Combined Video-Assisted Thoracic Surgery and Posterior Spinal Surgery for the Treatment of Dumbbell Tumor of the First Thoracic Nerve Root

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.

Minimally invasive resection of extradural dumbbell tumors of thoracic spine: surgical techniques and literature review

“…Ghostines et al demonstrated a thoracoscopic surgery was safety and effectiveness in treating the thoracic dumbbell nerve sheath tumors. Ohya et al performed successfully a combined VATS and posterior spinal surgery for the treatment of thoracic dumbbell tumors [15]. Tanaka et al treated successfully a woman with dumbbellshaped thoracic neurinoma by combining hemilaminectomy and thoracoscopic surgery [16].…”

“…In addition, for most thoracic tumors wholly confined to the chest wall, a video-assisted thoracoscopic surgery (VATS) via the thoracic cavity is advocated to carry out [15]. However, if a portion of the tumor extends into the spinal canal, the situation becomes quite different.…”

Surgical Principles for Spinal and Paraspinal Neurofibromas

“…Therefore, it is especially required to protect the T1 nerve root in dumbbell tumor surgery. As specified above, a standard surgical approach had not been notified in the surgery of dumbbell tumors arising from the T1 nerve root having the different functional and anatomic features rather than the other thoracic nerves [59].…”

“…The tumor is taken by making the partial costotransversectomy in the posterior spinal surgery. It had been indicated that 3D-CT was required to be used in the preoperative period in order to evaluate the tumor's relationship with the structures in the adjacency of it in details in the cases, for which this combined approach was planned [59]. Moreover, in these cases, it had been also notified that the intraoperative stimulation and neuromonitorization were required to be used in order to evaluate whether the T1 nerve function was protected.…”

“…Moreover, the hemorrhage, hemothorax, and/or intraabdominal hemorrhage can be observed depending on the surgery's duration length, especially in the combined posteroanterior approaches. One piece of a hemorrhagic drain inside of the lodge in the posterior and one piece of an intraabdominal drain in the anterior should be placed at the end of surgery in order to prevent these complications to be developed in the postoperative period [50,52,58,59,64,69].…”