Purely posterior midline approach resection for large intra- and extra-spinal dumbbell tumors extending into the thoracic cavity

Abstract

Objective To study the surgical technique and effect of purely posterior midline approach resection for large intra- and extra-spinal dumbbell tumors that extended into the thoracic cavity.  Methods Retrospectively analyze 12 cases of large intra- and extra-spinal dumbbell tumors that extended into the thoracic cavity and were resected through posterior midline approach. The clinical features and common surgical approaches of dumbbell tumors in literature were introduced to explore the advantages of purely posterior midline approach.  Results There were 12 patients (5 males and 7 females) with the age between 34-58 years old (average 45 years old). Eleven cases underwent first operation and one case underwent reoperation. There were 4 Eden type Ⅱ tumors, 5 Eden type Ⅲ tumors, and 3 Eden type Ⅳtumors with average size 4.50 cm × 4.00 cm × 3.00 cm. All cases were achieved total resection by purely posterior midline approach and one case received spinal fixation at the same time, with operation time ranged from 120-315 min (average 195 min) and average blood loss of 205 ml. Postoperative pathological findings included schwannoma in 9 patients, neurofibroma in one patient, meningioma in one patient and cavernous hemangioma in one patient. The follow-up period was 6-26 months (average 18 months) after operation, and all patients recovered well. Preoperative symptoms like root pain, spinal cord compression were relieved to various degrees. Neither new neurological defects nor tumor recurrence was found.  Conclusions Most of the intra- and extra-spinal dumbbell tumors that extend into thoracic cavity are schwannoma. Correctly preoperative radiographic assessment, purely posterior midline approach with piecemeal resection in the intercostal space can achieve total tumor resection in most cases without thoracotomy or assisted incision.

DOI: 10.3969/j.issn.1672-6731.2016.03.005