Combined minimally invasive resection of thoracic neurogenic dumbbell tumors: A European case series

Abstract

Background Paraspinal tumors are rare neoplasms arising from neurogenic elements of the posterior mediastinum and surgical resection can be challenging. Here, we demonstrate feasibility and outcomes from the first European case series of combined laminectomy and video‐assisted thoracoscopic surgery (VATS) resection of thoracic neurogenic dumbbell tumors. Methods A retrospective review of all combined thoracic dumbbell tumor resections performed at our institution between March 2015 to February 2019 was undertaken. Outcomes included operative time, blood loss, length of stay and recurrence rate. Statistical analysis was performed with SPSS statistics (v26). Values are given as mean ± standard deviation and median ± interquartile range. Results Seven patients were included in the case series and there were no major complications or mortality. Mean tumor size and operative time were 66 (± 35) mm and 171 (± 63) min, respectively. Median blood loss and length of stay were 40 (± 70) ml and four (± 3) days, respectively. One patient required conversion to thoracotomy to remove a tumor of 135 mm in maximal dimension. Histology in all seven cases confirmed schwannoma. There was no disease recurrence at a maximum follow‐up of 54 months. Conclusions Our experience demonstrates favorable operative times, minimal blood loss and short length of stay when dealing with relatively large tumors compared to previous reports. Thoracotomy may be required for tumors exceeding 90 mm and chest drain removal on the operative day can facilitate early mobility and discharge. We advocate a combined, minimally invasive laminectomy and VATS resection as the gold‐standard approach for thoracic neurogenic dumbbell tumors.

Endobronchial ultrasound-guided transbronchial needle aspiration as a diagnostic modality for schwannoma: A case report

“…[ 17 ] Some tumors grow across the intervertebral foramen, with one side of the tumor located in the mediastinum or thoracic cavity, and the other side in the spinal canal, growing in a dumbbell shape, connected by an enlarged intervertebral foramen, with resorption or destruction of adjacent bone. [ 4 ] Schwannomas occurring in the spinal canal are generally well-defined and exhibit characteristic target and nerve access signs, in addition to positive signs of foraminal enlargement. [ 19 ] For mediastinal neurogenic tumors that are a challenge to diagnose using CT, MRI can provide useful diagnostic information.…”

“…[ 16 ] Surgical excision is the preferred treatment for schwannomas. [ 2 , 4 ] Preoperative diagnosis facilitates disease management and prompts further clinical measures. For patients who require surgical treatment, a definitive diagnosis will provide guidance for the choice of surgical approach (e.g., thoracotomy, thoracoscopy, cervicotomy, laminectomy).…”

“…Most schwannomas, however, are benign and usually grow slowly; as such, for a malignant peripheral nerve sheath tumor to arise from a schwannoma is extremely rare. [3] Surgical excision is the preferred treatment for schwannomas [2,4] and the prognosis is favorable, with a typical 5-year survival rate of 97% after surgery. [5] The use of computed tomography (CT), magnetic resonance imaging (MRI), and/or positron emission tomography-CT (PET-CT) enables a precise preoperative diagnosis and the design of an appropriate surgical treatment strategy.…”

“…Most schwannomas, however, are benign and usually grow slowly; as such, for a malignant peripheral nerve sheath tumor to arise from a schwannoma is extremely rare. [ 3 ] Surgical excision is the preferred treatment for schwannomas [ 2 , 4 ] and the prognosis is favorable, with a typical 5-year survival rate of 97% after surgery. [ 5 ]…”

“…For patients who require surgical treatment, a definitive diagnosis can guide the choice of surgical approach. [ 2 , 4 , 6 ] Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has conventionally been used to diagnose mediastinal and hilar lesions and to stage malignancies, [ 7 ] but is less commonly used for neurogenic tumors. In particular, the use of EBUS-TBNA to diagnose schwannomas has not been frequently reported.…”