An Hourglass-Type Spinal Schwannoma Spreading to the Chest Treated with One-Stage Total Removal through Posterior Paravertebral Approach without Opening the Pleural Cavity (Clinical Observation)
https://doi.org/10.29413/ABS.2020-5.6.18
Abstract
The article describes the treatment of a 20-year-old patient with a spinal hourglass schwannoma (neurinoma) in the thoracic spine, growing from the right Th3 spinal root, spreading into the thoracic cavity and compressing the apex of the right lung. The introduction presents the frequency of occurrence of such neoplasms among all spinal cord tumors. Complaints, neurological symptoms, neoplasm diagnosis methods and its clinical and radiological manifestations are presented. The article describes stages and techniques of total surgical removal of the spinal hourglass schwannoma through the posterior paravertebral minimally invasive approach without opening the pleural cavity and with using neurophysiological monitoring of spinal cord function performed at the Neurosurgical Clinic of the Novosibirsk Research Institute of Traumatology and Orthopaedics named after Ya.L. Tsivyan. The data of histological examination and MRI control in the early postoperative period are presented. The follow-up was carried out at 6 and 12 months after surgical treatment. The publications describing the surgical treatment of paravertebral tumors through different approaches, the technique of their removal, possible complications and methods of their prevention are analyzed, and the classification according to Eden (1941), which characterizes the type of tumor growth, is presented.
About the Authors
I. A. Vasilyev
Novosibirsk Research Institute of Traumatology and Orthopaedics named after Ya.L. Tsivyan
Russian Federation
Russian Federation
Cand. Sc. (Med.), Research Officer at the Department of Neurosurgery, Neurosurgeon at the Neurosurgical Unit N 1
http://orcid.org/0000-0001-6118-5570
Frunze str. 17, Novosibirsk 630091, Russian Federation
I. V. Pendyurin
Novosibirsk Research Institute of Traumatology and Orthopaedics named after Ya.L. Tsivyan
Russian Federation
Cand. Sc. (Med.), Head of the Neurosurgical Unit N 1, Neurosurgeon
Frunze str. 17, Novosibirsk 630091, Russian Federation
Russian Federation
Cand. Sc. (Med.), Head of the Neurosurgical Unit N 1, Neurosurgeon
Frunze str. 17, Novosibirsk 630091, Russian Federation
A. V. Buzunov
Novosibirsk Research Institute of Traumatology and Orthopaedics named after Ya.L. Tsivyan
Russian Federation
Cand. Sc. (Med.), Research Officer at the Department of Pediatric Orthopaedics
Frunze str. 17, Novosibirsk 630091, Russian Federation
Russian Federation
Cand. Sc. (Med.), Research Officer at the Department of Pediatric Orthopaedics
Frunze str. 17, Novosibirsk 630091, Russian Federation
S. V. Tsvetkovskiy
Novosibirsk Research Institute of Traumatology and Orthopaedics named after Ya.L. Tsivyan
Russian Federation
Cand. Sc. (Biol.), Leading Research Officer at the Department of Neurosurgery
Frunze str. 17, Novosibirsk 630091, Russian Federation
Russian Federation
Cand. Sc. (Biol.), Leading Research Officer at the Department of Neurosurgery
Frunze str. 17, Novosibirsk 630091, Russian Federation
E. V. Stupak
Novosibirsk Research Institute of Traumatology and Orthopaedics named after Ya.L. Tsivyan
Russian Federation
Junior Research Officer at the Department of Neurosurgery, Neurosurgeon at the Neurosurgical Unit N 1
Frunze str. 17, Novosibirsk 630091, Russian Federation
Russian Federation
Junior Research Officer at the Department of Neurosurgery, Neurosurgeon at the Neurosurgical Unit N 1
Frunze str. 17, Novosibirsk 630091, Russian Federation
V. V. Stupak
Novosibirsk Research Institute of Traumatology and Orthopaedics named after Ya.L. Tsivyan
Russian Federation
Dr. Sc. (Med.), Professor, Neurosurgeon, Head of the Department of Neurosurgery
Frunze str. 17, Novosibirsk 630091, Russian Federation
Russian Federation
Dr. Sc. (Med.), Professor, Neurosurgeon, Head of the Department of Neurosurgery
Frunze str. 17, Novosibirsk 630091, Russian Federation
References
1. Samartzis D, Gillis C, Shih P, O’Toole JE, Richard GF. Intramedullary spinal cord tumors: Part I. Epidemiology, pathophysiology, and diagnosis. Global Spine J. 2015; 5(5): 425-435. doi: 10.1055/s-0035-1549029
2. Sun IM, Necmettin P. Non-syndromic spinal schwannomas: a novel classification. Front Neurol. 2017; 17(8): 318. doi: 10.3389/fneur.2017.00318
3. Vasilyev IA, Stupak VV, Tsvetkovskiy SB, Pendyurin IV, Selyakova MS, Voronina EI. et al. Late recurrence of spinal cord neuroma after one-stage total excision. Spine Surgery. 2018; (3): 100-105. doi: 10.14531/ss2018.3.100-105. (In Russ.)
