Surgical Treatment of Large Abdominally Involved Primary Dumbbell Tumor in the Lumbar Region

Yang, Ming; Wang, Xiaobin; Li, Jing; Xiong, Guangzhong; Lu, Chang; Li, Guohua

doi:10.1097/bsd.0000000000000108

Cited by 11 publications

(13 citation statements)

References 16 publications

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“…3,6 Moreover, data from the literature also support our finding of a strong association between malignant histology and worse prognosis. 11,13,14,19,24,29,35,39,59 PNNST includes different entities, both benign and malignant, that, in our series, showed a higher risk of recurrence compared with BPNST. This finding could be explained by the fact that, of 32 PNNSTs in our series, 13 (40.5%) showed malignant features on histopathology and 5 of these (38.5%) recurred after surgery.…”

Section: Discussionmentioning

confidence: 49%

Tumors of the peripheral nervous system: analysis of prognostic factors in a series with long-term follow-up and review of the literature

Montano¹,

D’Alessandris²,

D’Ercole³

et al. 2016

JNS

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abbreviatioNs BPNST = benign PNST; MPNST = malignant PNST; NF = neurofibromatosis; OS = overall survival; PFS = progression-free survival; PNNST = peripheral non-neural sheath tumor; PNST = peripheral nerve sheath tumor; VAS = visual analog scale. patients (with 173 surgically treated tumors) had adequate follow-up data available for analysis. Pain was assessed using a visual analog scale (VAS), and motor and sensory function were assessed by means of the Louisiana State University grading system. They also analyzed the relationship between tumor recurrence and patient sex, patient age, diagnosis of neurofibromatosis (NF), tumor histopathology, tumor size, tumor location, and extent of resection (subtotal vs gross-total resection), using univariate and multivariate analyses. results There was a statistically significant improvement in the mean VAS pain score (preoperative 3.96 ± 2.41 vs postoperative 0.95 ± 1.6, p = 0.0001). Motor strength and sensory function were significantly improved after resection of tumors involving the brachial plexus (p = 0.0457 and p = 0.0043, respectively), tumors involving the upper limb (p = 0.0016 and p = 0.0016, respectively), BPNSTs (p = 0.0011 and p < 0.0001, respectively), and tumors with dimensions less than 5 cm (motor strength: p = 0.0187 and p = 0.0021 for ≤ 3 cm and 3-5 cm tumors, respectively; sensory function: p = 0.0003 and p = 0.0001 for ≤ 3 cm and 3-5 cm tumors, respectively). Sensory function showed a statistically significant improvement also in patients who had undergone resection of tumors involving the lower limb (p = 0.0118). Total resection was associated with statistically significant improvement of motor strength (p = 0.0251) and sensory function (p < 0.0001). In univariate analysis, a history of NF (p = 0.0034), a diagnosis of MPNST or PNNST (p < 0.0001), and subtotal resection (p = 0.0042) were associated with higher risk of tumor recurrence. In multivariate analysis (logistic regression analysis), a history of NF (OR 9.28%, 95% CI 1.62-52.94, p = 0.0121) and a diagnosis of MPNST (OR 0.03%, 95% CI 0.002-0.429, p = 0.0098) or PNNST (OR 0.081%, 95% CI 0.013-0.509, p = 0.0077) emerged as independent prognostic factors for tumor recurrence. coNclusioNs A total resection should be attempted in all cases of peripheral nervous system tumors (irrespective of the supposed diagnosis and tumor dimensions) because it is associated with better prognosis in term of functional outcome and overall survival. Moreover, a total resection predicts a lower risk of tumor recurrence. Patients with a history of NF and tumors with malignant histology remain a challenge both for neurosurgeons and oncologists due to higher recurrence rates and the lack of standardized adjuvant therapies.

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Section: Discussionmentioning

confidence: 49%

Tumors of the peripheral nervous system: analysis of prognostic factors in a series with long-term follow-up and review of the literature

Montano¹,

D’Alessandris²,

D’Ercole³

et al. 2016

JNS

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“…While the lumbar dumbbell tumors' intraspinal part is taken by posterior approach, big dimensional extraspinal part is especially taken by the anterior approach [62,63]. But, the common iliac vein laceration, renal pedicle avulsions, and massive hemorrhages had been notified by the single-stage anterior approach, in which the total resection of the dumbbell tumor's intraspinal and extraspinal DOI: http://dx.doi.org /10.5772/intechopen.85760 components was planned [64,65]. Therefore, the combined posteroanterior approaches had become a current issue, especially for the big or huge dimensional lumbar dumbbell tumors.…”

Section: Surgical Approach Of the Lumbar Spinal Neurofibromasmentioning

confidence: 99%

“…Park et al had used the "huge" term for the tumors, of which size exceeds 2.5 cm beginning from the extraspinal component's dural margin [66]. On the contrary, many neurosurgeons had notified that using the "huge" tumor term would be more appropriate in the case where the tumor's extraspinal component caused a pushing or pressure in the retroperitoneal and/or internal organs when they were shown by the radiologic examinations [64]. The surgical approaches used in the conditions, in which the lumbar dumbbell tumors' extraspinal component was big, had been notified in limited number in the literature, and not any guideline describing the surgical approaches to be selected according to the tumor's localization and spreading patterns had been notified.…”

