Single stage complete excision of large thoracic dumbbell schwannoma by modified posterior approach

Agrawal, Amit; Srivastava, Sandeep; Joharapurkar, S.R.; Gharde, Pankaj; Ubeja, G

doi:10.1016/j.surneu.2007.07.043

Cited by 16 publications

(16 citation statements)

References 13 publications

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“…After the use of an operation microscope, intradural neoplasms can be safely and effectively treated with hemilaminectomy techniques. The classical posterior approach may be adopted in the surgery and the modified posterior approaches may, in particular, be used in the large invasive or dumbbell-shaped tumors [11,12,14-19]. In the classical posterior approach, the tumor is reached by dural incision through the median incision by multilevel laminectomy [7-12,14-20].…”

Section: Discussionmentioning

confidence: 99%

Management of Thoracal and Lumbar Schwannomas Using a Unilateral Approach without Instability: An Analysis of 15 Cases

et al. 2012

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Study DesignRetrospective case series.PurposeThe objectives of this study were to determine and discuss the surgical planning of patients who underwent operations following diagnoses of thoracal and lumbar spinal schwannomas. We also aimed to discuss the application of unilateral hemilaminectomy for the microsurgery of schwannomas.Overview of LiteratureSchwannomas are located in different regions and sites. These differences require several surgical approaches. Unilateral laminectomy without stabilization of the spine provides a more minimally invasive removal of the tumor.MethodsIn this retrospective study, 15 patients with spinal schwannomas were evaluated with regards to age, sex, onset history, neurological findings, tumor locations, McCormick scale, surgical procedure, and operational results. The lateral approach provides exposure of intradural structures and posterior paraspinal regions. Extensions of tumors cause problem for the surgeon in terms of approach, resectability of the tumor, and stability of the spine. Gross total resection was achieved in all cases, and none of the patients necessary required a fusion procedure.ResultsFive patients were males and 10 were females. The age interval was 29-65 years. The tumor was located in the lumbar region in 9 patients, in the thoracic region in 2 patients, and in the thoracolumbar junction in 4 patients. The intradural lesions were removed by laminectomy and the extradural lesions were resected with hemilaminectomy. The paramedian route was used to explore the extraspinal part of the tumor. Costotransversectomy was for the thoracic region. Subtotal resection was performed in 1 patient. Patient symptoms recovered gradually in the postoperative period.ConclusionsResection of giant schwannomas is challenging and usually requires a different approach. We describe the complete resection of complex dumbbell or paraspinal schwannomas of the thoracic and lumbar spine by unilateral hemilaminectomy.

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Section: Discussionmentioning

confidence: 99%

Management of Thoracal and Lumbar Schwannomas Using a Unilateral Approach without Instability: An Analysis of 15 Cases

et al. 2012

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“…Agrawal, et al30 reported on single stage excision with the posterior approach without instrumentation. We believe, however, that for safer surgery, intra- and large extraspinal lesions connected through the foramen should not be resected without facetectomy and costotransversectomy, considering partial facetectomy with scalloping lesions has the risk for postoperative instability.…”

Section: Discussionmentioning

confidence: 99%

Single-Stage Removal of Thoracic Dumbbell Tumors from a Posterior Approach Only with Costotransversectomy

et al. 2012

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PurposeThoracic dumbbell tumors are relatively rare, usually arising from neurogenic elements. Methods for surgical removal thereof remain controversial. The purpose of this study was to evaluate the surgical results of a single-stage posterior approach with laminectomy and costotransversectomy only for the management of thoracic dumbbell tumors.Materials and MethodsEight cases of thoracic large dumbbell tumor were analyzed retrospectively: seven men and one woman (mean age, 49 years). Pathologic findings included schwannoma in five patients, neurofibroma in two patients (Recklinghausen in one patient), and ganglioneuroma in one patient. All patients underwent single-stage removal of dumbbell tumors by a posterior approach followed by laminectomy and costotransversectomy combined with instrumentation. Clinical and radiologic outcomes were reviewed, thereafter.ResultsOperative time ranged from 185 to 420 minutes (mean, 313 minutes), with estimated blood loss ranging from 71 to 1830 mL (mean, 658 mL). Postoperative complications included atelectasis in one case. All patients had tumors successfully removed with no neurological deterioration. Spinal deformities were not observed in any patients at the last follow-up (mean, 52 months), with instrumentation.ConclusionSingle-stage surgery with laminectomy and costotransversectomy may be useful for removing thoracic dumbbell tumors without a combined anterior approach.

