Chirurgisches Management benigner paravertebraler Tumoren – Fallserie und Literaturübersicht

Zusammenfassung

Hintergrund

Benigne paravertebrale Tumoren im Bereich der Brustwirbelsäule sind seltene, meist aus peripheren Nervenwurzeln hervorgehende Läsionen, die häufig als Zufallsbefund entdeckt werden. Trotz ihres benignen Charakters stellen sie aufgrund der Nähe zu Pleura, Spinalkanal und großen Gefäßen eine operative Herausforderung dar.

Patienten und Methoden

Es werden 4 Patientinnen mit benignen paravertebralen Tumoren unterschiedlicher Lokalisation (BWK II–LWK I) vorgestellt, die zwischen 2021 und 2025 operativ behandelt wurden. Das operative Vorgehen umfasste dorsale, retropleurale, anterolaterale und thorakoskopische Zugänge.

Ergebnisse

In allen Fällen konnte eine vollständige Resektion erreicht werden. Neurologische Defizite traten nicht auf. Die histopathologische Untersuchung bestätigte in 3 Fällen ein Schwannom (WHO Grad I), in einem Fall einen benignen fibrösen Tumor. Die Nachuntersuchungen zeigten keine Rezidive.

Schlussfolgerung

Die operative Behandlung benigner paravertebraler Tumoren erfordert ein individuell angepasstes, interdisziplinäres Vorgehen. Thorakoskopische Verfahren (VATS) stellen bei geeigneter Tumorlage eine sichere, gewebeschonende Alternative zur Thorakotomie dar. Bei inoperablen Residuen oder Rezidiven kann die Radiochirurgie eine ergänzende Option bieten.

Abstract

Background

Benign paravertebral tumours of the spine are uncommon lesions, predominantly arising from Schwann cells. Despite their benign nature, their proximity to the spinal canal, pleura, and thoracic vessels makes surgical management challenging.

Methods

We report four cases of benign paravertebral thoracic tumours treated surgically between 2021 and 2025 using different approaches, including dorsal, retropleural, anterolateral, and thoracoscopic techniques.

Results

Complete resection was achieved in all cases without postoperative neurological deficits. Histopathology confirmed three schwannomas (WHO grade I) and one benign fibrous tumour.

Conclusion

An individualised, anatomy-based surgical strategy is crucial. Thoracoscopic approaches (VATS) offer a minimally invasive and safe option for selected cases, while total resection remains the key determinant of long-term tumour control.

Schlüsselwörter

Thorakoskopie - Schwannom - Wirbelsäule

Keywords

schwannoma - spine - thoracoscopy

Publication History

Received: 13 October 2025

Accepted after revision: 16 December 2025

Article published online:
20 January 2026

• Literatur

• 1 Safavi-Abbasi S, Senoglu M, Theodore N. et al. Microsurgical management of spinal schwannomas: evaluation of 128 cases. J Neurosurg Spine 2008; 9: 40-47
• 2 Fehlings MG, Nater A, Zamorano JJ. et al. Risk Factors for Recurrence of Surgically Treated Conventional Spinal Schwannomas: Analysis of 169 Patients From a Multicenter International Database. Spine (Phila Pa 1976) 2016; 41: 390-398
• 3 Schwake M, Maragno E, Gallus M. et al. Minimally Invasive Facetectomy and Fusion for Resection of Extensive Dumbbell Tumors in the Lumbar Spine. Medicina (Kaunas) 2022; 58: 1613
• 4 Schick U, Marquardt G, Lorenz R. Recurrence of benign spinal neoplasms. Neurosurg Rev 2001; 24: 20-25
• 5 Takahashi T, Hirai T, Yoshii T. et al. Risk factors for recurrence and regrowth of spinal schwannoma. J Orthop Sci 2023; 28: 554-559
• 6 Butenschoen VM, Kögl N, Meyer B. et al. A Case Series of Surgically Treated Spinal Dumbbell Tumors of Critical Parent Nerve Roots: To Cut or Not to Cut?. Oper Neurosurg 2021; 20: 260-267
• 7 Vandenbulcke A, D’Onofrio GF, Capo G. et al. Sacrifice of Involved Nerve Root during Surgical Resection of Foraminal and/or Dumbbell Spinal Neurinomas. Brain Sci 2023; 13: 109
• 8 Newman WC, Berry-Candelario J, Villavieja J. et al. Improvement in Quality of Life Following Surgical Resection of Benign Intradural Extramedullary Tumors: A Prospective Evaluation of Patient-Reported Outcomes. Neurosurgery 2021; 88: 989-995
• 9 Viereck MJ, Ghobrial GM, Beygi S. et al. Improved patient quality of life following intradural extramedullary spinal tumor resection. J Neurosurg Spine 2016; 25: 640-645
• 10 Dickman CA, Apfelbaum RI. Thoracoscopic microsurgical excision of a thoracic schwannoma. Case report. J Neurosurg 1998; 88: 898-902
• 11 Han PP, Dickman CA. Thoracoscopic resection of thoracic neurogenic tumors. J Neurosurg 2002; 96: 304-308
• 12 Corazzelli G, Bocchetti A, Filippelli M. et al. Assessing Surgical Approaches and Postoperative Complications for Thoracic Schwannomas: A Multicenter Retrospective Observational Analysis of 106 Cases. Cancers (Basel) 2025; 17: 1177
• 13 Lee MT, Panbehchi S, Sinha P. et al. Giant spinal nerve sheath tumours – Surgical challenges: case series and literature review. Br J Neurosurg 2019; 33: 541-549
• 14 Butenschoen VM, Nehiba A, Meyer B. et al. Neuropathic pain after spinal intradural benign tumor surgery: an underestimated complication?. Neurosurg Rev 2022; 45: 2681-2687
• 15 Schulte TL, Adolphs B, Oberdiek D. et al. Approach-related lesions of the sympathetic chain in anterior correction and instrumentation of idiopathic scoliosis. Eur Spine J 2010; 19: 1558-1568
• 16 Singhatanadgige W, Tangdamrongtham T, Limthongkul W. et al. Incidence and Risk Factors for Lumbar Sympathetic Chain Injury After Oblique Lumbar Interbody Fusion. Neurospine 2024; 21: 820-832
• 17 Hwang L, Okoye CC, Patel RB. et al. Stereotactic body radiotherapy for benign spinal tumors: Meningiomas, schwannomas, and neurofibromas. J Radiosurg SBRT 2019; 6: 167
• 18 Chang UK, Lee DH. Stereotactic radiosurgery for spinal neoplasms: current status and future perspective. J Neurosurg Sci 2013; 57: 87-101
• 19 Sachdev S, Dodd RL, Chang SD. et al. Stereotactic Radiosurgery Yields Long-term Control for Benign Intradural, Extramedullary Spinal Tumors. Neurosurgery 2011; 69: 533-539
• 20 Kalash R, Glaser SM, Flickinger JC. et al. Stereotactic body radiation therapy for benign spine tumors: is dose de-escalation appropriate?. J Neurosurg Spine 2018; 29: 220-225