Dumbbell neurogenic tumor of the mediastinum: A report of three cases undergoing single-staged complete romoval without thoracotomy

Abstract

Of a total thirteen patients who underwent surgery for a neurogenic tumor in the posterior mediastinum 4 (30.8 per cent) presented with dumbbell type development of the tumor. Along with a comparatively greater incidence in the number of cases of dumbbell neurogenic tumors in the posterior mediastinum, resection has also recently become more popular, necessitating the establishment of a standard operative approach for this type of tumor. We successfully removed dumbbell neurogenic tumor from the posterior mediastinum in our 3 most recent cases via a dorsal approach by virtue of a laminectomy and resection of a small portion of the neighbouring rib root without opening the parietal pleura at all. These three patients were a 14 year old female, a 54 year old male and a 68 year old female, respectively, and the largest diameter in cm and level of origin of the tumors were 5.5 at Th 1 in case 1, 3.0 at Th 2 in case 2 and 3.7 at Th 11 in case 3. The operative approach described herein was easy to perform, felt secure and was less invasive and better tolerated by the patients than the thoracotomy approach. Avoiding a thoracotomy in such cases has many advantages to enumerate, but does not seem to have been clearly aimed at by others to date. We therefore propose our technique as a standard approach for dumbbell neurogenic tumors in the posterior mediastinum.

Surgical treatment of benign neurogenic tumours of the mediastinum: a single institution report☆

“…Ricci et al [19] reported using Akwari's and Grillo's approaches selectively, reserving the latter for smaller tumours. Other groups [20][21][22][23] preferred a laminectomy and a costotransversectomy without entering the pleural cavity or a combined laminectomy and thoracotomy in either one or two stages. Vallières et al [24] described 4 patients treated with a surgical approach involving posterior microneurosurgery combined with anterior VATS.…”

One step removal of dumb-bell tumors by postero-lateral thoracotomy and extended foraminectomy

“…Due to recent case reports of paraplegia caused by swelled sponges in the postoperative period we advise to avoid application of similar materials or to use them with appropriate caution [16,17]. An interesting alternative to our technique is a dorsal approach, proposed by Osada et al [2], involving laminectomy and resection of a small portion of the adjacent rib without opening the parietal pleura. The avoidance of thoracotomy helps in postoperative pain control.…”

“…In the majority of cases they are neurogenic benign tumors which have their origin in the neuron sheath (68%), parasympathic ganglion (30%) or paraganglionic cells (2%) [2]. Only 3 -19% of such tumors, usually in children, are malignant.…”

Single-stage posterior midline approach for dumbbell tumors of the thoracic spine, with intraoperative CT guidance

“…[19] In a large number of cases, by Ozawa et al , the dumbbell tumors were excised through a hemilaminectomy and a facetectomy with the spinal stabilization/reconstruction by Rogers wiring and contralateral facet fusion, leaving the spinous process, supra- and intraspinous ligaments, and contralateral facet joint intact. [20] However, we are of the opinion that in large intradural/intraspinal tumors with cord compression and displacement, full laminectomy is safer over hemilaminectomy and protects the cord from trauma.…”