Thoracoscopic surgery for three cases of dumbbell type neurogenic tumor.

Nakamura, Hiroshige; Makihara, Kazuhiko; Taniguchi, Yoshihiro; Metsugi, Hiroyuki; Ishiguro, Kiyosuke; Ohgi, Shigetsugu

doi:10.2995/jacsurg.14.555

Cited by 1 publication

(3 citation statements)

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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. [ 2 15 17 21 23 ] 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. [ 2 15 17 21 23 ]…”

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. [ 2 15 17 21 23 ] 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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