Removal of thoracic dumbbell tumors through a single-stage posterior approach: its usefulness and limitations

The purpose of this study was to evaluate the surgical results of the single-stage surgery only from posterior approach for the management of thoracic dumbbell tumor and to discuss its usefulness and limitations.

Sixteen cases of large thoracic dumbbell tumor (11 men and 5 woman, mean age, 44 years) were analyzed retrospectively. Pathologic findings included schwannoma in 10 patients, neurofibroma in 2 patients (Recklinghausen in 1 patient), meningioma in 2 patients, myxolipoma in 1 and ganglioneuroma in 1. They underwent single-stage removal of dumbbell tumor using the posterior approach followed by laminectomy and often costotransversectomy combined with instrumentation. Clinical and radiologic outcomes are reviewed.

The mean follow-up period for clinical and radiographic outcome variables was 66 months (range, 24-120 months). Operative time ranged from 185 to 420 min (mean, 320 min), with estimated blood loss ranging from 71 to 1830 ml (mean, 540 ml). Postoperative complications were pleural injury during the enucleation of paravertebral tumors, which could be repaired, and the chest tube was detained to prevent postoperative pneumothorax. Postoperative complications included atelectasis in one case. All patients had tumors successfully removed with no neurological deterioration. One patient underwent both posterior and anterior surgery because of attachment to and compression of an artery. We were not able to diagnose this case preoperatively, although a biopsy had been performed.

Single-stage surgery may be a useful method for removing thoracic dumbbell tumors without the combined anterior approach, unless they are attached to and compressing the artery and the diagnosis cannot be made preoperatively.