Management of dumbbell tumours. Reports of seven cases

Seven dumbbell tumours were histologically diagnosed as neurilemmoma (4), echinococcus cyst (1), chondrosarcoma (1) or neuroblastoma (1). Radical removal was achieved by thoracotomy and enlargement of the intervertebral foramen in two cases. Thoracotomy and laminectomy were performed on separate occasions in three cases. One patient, in whom the extent of the pathologic process was known preoperatively, underwent concomitant 'minithoracotomy' and laminectomy. Postoperative bleeding required reoperation in one case. The patient with chrondrosarcoma died of local recurrence 16 months postoperatively, and the patient with neuroblastoma died of metastatic spread after 6 years. The five survivors are well. Preoperative recognition of intraspinal extension should be obtainable if a high index of suspicion is maintained in cases of paravertebral tumour. Computed tomography is the diagnostic method of choice. Single-stage removal of the intrathoracic and intraspinal portions of the tumour is desirable. The recommended procedure is posterior minithoracotomy with rib resections for exposure and possibly also laminectomy, with the patient in prone position.