Thoracic Dumbbell-shaped Neurinoma Treated by Unilateral Hemilaminectomy with Partial Costotransversectomy —Case Report—

Abstract

A 56-year-old male was admitted in January 1994, with back pain persisting for 2 months. Magnetic resonance imaging disclosed a homogeneously enhanced mass occupying the spinal canal at the T-8 lev el and extending into the retropleural space through the left intervertebral foramen between T-8 and T -9. The diagnosis was a thoracic dumbbell-shaped neurinoma. The tumor was successfully removed through a posterolateral approach using hemilaminectomy and partial costotransversectomy with preservation of ipsilateral joint facets. Histological examination indicated neurinoma. This approach allows excellent visualization of anterior paraspinal components of the tumor, preserves important ana tomic structures, and requires minimal compression of the cord for removal of the lesion.

Surgical Strategies in the Management of Spinal Nerve Sheath Tumors

“…Small tumors are easily resected through hemilaminectomy with or without medial facetectomy. Large lesions require more resection of the bone laterally, such as unilateral total facetectomy, transversectomy, pedicle resection, costotransversectomy, and wide lateral extracavitary approaches (2,18,24,37,47,49 FORUM posterolateral and lateral approaches may require anterior thoracolumbar and retroperitoneal approaches. In contrast to in thoracic spine, exposure of lumbar tumors from the lateral extracavitary approach requires careful mobilization of nerves embedded in substance of psoas muscle to prevent nerve palsy (37).…”

“…Most SNSTs are easily accessible with standard operative approaches and carry a good prognosis. Lesions with large extraspinal extension, ventral tumors, and giant lesions with extensive bony scalloping may require wider or circumferential surgical approaches, spinal stabilization, and multidisciplinary involvement (3,12,16,32,37,45,47,50).…”

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

“…For these reasons, several authors hypothesized that segmental stability may be less compromised with a combined approach than a purely posterior approach with costotransversectomy 6,8,18…”

“…Takamura, et al18 reported that it is essential to individualize preoperative surgical strategies to each patient. In all cases, surgical strategies were devised preoperatively supported by 3D-CT images revealing the relationships between tumors and peritumoral structures, such as arteries, ribs, and vertebrae.…”

Simultaneous Anterior-Posterior Approach Through a Costotransversectomy for the Treatment of Congenital Kyphosis and Acquired Kyphoscoliotic Deformities

“…Costotransversectomy approaches have been used extensively for a variety of purposes, including the treatment of thoracic disc herniations 8 , the excision of spinal neurinomas 10 , and the excision of ventrally based space-occupying intraspinal lesions 11 . Shono et al 12 described a similar procedure for resection of an isolated nonincarcerated hemivertebra causing kyphoscoliosis.…”