Surgical Principles of Dumbbell-shaped Spinal Nerve Sheath Tumors

Česká verzia

Authors: L. Hrabálek; V. Novák; M. Vaverka
Authors place of work: Neurochirurgická klinika LF UP a FN v Olomouci
Published in the journal: Cesk Slov Neurol N 2016; 79/112(4): 445-452
Category: Short Communication

Summary

We retrospectively evaluated outcomes of dumbbell-shaped spinal nerve sheath tumors (neurinoma, neurofibroma) surgeries. The study group consisted of 15 patients with the mean age of 43.6 years (22–76 years) and we performed surgery of 17 tumors. We extirpated intraspinal part via posterior approach at first, then extraspinal part using the same incision, or from a second, separated anterolateral incision. Tumor resection was always complete. We performed delayed stabilization in one case. On the basis of our experience and literature review, we aimed to establish essential principles and to develop recommendations for surgical management of these tumors. Surgical management is determined by the patient’s clinical condition, his/her risk of surgical complications, and by the size and location of the extraspinal part and its proximity to critical structures. We recommend unilateral approach with hemilaminectomy and extirpation of intraspinal component of the tumor first. Combined approaches are suitable in cervical and lumbar spine in particular, with respect to thoracic spine, it should only be used in cases of giant tumors with close proximity to anatomical structures.

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers.

Key words:
dumbbell-shaped tumor – nerve sheath tumor – neurinoma – neurofibroma – spinal surgery

Zdroje

1. Eden K. The dumb-bell tumours of the spine. Br J Surg 1941;28:549–70.

2. Tanaka T, Kato N, Aoki K, et al. Combined unilateral hemilaminectomy and thoracoscopic resection of the dumbbell-shaped thoracic neurinoma: a case report. Case Rep Neurol Med 2012;2012:517563. doi: 10.1155/ 2012/ 517563.

3. Iraci G, Peserico I, Salar G. Intraspinal neurinomas and meningiomas. A clinical survey of 172 cases. International Surgery 1971;56(5):289– 303.

4. Akwari OE, Payne WS, Onofrio BM, et al. Dumbbell neurogenic tumors of the mediastinum. Mayo Clin Proc 1978;53(6):353– 8.

5. Ando K, Imagama S, Wakao N, et al. Single-stage removal of thoracic dumbbell tumors from a posterior approach only with costotransversectomy. Yonsei Med J 2012;53(3):611– 7. doi: 10.3349/ ymj.2012.53.3.611.

6. Ando K, Imagama S, Ito Z, et al. Removal of thoracic dumbbell tumors through a single-stage posterior approach: its usufulness and limitations. J Orthop Sci 2013;18(3):380– 7. doi: 10.1007/ s00776-013-0370-9.

7. Yuksel M, Pamir N, Ozer F, et al. The principles of surgical management in dumbbell tumors. Eur J Cardiothorac Surg 1996;10(7):569– 73.

8. McCormick PC. Surgical management of dumbbell tumors of the cervical spine. Neurosurgery 1996;38(2):294–300.

9. Grillo HC, Ojemann RG, Scannel JG, et al. Combined approach to „dumbbell“ intrathoracic and intraspinal neurogenic tumors. Ann Thorac Surg 1983;36(4):402– 7.

10. Onesti ST, Ashkenazi E, Michelsen WJ. Transparaspinal exposure of dumbbell tumors of the spine. Report of two cases. J Neurosurg 1998;88(1):106–10.

11. Osada H, Aoki H, Yokote K, et al. Dumbbell neurogenic tumor of the mediastinum: a report of three cases undergoing single-staged complete removal without thoracotomy. Jpn J Surg 1991;21(2):224– 8.

12. Asazuma T, Toyama Y, Maruiwa H, et al. Surgical strategy for cervical dumbbell tumors based on a free-dimensional classification. Spine 2003;29(1):E10– 4.

13. Jiang L, Lv Y, Liu XG, et al. Results of surgical treatment of cervical dumbbell tumors: surgical approach and development of an anatomic classification system. Spine 2009;34(12):1307– 14. doi: 10.1097/ BRS.0b013e3181a27a32.

14. McCormick PC. Surgical management of dumbbell and paraspinal tumors of the thoracic and lumbar spine. Neurosurgery 1996;38(1):67– 74.

15. Payer M, Radovanovic I, Jost G. Resection of thoracic dumbbell neurinomas: single postero-lateral approach or combined posterior and transthoracic approach? J Clin Neurosci 2006;13(6):690– 3.

16. Lucas S, Cendan E, Auque J, et al. Asymptomatic giant thoracic dumbbell neurinoma. Apropos of a case. J Chir (Paris) 1992;129(2):81– 7.

17. Dehcordi SR, Marzi S, Ricci A, et al. Less invasive approaches for the treatment of cervical schwannomas: our experience. Eur Spine J 2012;21(5):887– 96. doi: 10.1007/ s00586-011-2118-6.

18. Miura J, Doita M, Miyata K, et al. Hornerś syndrome caused by a thoracic dumbbell-shaped schwannoma: sympathetic chain reconstruction after a one-stage removal of the tumor. Spine 2003;28(2):E33– 6.

19. Yu Y, Hu F, Zhang X, et al. Application of the hemi-semi-laminectomy approach in the microsurgical treatment of C2 schwannomas. J Spinal Disord Tech 2014;27(6):E199– 204. doi: 10.1097/ BSD.0b013e318299f606.

20. Gu BS, Park JH, Roh SW, et al. Surgical strategies for removal of intra- and extraforaminal dumbbell--shaped schwannomas in the subaxial cervical spine. Eur Spine J 2015;24(10):2114– 8. doi: 10.1007/ s00586-014-3458-9.

21. Citow JS, Macdonald RL, Ferguson MK. Combined laminectomy and thoracoscopic resection of a dumbbell neurofibroma: technical case report. Neurosurgery 1999;45(5):1263– 5.

22. Konno S, Yabuki S, Kinoshita T, et al. Combined laminectomy and thoracoscopic resection of dumbbell-type thoracic cord tumor. Spine 2001;26(6):E130– 4.

23. Vallieres E, Findlay JM, Fraser RE. Combined microsurgical and thoracoscopic removal of neurogenic dumbbell tumors. Ann Thorac Surg 1995;59(2):469– 72.

24. Ito K, Aoyama T, Kuroiwa M, et al. Surgical strategy and results of treatment for dumbbell-shaped spinal neurinoma with a posterior approach. Br J Neurosurg 2014;28(3):324– 9. doi: 10.3109/ 02688697.2013.835372.

25. Klekamp J, Samii M. Surgery of spinal nerve sheath tumors with special reference to neurofibromatosis. Neurosurgery 1998;42(2):279– 90.

26. Lot G, George B. Cervical neuromas with extradurale components: surgical management in a series of 57 patients. Neurosurgery 1997;41(4):813– 22.

27. Schultheiss R, Gullotta G. Resection of relevant nerve roots in surgery of spinal neurinomas without persisting neurological deficit. Acta Neurochir 1993;122(1– 2):91– 6.