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.

Solitary Osteochondroma Presenting as a Dumbbell Tumor Compressing the Cervical Spinal Cord

We report a case of a solitary osteochondroma as a dumbbell tumor compressing the spinal cord and its surgical strategy. The patient is a 16-year-old female with longstanding posterior neck pain and left arm abduction weakness. She was examined by plain X-ray, three-dimensional-computed tomography, magnetic resonance imaging, and vertebral angiography. The analyses indicated a calcified extradural mass compressing the cord in the C3–4 portion extending into the neural and vertebral foramen with eroded vertebral body. The tumor was successfully excised using a modified combined anterior and posterior approach. Histopathologic study of the resected material confirmed the diagnosis. The postoperative assessment was followed by clinical and radiologically therapy for 5 years after surgery. Osteochondroma arises from enchondral bone but it rarely involves the spine, especially not as s dumbbell type. In this patient, the tumor may have arisen from the neural arch and extended into the extradural and extraforaminal space over a long period. We successfully removed the dumbbell tumor with a combined anterior oblique and posterior approach. However, further observation is essential because of the possibility of recurrence and sarcomatous change.

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.

Differences between Cervical Schwannomas of the Anterior and Posterior Nerve Roots in Relation to the Incidence of Postoperative Radicular Dysfunction

STUDY DESIGN: A retrospective study. PURPOSE: To assess the case files of patients who underwent surgery for cervical dumbbell schwannoma for determining the differences between schwannomas of the anterior and posterior nerve roots with respect to the incidence of postoperative radicular dysfunction. OVERVIEW OF LITERATURE: The spinal roots giving origin to schwannoma are frequently nonfunctional, but there is a risk of postoperative neurological deficit once these roots are resected during surgery. METHODS: Fifteen patients with cervical dumbbell schwannomas were treated surgically. Ten men and 5 women, who were 35-79 years old (mean age, 61.5 years), presented with neck pain (n=6), radiculopathy (n=10), and myelopathy (n=11). RESULTS: Fourteen patients underwent gross total resection and exhibited no recurrence. Follow-ups were performed for a period of 6-66 months (mean, 28 months). Preoperative symptoms resolved in 11 patients (73.3%) but they persisted partially in 4 patients (26.7%). Six patients had tumors of anterior nerve root origin, and 9 patients had tumors of posterior nerve root origin. Two patients who underwent total resection of anterior nerve root tumors (33.3%) displayed minor postoperative motor weakness. One patient who underwent total resection of a posterior nerve root tumor (11.1%) showed postoperative numbness. CONCLUSIONS: Appropriate tumor removal improved the neurological symptoms. In this study, the incidence of radicular dysfunction was higher in patients who underwent resection of anterior nerve root tumors than in patients who underwent resection of posterior nerve root tumors.

Spinal Burkitt's Lymphoma Mimicking Dumbbell Shape Neurogenic Tumor: A Case Report and Review of the Literature

Non-Hodgkin's lymphoma (NHL), a disease which may involve the spine, is frequently associated with advanced disease. Radiculopathy caused by spinal root compression as the initial presentation in patients with NHL is very rare and thought to occur in less than 5% of cases. A 69-year-old woman complained of a history of low back pain with right sciatica for 1 month prior to admission. Computed tomography and magnetic resonance imaging of the lumbar spine showed a dumbbell-shape epidural mass lesion extending from L2 to L3, which was suggestive of a neurogenic tumor. After paraspinal approach and L2 lower half partial hemilaminectomy, total excision of the tumor was achieved, followed by rapid improvement of back pain and radiating pain. The lesion was confirmed to be Burkitt's lymphoma by histopathological examination. We then checked whole-body PET-CT, which showed multifocal malignant lesions in the intestine, liver, bone and left supraclavicular lymph node. Although a rare situation, Burkitt's lymphoma should be considered in the differential diagnosis for patients presenting with back and lumbar radicular pain without a prior history of malignancy. Burkitt's lymphoma could be the cause of dumbbell-shape spinal tumor.

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.

