Individualized microsurgical analysis of spinal dumbbell tumors / 西安交通大学学报(医学版)

Objective: To explore the individualized surgical approach and microsurgical treatment of spinal dumbbell tumors. Methods: We made a retrospective analysis of the clinical data of 26 cases of spinal dumbbell tumors resected at the Neurosurgery Department of The First Affiliated Hospital of Xi'an Jiaotong University from January 2015 to December 2018. Individualized surgical approach was selected by the Toyama tumor classification and spinal internal fixation was conducted according to the patients' spinal instability before and during the operation. The sensory and motor scores of the American Spinal Cord Injury Association (ASIA) were compared before and after the surgery in order to evaluate the therapeutic effect. Results: All the 26 cases of spinal dumbbell tumors underwent single stage resection. There were 20 cases of schwannoma, 3 cases of ganglion neuroma, 2 cases of spinal meningioma, and 1 case of neurofibroma. The neurological symptoms of the patients were improved to different extent after the operation, and there was no increase in motor dysfunction. The ASIA sensory score was 219.34±1.62 and the ASIA motor score was 98.61±1.25 at 1 month after the surgery, and both of them were significantly higher than those before surgery (P<0.001). The follow-up period was 6-52 months, with an average of 28 months. No tumor recurrence or spinal deformity was observed. Conclusion: Single stage micro-resection of spinal dumbbell tumors could be achieved by modern microsurgical technology and individualized surgical approach according to tumor characteristics. Based on accurate evaluation of the stability of the spine before and during the operation, reasonable selection of spinal internal fixation are crucial for preventing postoperative spinal deformity and improve patients' quality of postoperative life.

Application of 3D printing in surgical approach choice for treatment of cervical vertebra dumbbell tumor / 局解手术学杂志

Objective To explore the application of 3D printing technology in surgical approach choice for cervical vertebra dumbbell tumor.Methods Retrospectively analyzed the clinical data of 17 patients with cervical vertebra dumbbell tumor who were admitted into our hospital from August 2012 and February 2017 and recieved 3D model printing.Three director surgeons chosen surgical approach for each pa-tient with or without 3D printing models.The surgical approach,combined with 3D printing and chosen by most surgeons,was selected as final surgical approach for patients.All the patients were evaluated by JOA score and Frankel grade before and after operation.Results The tumor of patients who selected surgical approach with 3D printing was completely resected.Without 3D printing models in preoperation,3 surgeons selected the same surgical approach for 8 patients,2 surgeons selected the same surgical approach for 9 patients.Compared with those who se-lected surgical approach with 3D printing models in preoperation,the 3 surgeons changed surgical approach in a total of 13 times.The surgical approach of 5 patients were changed,including 2 cases changed from posterior approach to lateral approach,2 cases changed from lateral ap-proach to posterior approach,and 1 case changed from lateral approach to anterior approach.Eventually,11 cases underwent posterior ap-proach,1 case underwent anterior approach,3 cases underwent lateral approach and 2 cases underwent far lateral approach.Conclusion Ap-plied of 3D printing in treatment of cervical vertebra dumbbell tumor can rebuild and print local anatomy by digitizing method.It can excel-lently show the tumor form,relationship of tumor and vertebrae,tumor and foramen intervertebrale,tumor and vessel.3D printing technology could help surgeon precisely and directly understand the operation area and select advanced surgical approach to reduce surgical risk and in -crease the resection rate of tumor.And it has an excellent display effect especially for complex tumors and abnormal blood vessels.

