Combined Minimally Invasive Approach Using Microsurgery and Thoracoscopic Surgery for Resecting a Dumbbell-Type Thoracic Schwannoma

Abstract

We present a case of a thoracic schwannoma with an intravertebral component, a so-called “dumbbell-type” tumor, that was resected with a combined minimally invasive approach using microsurgery and thoracoscopic surgery simultaneously. A 31-year-old man was admitted to our hospital for treatment of a thoracic schwannoma 45 mm in maximal diameter at the level of the third thoracic vertebra. After the tumor was separated from intravertebral structures by using a microsurgical technique via the posterior approach with a hemilaminectomy and minimal unilateral facetectomy, the mass was removed completely by using video thoracoscopy. We stress that this approach should be the most useful and less invasive technique for treating the dumbbell-type of thoracic neurogenic tumor compared with a single or combination technique involving thoracotomy, multi-level laminectomy and costotransversectomy. Below, we make some notes on this technique from the neurosurgeon’s standpoint.

Thoracic Schwannoma - Nerve Root Tumor - Thoracoscopic Surgery - Minimally Invasive Surgery

References

• 1 Akwari O E, Payne W S, Onofrio B M, Dines D E, Muhm J R. Dumbbell neurogenic tumors of the mediastinum: Diagnosis and management.  Mayo Clin Proc. 1978;  53 353-358
• 2 Citow J S, Macdonald R L, Ferguson M K. Combined laminectomy and thoracoscopic resection of a dumbbell neurofibroma: technical case report.  Neurosurgery. 1999;  45 1263-1265
• 3 Heltzer J M, Krasna M J, Aldrich F, McLaughlin J S. Thoracoscopic excision of a posterior mediastinal “dumbbell” tumor using a combined approach.  Ann Thorac Surg. 1995;  60 431-433
• 4 Konno S, Yabuki S, Kinoshita T, Kikuchi S. Combined laminectomy and thoracoscopic resection of dumbbell-type thoracic cord tumor.  Spine. 2001;  26 E130-134
• 5 Vallieres E, Findlay HJ, Fraser R E. Combined microneurosurgical and thoracoscopic removal of neurogenic dumbbell tumors.  Ann Thorac Surg. 1995;  59 469-472
• 6 Ricci C, Rendina E A, Venuta F, Pescarmona E O, Gagliardi F. Diagnostic imaging and surgical treatment of dumbbell tumors of the mediastinum.  Ann Thorac Surg. 1990;  50 586-589
• 7 Hazelrigg S R, Boley T M, Krasna M J, Landreneau R J, Yim A P. Thoracoscopic resection of posterior neurogenic tumors.  Ann Surg. 1999;  65 1129-1133
• 8 Weder W, Schlumpf R, Schimmer R, Kotulek T, Largiader F. Thoracoscopic resection of benign schwannoma.  Thorac Cardiovasc Surg. 1992;  40 192-194
• 9 Dickman C A, Apfelbaum R I. Thoracoscopic microsurgical excision of a thoracic schwannoma. Case report.  J Neurosurg. 1998;  88 898-902
• 10 Hazelrigg S R, Nunchuck S K, LoCicero J 3rd. Video Assisted Thoracic Surgery Study Group data.  Ann Thorac Surg. 1993;  56 1039-1043
• 11 Riquet M, Mouroux J, Pons F, Debrosse D, Dujon A, Dahan M, Jancovici R. Videothoracoscopic excision of thoracic neurogenic tumors.  Ann Thorac Surg. 1995;  60 943-946
• 12 Sakumoto N, Inafuku S, Shimoji H, Nomura K, Honma K, Kawabata T, Ohta M, Kuniyoshi M, Ishikawa K, Genka K. Videothoracoscopic surgery for thoracic neurogenic tumors: a 7-year experience.  Surg Today. 2000;  30 974-977
• 13 Grillo H C, Ojemann R G, Scannell J G, Zervas N T. Combined approach to “dumbbell” intrathoracic and intraspinal neurogenic tumors.  Ann Thoracic Surg. 1983;  36 402-407
• 14 Osada H, Aoki H, Yokote K, Taira Y, Yamate N. Dumbbell neurogenic tumor of the mediastinum: a report of three cases undergoing single-staged complete removal without thoracotomy.  Jpn J Surg. 1991;  21 224-228