A Dumbbell-Shaped Meningioma Mimicking a Schwannoma in the Thoracic Spine

A 50-year-old man presented bilateral hypesthesia on and below the T6 dermatome and paresthesia. Magnetic resonance imaging (MRI) showed an intraspinal extradural tumor, which located from the 6th thoracic vertebral body to the upper margin of the 7th vertebral body, continuing dumbbell-like through the intervertebral foramen into the right middle thorax suggesting a neurogenic tumor (neurofibroma or neurilemmoma). With the patient in a prone position, we exposed and excised the tumor via a one stage posterior approach through a hemi-laminictomy of T6. Histologic examination showed a grade 1 meningothelial meningioma, according to the World Health Organization classification. Initially, we assumed the mass was a schwannoma because of its location and dumbbell shape. However, the tumor was actually a meningioma. Postoperatively, hypesthesia resolved completely and motor power of the leg gradually full recovered. A postoperative MRI revealed no evidence of residual tumor.

Two-Stage Surgery for a Large Cervical Dumbbell Tumour in Neurofibromatosis 1: A Case Report

Spinal neurofibromas occur sporadically and typically occur in association with neurofibromatosis 1. Patients afflicted with neurofibromatosis 1 usually present with involvement of several nerve roots. This report describes the case of a 14-year-old child with a large intraspinal, but extradural tumour with paraspinal extension, dumbbell neurofibroma of the cervical region extending from the C2 to C4 vertebrae. The lesions were readily detected by MR imaging and were successfully resected in a two-stage surgery. The time interval between the first and second surgery was one month. We provide a brief review of the literature regarding various surgical approaches, emphasising the utility of anterior and posterior approaches.

(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.

Staged Operation of a Dumbbell-Shaped Schwannoma in High Cervical Region: Case Report

The authors report a case of high cervical giant dumbbell-shaped schwannoma. A 43-year-old man admitted for the evaluation of gait disturbance and hypesthesia below C2 dermatome for six years. Magnetic resonance imaging showed a large enhancing dumbbell-shaped mass, extending from carotid sheath to craniovertebral junction, and in C1, C2 spinal canal, which causes significant compression of the cervical cord posteriorly. we decided to do staged operations. First, the intraspinal portion was removed in order to decompress the spinal cord from the tumor. Second, residual extraspinal tumor was removed via high cervical retropharyngeal approach. The patient recovered well without any neurological deficit.

A Dumbbell-shaped Thoraco-lumbar Extradural Ganglioneuroma: Case Report

Ganglioneuromas commonly arise from sympathetic ganglia. These neoplasm may be located wherever ganglion cells are normally found from skull base to pelvis including adrenal gland. Ganglioneuromas in spinal cord are very rare. We report a case of dumbbell-shaped extradural spinal ganglioneuroma. A 7-year-old boy was admitted to our hospital with a 20 day-history of both leg pain and a 10 day-history of progressive paraparesis. On magnetic resonance image, there was a dumbbell-shaped extradural spinal cord tumor in T11-L4 level. Two stage operation(First : Laminoplastic laminotomy of T11-L4 to remove the extradural portion of the tumor in the spinal canal, Second : Right retroperitoneal approach for the removal of paraspinal tumor located in L2-3 level) was performed. Pathologic diagnosis was a ganglioneuroma and paraparesis improved postoperatively.

