Clinical analysis of dumbbell tumors inside and outside the thoracic spinal canal using microscope assisted resection by costotransverse approach: report of 16 cases
Zhang Jitao*, Chen Jia, Wang Wentao, Li Zheng, Hao Dingjun, Shan Lequn
*Department of Spine Surgery, Xi'an Honghui Hospital Affiliated to Medical College of Xi'an Jiaotong University, Xi'an 710054, China
Abstract：Objective To explore the safety, efficacy and advantages of microscope assisted posterior costotransverse approach resection of dumbbell tumors inside and outside the spinal canal. Methods A retrospective cross-sectional study was conducted. Clinical data of 16 patients with dumbbell tumors inside and outside the thoracic spinal canal in Tangdu Hospital of the Fourth Military Medical University between January 2011 and June 2017 were collected. Among them, there were 10 males and 6 females, aged 20-69 years, with an average of 47.2 years. All the patients were examined by X-ray, CT and MRI. During operation, all the lesion segments were exposed by posterior costotransverse approach. The lateral laminae, facet joints, transverse processes and ribs were resected under microscope. Then microsurgical technique was used to remove the tumors inside and outside the spinal canal in one stage operation following by posterior screw-rod fixation of decompression and fusion segments. To compare the changes of sensory and motor dysfunction between before and after operation. American Spine Injury Association(ASIA) scores was used to assess the neurologic function of the 16 patients. The incidence rate of hemopneumothorax, recurrence rate of tumor and secondary malformation of the 16 patients after operation were observed. Results All the tumors were completely resected in this group. Tumor properties: neurilemmoma in 9 cases, neurofibroma in 3 cases, meningioma in 2 cases, melanoma in 1 case, and osteochondrosarcoma in 1 case. All patients were followed up for 6-36 months. After operation, the symptoms such as nervous radical pain, sensory disturbance, dyskinesia, and sphincter dysfunction were improved obviously. The ASIA score of 3 months postoperative (194.87±36.75) and last follow-up (209.50±19.25) was significantly higher than that before surgery [(179.75±90.45), all P values＜0.01]; And the ASIA sports score after operation (90.56±15.75, 94.56±13.75) was also significantly higher than that of pre-surgery [(83.25±32.75), all P values＜0.01)]. No postoperative pneumothorax occurred and no thoracic closed drainage were placed. There was no recurrence of tumor and secondary spinal deformity at the last follow-up. Conclusions Resection of dumbbell tumors inside and outside the spinal canal can be achieved in one stage by microscope assisted costotransverse approach. After operation, all the symptoms are significantly improved and the nerve function is well recovered. Furthermore, this approach can avoid thoracotomy, thus reduce the surgical trauma and minimize negative influences on the respiratory function. In conclusion, microscope assisted costotransverse approach is safe and effective in surgical treatment of dumbbell tumors inside and outside the spinal canal.
张吉涛, 陈佳, 王文涛, 李政, 郝定均, 单乐群. 显微镜辅助后路经肋横突入路胸椎管内外哑铃形肿瘤切除术16例[J]. 中华解剖与临床杂志, 2018, 23(3): 178-183.
Zhang Jitao*, Chen Jia, Wang Wentao, Li Zheng, Hao Dingjun, Shan Lequn. Clinical analysis of dumbbell tumors inside and outside the thoracic spinal canal using microscope assisted resection by costotransverse approach: report of 16 cases. Chinese Journal of Anatomy and Clinics, 2018, 23(3): 178-183.
Shiraishi T, Hida S, Isayama T, et al. A combined thoracoscopic and posterior-spinal approach for “dumbbell” neurofibroma minimizes the anatomical destruction of the vertebrae: report of a case[J]. Surg Today, 2002, 32(2): 155-158. DOI:10.1007/s005950200010.
[4]
Konno S, Yabuki S, Kinoshita T, et al. Combined laminectomy and thoracoscopic resection of dumbbell-type thoracic cord tumor[J]. Spine(Phila Pa 1976), 2001, 26(6): E130-E134. DOI:10.1097/00007632-200103150-00005.
[5]
Li Y, Wang B, Li L, et al. Posterior surgery versus combined laminectomy and thoracoscopic surgery for treatment of dumbbell-type thoracic cord tumor: a long-term follow-up[J]. Clin Neurol Neurosurg, 2018, 166: 31-35. DOI:10.1016/j.clineuro.2018.01.019.
[6]
Payer M, Radovanovic I, Jost G. Resection of thoracic dumbbell neurinomas: single postero-lateral approach or combined posterior and transthoracic approach?[J]. J Clin Neurosci, 2006, 13(6): 690-693. DOI:10.1016/j.jocn.2005.09.010.
[7]
Grillo HC, Ojemann RG, Scannell JG, et al. Combined approach to “dumbbell” intrathoracic and intraspinal neurogenic tumors[J]. Ann Thorac Surg, 1983, 36(4): 402-407. DOI:10.1016/s0003-4975(10)60477-8.
[8]
McCormick PC. Surgical management of dumbbell and paraspinal tumors of the thoracic and lumbar spine[J]. Neurosurgery, 1996, 38(1): 67-75. DOI:10.1097/00006123-199601000-00017.
[9]
Onesti ST, Ashkenazi E, Michelsen WJ. Transparaspinal exposure of dumbbell tumors of the spine. Report of two cases[J]. J Neurosurg, 1998, 88(1): 106-110. DOI:10.3171/jns.1998.88.1.0106.
[10]
Bousamra M 2nd, Haasler GB, Patterson GA, et al. A comparative study of thoracoscopic vs open removal of benign neurogenic mediastinal tumors[J]. Chest, 1996, 109(6): 1461-1465. DOI:10.1378/chest.109.6.1461.
[11]
Ito K, Aoyama T, Kuroiwa M, et al. Surgical strategy and results of treatment for dumbbell-shaped spinal neurinoma with a posterior approach[J]. Br J Neurosurg, 2014, 28(3): 324-329. DOI:10.3109/02688697.2013.835372.
[12]
McGirt MJ, Garcés-Ambrossi GL, Parker SL, et al. Short-term progressive spinal deformity following laminoplasty versus laminectomy for resection of intradural spinal tumors : analysis of 238 patients[J]. Neurosurgery, 2010, 66(5): 1005-1012. DOI:10.1227/01.neu.0000367721.73220.c9.
[13]
Gu R, Liu JB, Xia P, et al. Evaluation of hemilaminectomy use in microsurgical resection of intradural extramedullary tumors[J]. Oncol Lett, 2014, 7(5): 1669-1672. DOI:10.3892/ol.2014.1949.
[14]
Aich RK, Suman G, Phalguni G, et al. Bone metastasis[J]. J Cancer Res Ther, 2014, 10(2): 413-415. DOI:10.4103/0973-1482.136675.
[15]
Monfardini L, Preda L, Aurilio G, et al. CT-guided bone biopsy in cancer patients with suspected bone metastases: retrospective review of 308 procedures[J]. Radiol Med, 2014, 119(11): 852-860. DOI:10.1007/s11547-014-0401-4.
Ozawa H, Kokubun S, Aizawa T, et al. Spinal dumbbell tumors: an analysis of a series of 118 cases[J]. J Neurosurg Spine, 2007, 7(6): 587-593. DOI:10.3171/SPI-07/12/587.
2018, Vol. 23 