One Stage Posterior Minimal Laminectomy and Video-Assisted Thoracoscopic Surgery (VATS) for Removal of Thoracic Dumbbell Tumor

OBJECTIVE: This study was conducted to assess the surgical results of one-stage posterior minimal laminectomy and video-assisted thoracoscopic surgery (VATS) for the treatment of thoracic dumbbell tumor and to describe its precise technique. In addition, we investigated the technique's usefulness and limitations. METHODS: Seven cases of thoracic dumbbell tumor (two men and five women, mean age, 43 years) were analyzed retrospectively. Pathological findings included schwannoma in four patients, neurofibroma in two patients, and hemangioma in one patient. The location of tumors varied from T2/3 to T12/L1. Dumbbell tumors were resected by one-stage operation using posterior laminectomy followed by VATS without instrumentation. Clinical data were reviewed. RESULTS: The mean follow-up period was 25 months (range, 3–58 months), and the operative time ranged from 255 to 385 min (mean, 331 min), with estimated blood loss ranging from 110 to 930 mL (mean, 348 mL). The tumor was completely resected without instrumentation and postoperative instability in all cases. Postoperative complications included atelectasis and facial anhydrosis in one case each. CONCLUSION: One-stage posterior minimal laminectomy and VATS may be a safe and less invasive technique for removal of thoracic dumbbell tumor without instability. This method has the advantage of early ambulation and rapid recovery because it reduces blood loss and postoperative pain.

Cervical Symmetric Dumbbell Ganglioneuromas Causing Severe Paresis

We report an extremely rare case with bilateral and symmetric dumbbell ganglioneuromas of the cervical spine in an elderly patient. A 72-year-old man came by ambulance to our hospital due to progressive incomplete paraplegia. Magnetic resonance imaging demonstrated bilateral symmetric dumbbell tumors at the C1/2 level. We performed total resection of the intracanalar tumor, aiming at complete decompression of the spinal cord, and partial and subtotal resection of foraminal outside portions. Histopathological examination of the surgical specimen indicated the tumor cells to be spindle cells with the presence of ganglion cells and no cellular pleomorphism, suggesting a diagnosis of ganglioneuroma. Although the surgery was not curative, the postoperative course was uneventful and provided a satisfactory outcome. This is the fourth known case of cervical ganglioneuromas of the bilateral symmetric dumbbell type.

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

PURPOSE: Thoracic 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 METHODS: Eight 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. RESULTS: Operative 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. CONCLUSION: Single-stage surgery with laminectomy and costotransversectomy may be useful for removing thoracic dumbbell tumors without a combined anterior approach.

(One Year Interval) Staged Surgery of Giant Lumbar Dumbbell Neurofibroma

Giant dumbbell neurofibroma is a rare tumor which belongs to large family that is the nerve sheath tumor composed of two main types of tumors that include neurofibroma and schwannoma. Neurofibroma arises from a mesenchymal origin closer to a fibroblast which differs from the schwannoma arising from the progenitor of the schwann cell. I report on one case of giant lumbar dumbbell neurofibroma that occured in the spinal and paraspinal retoperitoneal region which was removed by combined and one-year delayed surgery.

Microsurgical treatment of dumbbell tumors of high cervical spine / 中国医师进修杂志

Objective To summarize experiences of microsurgical treatment of dumbbell tumors of the high cervical spine. Methods A series of 12 patients with dumbbell tumors of the high cervical spine were treated by using microsurgical techniques through posterior approach or antero-lateral approach. Results Complete resection was achieved in 10 patients. Postoperative neurological symptoms improved greatly in all. Conclusion The key points of treatment in dumbbell tumors of the high cervical spine are to analyze the preoperative image carefully and have knowledge about anatomy of high cervical spine as well as the experience of microsurgical technique.

Lincoln Highway Transuncodiscal Approach to Dumbbell Tumors of the Cervical Spinal Canal

A combined anterior and lateral approach to the anterior cervical canal was performed on 2 patients with cervical dumbbell-shaped tumors. The procedure consists of anterior discetomy and ispsilateral uncectomy, and removal of the posterolateral corners and posterior transverse fidges of the upper and lower verterbral bodies at the tumor. In one case of a large tumor in the spinal canal, additional removal of a limited segment from the lateral part of the vertebral body was performed and the bone defect was filled with a T-shaped bone graft. The higest level of the operation was C-2 and the lowes was C-4. The authors believe that any cervical dumbbell-shaped tumor below the C-2 level can be removed via anterolateral approach as long as no more than 3 levels of the spine are involved.