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“…The use of two stages and/or two surgical approaches includes an open thoracotomy and increased morbidity (blood loss, coagulopathy, paralytic ileus, respiratory complications, and infection), prolonged postoperative stay and postoperative pain. [215172123] Akwari et al ,[3] performed single-stage operation consisting of two approaches and repositioning (posterior midline for laminectomy and then a postero-lateral thoracotomy). Grillo et al ,[9] in 1983, similarly demonstrated laminectomy and thoracotomy approaches in prone position via “L” shaped incision in a one-stage technique.…”

Section: Discussionmentioning

confidence: 99%

“…Due to the controversies in managing them, several approaches have been described in single or multiple stages combining laminectomy and thoracotomy in the same or separate incisions. [215172123]…”

Section: Introductionmentioning

confidence: 99%

“…[3] Therefore, unlike previously reported approaches, we standardized a one-step midline approach for complete tumor excision, avoiding an open thoracotomy, additional incisions or repositioning as well as addressing the issue of stability. [215172123] We have described a simple straightforward single midline (one-stage) approach for these complex tumors, establishing the basic principles outlining our strategy, i.e. complete safe resection, providing foremost cord decompression as well as addressing the long-term effect of instability at transitional spinal regions.…”

Section: Introductionmentioning

confidence: 99%

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

Thorat¹,

Rajendra²,

Agasthian³

et al. 2011

Surg Neurol Int

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Background:Several different procedures have been advocated for thoracic spine dumbbell tumor resection, combining thoracic and neurosurgical approaches, in single and multiple stages, using various incisions and positions. These have led to controversies in the ideal management. The authors report their analysis of a series of 11 patients successfully treated through a one-step midline approach for complete resection and instrumentation when indicated under intraoperative CT (ICT) guidance.Methods:The patients’ clinical presentations, imaging results, operative findings and follow-up were reviewed in 11 patients (age ranged from 11 to 62 years), over the period from August 2007 to May 2010. A single-stage, posterior midline incision approach with laminectomy, facetectomy, costotransversectomy, for complete resection of intraspinal and paraspinal components of tumor was used. Spinal instrumentation under ICT guidance was also carried out in relevant (six) cases with tumors involving junctional spinal regions such the cervico-thoracic or thoraco-lumbar region.Results:The initial clinical presenting symptom was pain in eight patients and paresthesia in one, while two patients were detected incidentally on routine chest X-rays. Total excision was achieved in 10 patients (9 schwanommas, 1 neurofibroma) with the exception of one patient who had a recurrent malignant peripheral nerve sheath tumor adherent to the vertebral artery. No significant postoperative complications occurred and an early mobilization/discharge was achieved in all patients with an average hospital stay of 5 days.Conclusions:A one-step approach through a posterior midline incision is feasible, safe and efficient for complete excision of thoracic dumbbell tumors. This approach facilitates laminectomy, facetectomy, costotransversectomy and instrumentation under ICT guidance, while limiting muscle damage, blood loss, operative time, postoperative pain, thus enabling early mobilization with a reduced hospital stay.

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Single stage complete excision of large thoracic dumbbell schwannoma by modified posterior approach

Cited by 16 publications

References 13 publications

Management of Thoracal and Lumbar Schwannomas Using a Unilateral Approach without Instability: An Analysis of 15 Cases

Management of Thoracal and Lumbar Schwannomas Using a Unilateral Approach without Instability: An Analysis of 15 Cases

Single-Stage Removal of Thoracic Dumbbell Tumors from a Posterior Approach Only with Costotransversectomy

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

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