Yonsei Med J.  2012 May;53(3):611-617. 10.3349/ymj.2012.53.3.611.

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

• Ando K
• Imagama S
• Wakao N
• Hirano K
• Tauchii R
• Muramoto A
• Matsui H
• Matsumoto
• Matsuyama
• Ishiguro N

• KMID: 1776998
• DOI: http://doi.org/10.3349/ymj.2012.53.3.611

Abstract

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.

Keyword

Thoracic dumbbell tumor; single-stage surgery; posterior approach; posterior fusion; laminectomy; costotransversectomy

MeSH Terms

Adolescent
Adult
Aged
Female
Humans
Laminectomy
Male
Retrospective Studies
Thoracic Neoplasms/*surgery
Thoracic Vertebrae/*surgery

Figure

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  Fig. 1 (A) A vertical midline incision was made to expose the laminae bilaterally at designated levels and at the transverse process and rib of the costotransverse joint on the affected side. (B) Costotransversectomy at the affected side was resected. (C) An encapsulated smooth surface tumor at the back side was exposed and enucleated to prevent the need for thoracotomy. (D) An enucleated tumor.

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  Fig. 2 Plain radiography of the chest revealed a circular-shaped shadow of the left, upper portion of the lung and left T2 pedicle sign.

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  Fig. 3 MRI showing coronal and axial views of the intraspinal and extraspinal soft tissue mass at T2-T3.

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  Fig. 4 3D-CT showing the relationships between the tumor and peritumoral structures, that is, the aorta, ribs, and vertebrae. (A) From anterior side. (B) From posterior side. 3D-CT, 3-dimensional computed tomography.

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  Fig. 5 MRI at last follow-up showed no relapse.

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  Fig. 6 Plain radiography at last follow-up. (A) Anteriorposterior view. (B) Lateral view.

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