Dumbbell Tumors of the Spine

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The term “dumbbell tumors” is used for separate tumors that connect and are comprise two or more separate regions, such as the intradural space, epidural space, and locations outside the spinal canal. Schwannoma and meningioma are the two most common intraspinal tumors. Ninety percent of spinal dumbbell tumors are schwannomas, and up to 33% of schwannomas have dumbbell form with higher incidence in cervical spine. Non-schwannoma non-neurofibroma dumbbell tumors of the spinal cord include 28 different pathological entities. It is often impossible to differentiate between dumbbell-shaped schwannoma, meningioma, or vascular lesion on MRI of the spine. Vascular lesions are particularly important in differential diagnosis as they can present with bleeding. Eden Classification in four types represents a gold standard. Type I, II and III tumors can be resected via the posterior route; the anterior approach is appropriate for Eden Type IV tumors. The surgical approach is dictated by tumor location and size. Tumors located entirely or partially within the spinal canal can be accessed through the midline posterior approach. When anterior approaches are employed, the operation should be performed in conjunction with surgeons who specialize in the region-specific approaches, such as head and neck, thoracic, and abdominal surgeons. Gross total resection should be performed whenever possible without risk of vascular or neurologic injury, as risk of recurrence rises with subtotal resection. Dumbbell lesions are associated with higher rates of CSF leakage, pseudomeningocoele, and wound infection compared with non-dumbbell spinal nerve sheath tumors, which emphasizes the importance of proper surgical strategy in treatment of these lesions.