4. Pojskić M, Zbytek B, Mutrie CJ, Arnautović KI. Spinal dumbbell epidural hemangioma: two stage/same sitting/same position posterior microsurgical and transthoracic endoscopic resection – case report and review of the literature. Acta Clin Croat. 2018; 57(4): 797-808. doi: 10.20471/acc.2018.57.04.27
5. Rong HT, Fan YS, Li SP, Zhang ZS, Liu H, Liu T, et al. Management of dumbbell and paraspinal tumors of the thoracic spine using a single-stage posterolateral approach: case series. Orthop Surg. 2020; 10(4): 343-349. doi: 10.1111/os.12405
6. Bobinski L, Henchoz Y, Sandu K, Duff JM. Single stage transforaminal retrojugular tumor resection: The spinal keyhole for dumbbell tumors in the cervical spine. Surg Neurol. 2015; 1(6): 53. doi: 10.4103/2152-7806.154453
7. Thorat JD, Rajendra T, Thirugnanam A, Ng IHB. Single-stage posterior midline approach for dumbbell tumors of the thoracic spine, with intraoperative CT guidance. Surg Neurol Int. 2011; 23(2): 31. doi: 10.4103/2152-7806.77272
8. McCormick PC. Surgical management of dumbbell and paraspinal tumors of the thoracic and lumbar spine. Neurosurgery. 1996; 38(1): 67-74.
9. Ando K, Imagama S, Wakao N, Hirano K, Tauchi R, Muramoto A, et al. Single-stage removal of thoracic dumbbell tumors from a posterior approach only with costotransversectomy. Yonsei Med J. 2012; 53(3): 611-617. doi: 10.3349/ymj.2012.53.3.611
10. Stupak VV, Shabanov SV, Pendyurin IV, Rabinovich SS. Results of surgical treatment of patients with extramedullary dumbshell tumors. Spine Surgery. 2014; (4): 65-71. doi: 10.14531/ss2014.4.65-71. (In Russ.)
11. Ando K, Imagama S, Ito Z, Tauchi R, Muramoto A, Matsui H, et al. Removal of thoracic dumbbell tumors through a single-stage posterior approach : its usefulness and limitations. J Orthop Sci. 2013; (18): 380-387.
12. Maeda S, Takahashi S, Koike K, Sato M. Preferred surgical approach for dumbbell-shaped tumors in the posterior mediastinum. Ann Thorac Cardiovasc Surg. 2011, 17(4); 394-396. doi: 10.5761/atcs.cr.10.01537
13. Nzokou A, Weil AG, Shedid D. Minimally invasive removal of thoracic and lumbar spinal tumors using a nonexpandable tubular retractor. J Neurosurg Spine. 2013, 19(6): 708-715. doi: 10.3171/2013.9.SPINE121061
14. Shi J, Ding H, Fu B, Niu N, Yue X, Yang Z, et al. Combined posterior and anterior approaches for resection of thoracolumbar spinal huge dumbbell-shaped tumor. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2016; 30 (2): 183-188.
15. Payer M, Radovanovic I, Jost G. Resection of thoracic dumbbell neurinomas: single postero-lateral approach or combined posterior and transthoracic approach. J Clin Neurosci. 2006; 13(6): 690-693. doi: 10.1016/j.jocn.2005.09.010
16. Prieto R, Santander X, Naranjo JM, Marín E, Corbacho C. Giant dumbbell-shaped thoracic schwannoma in an elderly patient resected through a single-stage combined laminectomy and videoassisted thoracoscopy: surgical strategy and technical nuances. World Neurosurg. 2018; 119(6): 155-162. doi: 10.1016/j.wneu.2018.07.238
17. Sis HL, Mannen EM, Wong BM, Cadel ES, Bouxsein ML, Anderson DE, et al. Effect of follower load on motion and stiffness of the human thoracic spine with intact rib cage. J Biomech. 2016; 49(14): 3252-3259. doi: 10.1016/j.jbiomech.2016.08.003
18. Liebsch C, Graf N, Wilke HJ. Wire cerclage can restore the stability of the thoracic spine after median sternotomy: an in vitro study with entire rib cage specimens. Eur Spine J. 2017; 26(5): 1401-1407. doi: 10.1007/s00586-016-4768-x
Review
For citations:
Vasilyev I.A., Pendyurin I.V., Buzunov A.V., Tsvetkovskiy S.V., Stupak E.V., Stupak V.V. An Hourglass-Type Spinal Schwannoma Spreading to the Chest Treated with One-Stage Total Removal through Posterior Paravertebral Approach without Opening the Pleural Cavity (Clinical Observation). Acta Biomedica Scientifica. 2020;5(6):157-164. (In Russ.) https://doi.org/10.29413/ABS.2020-5.6.18
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