Section: Surgical Approach Of the Lumbar Spinal Neurofibromasmentioning

confidence: 99%

“…Then, the cohesiveness of the tumor's extraspinal component with the retroperitoneal and intraabdominal organs is tried to be separated as far as possible by making a blunt dissection, and the extraspinal component is taken by resecting gross totally and/or totally. Sometimes, the debulking can be applied in order to minimize the tumor size in the lumbar dumbbell tumors having a huge extraspinal component [64].…”

Section: Surgical Approach Of the Lumbar Spinal Neurofibromasmentioning

confidence: 99%

“…The principal factor preventing the instability in the thoracic region is originated from a more stable nature of the thoracic spinal axis compared to the cervical and lumbar regions [50,69]. But, the transpedicular stabilization can be made by putting a pedicle screw following the reconstruction made by putting a cage or bone strut to the defective field when the vertebra destruction developed as a result of the tumor pressure in the adjacency of vertebra body observed in the thoracic paravertebral neurofibroma cases showing an extension to the lateral [64]. The fusion with the similar instrumentation is planned since the postoperative instability development risk is high due to the thoracic vertebra scalloping lesions accompanying to the NF1 [70].…”

Section: Spinal Deformity and Instabilitymentioning

confidence: 99%

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Surgical Principles for Spinal and Paraspinal Neurofibromas

Sarica¹

2020

Brain and Spinal Tumors - Primary and Secondary

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Neurofibromas are the most prevalent seen tumor in the neurofibromatosis type 1 (NF1) disease. Spinal neurofibromas, which are the major diagnostic criteria of disease, are seen in approximately 60% of the patients with NF1. They constitute 23% of all of the spinal tumors. While the spinal neurofibromas most frequently show a location in thoracic region, it is followed by their predilection in cervical and lumbar regions, respectively. The spinal neurofibromas located in the sacral region are quite rarely observed and show an asymptomatic course until reaching to the big sizes. Of these spinal neurofibromas, 72% were with intradural extramedullary, 14% with extradural, and 13% with intradural and extradural "dumbbell formation." Only 1% of the spinal neurofibromas are intramedullary located. The total taking of the single solitary neurofibroma surgically is relatively easier. But, the difficulties can be encountered in taking these tumors surgically since they are characterized by the multiple tumors in the plexiform neurofibromas, especially accompanying to the NF1. In this chapter, the surgical difficulties encountered in the region in which the tumor is localized and different surgical approaches are developed in the course of time in order to exceed these difficulties are described.Keywords: dumbbell neurofibroma, dumbbell tumor, neurofibromatosis type 1, NF1, paraspinal neurofibroma, spinal nerve sheath tumor, spinal neurofibroma, surgery, surgical approach, surgical treatment, von Recklinghausen disease Brain and Spinal Tumors -Primary and Secondary 2 single-stage combined posteroanterior approach in order to eliminate the excessive hemorrhage risk arising from the length of surgery duration. In this approach, the dumbbell tumor is firstly taken by the intraspinal component's posterior approach, and then, by giving a certain period, the tumors' extraspinal component is taken by the anterior approach. In time, the lateral approaches applied by using the extensive posterolateral exposure had been described instead of the single-stage or two-stage combined posteroanterior approaches in order to totally take the dumbbell tumors, in which especially huge extraforaminal component is found. A wider visual angle can be provided by the lateral approaches to the spinal channel lateral, intervertebral foramen, and extraforaminal regions, and the tumor can be totally taken in a single session.

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Retrospective analysis of robot‐assisted laparoscopic transabdominal anterior approach for the treatment of lumbar paravertebral schwannoma

Zhao,

Wei,

et al. 2023

Robotics Computer Surgery

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BackgroundThe main objective of this study was to investigate the impact of robot‐assisted laparoscopic resection on paravertebral tumours using the anterior peritoneal approach.MethodsA retrospective analysis to identify patients with paravertebral tumours. A total of 21 patients, who underwent robot‐assisted laparoscopic transabdominal anterior approach surgery from March 2012 to August 2020.ResultsThe median operation time was 66.2 ± 14.5 min, with a range of 0–100 min. Intraoperative blood loss was minimal, with a median of 11.4 ± 7.9 mL and a range of 5–30 mL. The median tumour length was 4.8 ± 2.3 cm, ranging from 2.1 to 11.3 cm. Postoperative hospitalisation lasted for a median of 3.2 ± 0.9 days. During the 48‐month follow‐up period, no tumour recurrence or residual was observed in any patient.ConclusionsRobot‐assisted laparoscopic resection of lumbar paravertebral schwannoma proved to be a safe and viable surgical approach. It offers a relatively new treatment option for paraspinal schwannoma.

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Surgical Treatment of Large Abdominally Involved Primary Dumbbell Tumor in the Lumbar Region

Abstract: The posterior extensive approach is safe and effective to remove the large abdominally involved dumbbell tumors, and also facilitates simultaneously reconstruction of the vertebral body, as compared with the combined posterior and anterior approach.

Cited by 11 publications

References 16 publications

Tumors of the peripheral nervous system: analysis of prognostic factors in a series with long-term follow-up and review of the literature

Tumors of the peripheral nervous system: analysis of prognostic factors in a series with long-term follow-up and review of the literature

Surgical Principles for Spinal and Paraspinal Neurofibromas

Retrospective analysis of robot‐assisted laparoscopic transabdominal anterior approach for the treatment of lumbar paravertebral schwannoma

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