Efficacy of One‐stage Paravertebral Approach using a Micro‐Tubular Technique in Treating Thoracic Dumbbell Tumors

Abstract

The aim of the present study was to investigate the feasibility and efficacy of one-stage surgical resection of thoracic dumbbell tumors using a paravertebral approach and a micro-tubular technique.Methods: Clinical data of thoracic dumbbell tumors resected using a paravertebral approach and a micro-tubular technique (14 mm, non-expandable type) in the Department of Neurosurgery at our hospital from July 2014 to July 2019 were retrospectively analyzed. Tumors were found between T1 and T12 vertebrae. Operation time, blood loss, hospitalization, recovery of neurological function, complications, the Japanese Orthopaedic Association (JOA) score, and the visual analogue scale (VAS) score were used to evaluate clinical efficacy.Results: In all 31 cases, tumors were completely resected in one operation, with a mean blood loss of 53.23 AE 33.08 mL (20-150 mL) and a mean operation time of 95.16 AE 20.31 min (60-180 min). According to the Eden classification, there were four type II cases, 16 type III cases, and 11 type IV cases. The incidence of tumors in the lower thoracic segment (T8-T12) was 51.6% (16/31 cases), while the incidences in the upper thoracic segment (T1-T4) and middle segment (T5-T8) were 25.8% (8/31 cases) and 22.6% (7/31 cases), respectively. Pathological diagnoses were schwannoma (n = 22), gangliocytoma (n = 4), metastatic tumor (n = 2), neurofibroma (n = 1), granuloma (n = 1), and lipoma (n = 1). After surgery, symptoms were relieved in all patients. VAS and JOA scores significantly improved (P < 0.001). There was no pleural or lung injury, and there were no complications, such as cerebrospinal fluid leakage. The average follow-up duration was 29 months (13-59 months), during which time no tumor recurrence or spinal instability occurred. The group of Eden type II tumors had lower JOA scores at 12 months postoperatively, longer operation times, and more estimated blood loss compared with other groups (P < 0.05). There were no significant influences on VAS scores at 12 months postoperatively and postoperative hospital stay from the different types of tumors. Conclusion:The paravertebral approach with a micro-tubular technique is a safe and effective minimally invasive surgical approach for thoracic dumbbell tumors that allows one-stage tumor resection using a single incision. Using this approach significantly reduces intraoperative blood loss and postoperative complications, shortens hospital stay, and reduces the rates of postoperative spinal instability.

Comparison of the Clinical Efficacy of Transforaminal Endoscopy and Microtubular Technology for the Treatment of Lumbar Dumbbell-Shaped Tumors

“…We have previously performed intraspinal subdural schwannoma and thoracic dumbbell tumor resections using the microtubular technique, and we have also attempted lumbar dumbbell tumor resection under spinal endoscopy. 9,15,16 For Eden type III-IV lumbar tumors with a single segment and a maximum diameter of < 5 cm, both PTET and PAMT achieved 1-stage total resection. In PTET approach, the tumor resection procedure extends from the paravertebral tumor to the intraspinal canal tumor.…”

“…In addition, patients have been reported to recover slowly, suffer from chronic low back pain, and have limited lumbar movement after open surgery. We have previously performed intraspinal subdural schwannoma and thoracic dumbbell tumor resections using the microtubular technique, and we have also attempted lumbar dumbbell tumor resection under spinal endoscopy [ 9 , 15 , 16 ].…”

Feasibility and efficacy of spinal microtubular technique for resection of lumbar dumbbell-shaped tumors

“…completed GTR of subdural extramedullary schwannomas using a tubular retractor (6 cases) or unilateral hemilaminectomy (18 cases) ( 10 ). We have previously performed GTR of 56 subdural extramedullary schwannomas under the tubule ( 11 ) and also performed 31 resections of thoracic dumbbell-shaped tumors (Eden II-IV) under the micro-tubule ( 12 ). Thavara et al.…”

Clinical evaluation of paraspinal mini-tubular technique vs. laminoplasty for spinal intradural extramedullary tumors: Study protocol for a multicenter, randomized controlled trial

“…Among the available spinal surgeries with different indications, a "standard surgical procedure" for treating spinal IDEM tumors has not been determined. Owing to the development of minimally invasive spine surgery (MISS), the paraspinal minitubular technique (PMTT) has been introduced for treating IDEM tumors (5)(6)(7). Most studies reported that tubular spine surgeries reduced the volume of estimated blood loss (EBL) and shortened the length of hospital stay.…”