/2022] [Indexed: 11/13/2022] Open
Abstract
IntroductionSpinal dumbbell-shaped tumors are rare, usually benign tumors with intraspinal and paravertebral components connected through intervertebral foramen. Complete excision is often performed through traditional open surgery (TOS). The efficacy and long-term outcomes of minimally invasive surgery (MIS) have not been reported to date in resection of dumbbell-shaped spinal tumors.PurposeThe purpose was to evaluate the efficacy and long-term outcomes of minimally invasive resection combined with unilateral transforaminal intervertebral fusion (TIF) through comparing with TOS in the treatment of spinal dumbbell-shaped tumors.MethodsFifteen patients underwent MIS and 18 patients underwent TOS. Thoracic dumbbell-shaped tumors were directly exposed after removal of costotransverse joints, adjacent rib components, unilateral hemilamina, and facet joints. Lumbar dumbbell-shaped tumors were completely exposed after removal of transverse processes, unilateral hemilamina, and facet joints. Whether for minimally invasive resection or traditional open removal, dumbbell-shaped tumors were completely excised and unilateral TIF was performed to guarantee spinal stability. All patients were followed up for 5 years at least.ResultsThe mean length of surgical incision for two groups was 3.47 ± 0.37 vs. 6.49 ± 0.39 cm (p < 0.05). The average duration of the operation was 131.67 ± 26.90 vs. 144.17 ± 23.59 min (p > 0.05). The mean blood loss was 172.00 ± 48.79 vs. 285.83 ± 99.31 ml (p < 0.05). No blood transfusions were required in the two groups. The median length of hospitalization was 6 vs. 10 days (range: 5–8 vs. 7–14 days). The patients of two groups were monitored for an average of 65.93 ± 3.88 vs. 65.78 ± 3.56 months. At 5-year follow-up, all patients presented with normal neurological function (American Spinal Injury Association scale E). The Oswestry Disability Index in the MIS group decreased significantly more than the TOS group. No spondylolisthesis or spinal instability were found in the follow-up period. There was no recurrence of any spinal tumor 5 years after surgery.ConclusionsSpinal dumbbell-shaped tumors can be safely and effectively treated with minimally invasive resection combined with unilateral TIF. Compared with TOS, MIS offers a reduced length of surgical incision, blood loss, hospital stay, and postoperative pain. This surgical protocol might provide an alternative for the treatment of spinal dumbbell-shaped tumors.
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Affiliation(s)
- Jianfeng Pan
- Department of Orthopedic Surgery, Zhongshan Hospital Fudan University, Shanghai, China
- Department of Orthopedic Surgery, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yutong Gu
- Department of Orthopedic Surgery, Zhongshan Hospital Fudan University, Shanghai, China
- Shanghai Southwest Spine Surgery Center, Shanghai, China
- Correspondence: Yutong Gu
| | - Feng Zhang
- Shanghai Southwest Spine Surgery Center, Shanghai, China
- Joseph M. Still Burn and Reconstructive Center, Jackson, Mississippi, United States
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Martos M, Cano P, Molino JA, López-Fernández S, Hladun R, López M, Guillén G. Minimally invasive surgery for pediatric dumbbell neuroblastoma: systematic literature review and report of a single-stage neurosurgical and thoracoscopic approach. Clin Transl Oncol 2021; 24:950-957. [PMID: 34718957 DOI: 10.1007/s12094-021-02724-4] [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: 08/31/2021] [Accepted: 10/13/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Traditional surgical strategies for dumbbell neuroblastoma entail, among others, high risk of spinal deformity. Less invasive procedures might reduce these sequelae, however, there is small evidence comparing different strategies. Indications of minimally invasive surgery in neuroblastoma are still developing. Our aim is to identify and analyze different surgical approaches described in the recent literature and to suggest a minimally invasive option. METHODS A systematic review of the literature was conducted in PubMed (Jan 2000-Dec 2021) to identify reports describing surgical resection of dumbbell neuroblastoma in children, according to the PRISMA guidelines. Only full-text articles were included. RESULTS 7 articles met the inclusion criteria which, added to the present case, represent a total of 43 patients. All were retrospective studies, most of them small series. Tumor location was mostly thoracic. Most of combined approaches were performed in two stages. Spinal deformity after surgery was reported in 3 patients. Minimally invasive approach was described in only one paper, with no reported cases of its use in a single-stage combined surgery. We also report, to our knowledge, the first single-stage posterior neurosurgical approach combined with thoracoscopy for resection of a dumbbell neuroblastoma in an infant. CONCLUSION Surgical resection of dumbbell neuroblastomas is challenging. There is no consensus on best surgical approach. Dumbbell tumors should not be considered a contraindication for minimally invasive surgery. A single stage and minimally invasive strategy is proposed.
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Affiliation(s)
- M Martos
- Pediatric Surgery Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - P Cano
- Neurosurgery Department, Hospital Infantil Vall d'Hebron, Barcelona, Spain
| | - J A Molino
- Pediatric Surgery Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - S López-Fernández
- Pediatric Surgery Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - R Hladun
- Pediatric Oncohematology Department, Hospital Infantil Vall d'Hebron, Barcelona, Spain
| | - M López
- Pediatric Surgery Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Surgery Department, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - G Guillén
- Pediatric Surgery Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain. .,Surgery Department, Universitat Autònoma de Barcelona, Barcelona, Spain.
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Li J, Wei W, Xu F, Wang Y, Liu Y, Fu C. Clinical Therapy of Metastatic Spinal Tumors. Front Surg 2021; 8:626873. [PMID: 33937314 PMCID: PMC8084350 DOI: 10.3389/fsurg.2021.626873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 03/23/2021] [Indexed: 11/13/2022] Open
Abstract
Metastatic spinal tumors (MST) have high rates of morbidity and mortality. MST can destroy the vertebral body or compress the nerve roots, resulting in an increased risk of pathological fractures and intractable pain. Here, we elaborately reviewed the currently available therapeutic options for MST according to the following four aspects: surgical management, minimally invasive therapy (MIT), radiation therapy, and systemic therapy. In particular, these aspects were classified and introduced to show their developmental process, clinical effects, advantages, and current limitations. Furthermore, with the improvement of treatment concepts and techniques, we discovered the prevalent trend toward the use of radiation therapy and MIT in clinic therapies. Finally, the future directions of these treatment options were discussed. We hoped that along with future advances and study will lead to the improvement of living standard and present status of treatment in patients with MST.
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Affiliation(s)
- Jie Li
- Department of Spine Surgery, The First Hospital of Jilin University, Changchun, China.,Key Laboratory of Polymer Ecomaterials, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, Changchun, China
| | - Wenjie Wei
- Key Laboratory of Pathobiology, Ministry of Education, School of Basic Medical Sciences, Jilin University, Changchun, China
| | - Feng Xu
- Department of Spine Surgery, The First Hospital of Jilin University, Changchun, China
| | - Yuanyi Wang
- Department of Spine Surgery, The First Hospital of Jilin University, Changchun, China
| | - Yadong Liu
- Department of Spine Surgery, The First Hospital of Jilin University, Changchun, China
| | - Changfeng Fu
- Department of Spine Surgery, The First Hospital of Jilin University, Changchun, China
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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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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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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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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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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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Li C, Ye Y, Gu Y, Dong J. Minimally invasive resection of extradural dumbbell tumors of thoracic spine: surgical techniques and literature review. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2016; 25:4108-4115. [DOI: 10.1007/s00586-016-4677-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 06/03/2016] [Accepted: 06/21/2016] [Indexed: 12/13/2022]
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