One-stage microsurgical treatment of dumbbell tumors / 中国微创外科杂志

Objective To summarize our experience in microsurgical treatment of dumbbell tumors. Methods The clinical features,surgical approaches,operative techniques and surgical results of 21 cases of dumbbell tumors were analyzed retrospectively.Four surgical approaches were adopted according to the size and location of tumors,including,posterior midline approach(in 7 cases),modified far lateral approach(in 5 cases),posterior midline supplied by anterior cervical approach(in 2 cases)and paramidline approach(in 7 cases). Results In this series,10 cases of tumors were situated in the cervical,6 in thoracic,4 in lumbar and 1 in sacral segment of the spine.Total removal were achieved in 95% (20/21),and subtotal removal in 5%(1/21).Postoperative pathological diagnosis revealed 15 neurinomas,5 spinal meningiomas and 1 metastatic adenocarcinoma.14 cases of meningiomas and 1 metastatic adenocarcinoma were followed up for 1 to 48 months.11 of the 14 patients recovered completely,with 3 of them living daily life independently,4 maintainly radical hypoesthesia,and one having decubital ulcer unhealed.No postoperative malformation and dysfunction of the disposed spine occurred in these patients.Magnetic resonance imaging scans in 11 of the 14 follow-up cases revealed no tumor recurrence,of which inhanced MRI scans were performed in 8 cases. Conclusions dumbbell tumors should be treated by one-stage operation.Microsurgical technique could improve the rate of total removal,and decrease postoperative complications.

Removal of Cervical Dumbbell Schwannoma in a Single Stage by Posterior Approach

Single staged posterior approach was carried out for three patients of dumbbell shaped schwannomas at the cervical region. Gross total resection was achieved in all of the patients, using a modified posterior midline exposure with hemilaminectomy and complete unilateral facetectorny. This exposure provided contiguous intraspinal, foraminal and extraforaminal access delete up to 2-3cm from lateral dural margin. The vertebral artery could be safely preserved from tumor mass. Although the follow up period is short, three patients showed no postoperative cervical spinalies from these operation. Illustrations of this approach with its possible application is discussed.

Modified Transcondylar Approach for a Case of Hypoglossal Neurinoma: Technique

Hypoglossal neurinomas are very rare and those which simultaneously involve the intracranial and extracranial portions are extremely unusual. Using the modified transcondylar approach, the authors successfully removed a dumbbell-shaped hypoglossal neurinoma at the intracranial portion and extending to the anterior upper portion of the axis through the hypoglossal canal. After dividing the cervical musculatures into layers, the vertebral artery was mobilized by opening the foramen transversarium and removing the postero-lateral part of the right occipital condyle, the lateral mass of the atlas and the mastoid tip by means of a small lateral suboccipital craniotomy. This approach offers a wide surgical field and a direct approach to the skull base and upper anterior cervical spine. After total removal of the hypoglossal neurinoma, a very simple supplementary autogenous bone graft was performed between the occipital bone and the lateral mass of the atlas, using the corticocancellous bone fixed with small screws. Postoperatively, the tumor was removed totally and there was no limitation on the cervical rotatory movement. A review of cases of hypoglossal neurinomas and the surgical approaches employed is included in this paper.

Posterior and Anterolateral Approaches in a Single Stage to Dumbbell Tumors of the Spine

The surgical approach to spinal tumors varies not only with the level and location of the tumor, but also with the type and extent of the tumor. Some of the dumbbell neurofibroma(neurilemmoma) can be removed through simple laminectomy, but usually are approached through two separate incisions by two stages. In this report, posterior and anterolateral approaches in a single stage to dumbbell neurofibroma(neurilemmoma) of the spinal region are described. This approach provides full exposure of intra- and paraspinal portions of the tumor, thus permitting safe dissection and total removal. Six patients who underwent this procedure are described to illustrate its application.

Dumbbell-Shaped Hypoglossal Neurinoma: Case Report and One-stage Operation

A case of dumbbell-shaped hypoglossal neurinoma is reported. Neurinomas of the hypoglossal nerve are very rare, only 35 cases reported. Of these cases, most are intracranial and only 7 were dumbbell-shaped with both intracranial and extracranial components. The clinical feature of the patient was marked ipsilateral atrophy of the tongue. Magnetic resonance imaging should be included in the examination of tumors, and great aids in planning the radical removal of the tumor. In this one-stage operation which was modified lateral inferior suboccipital craniectomy, the most important aspect was removal of the posterior wall of anterior condylar canal and lateral mass of C1. This approach requires a thorough understanding of microsurgical anatomy of the region of foramen magnum. Patient's postoperative course was uneventful. The literatures concerning this lesion were reviewed.

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.