Dumbbell Tumors Research Articles

Results of Surgical Treatment of Cervical Dumbbell Tumors

A retrospective study of a new classification and surgical approach of cervical dumbbell tumors. To evaluate PUTH classification. The high recurrence rate and postoperative deformity are unsolved problems. Asazuma's landmark classification could not cover all cases and could not provide clear suggestion for the surgical approach. The ideal classification should be comprehensive, easily understood and of practical value. PUTH classification for cervical dumbbell tumors includes 7 categories (types 1-7) and 2 foraminal modifiers. Posterior approach is appropriate for type 1, 2 and 5 tumors, anterior and anterolateral approach is an ideal choice for type 4 and 6 tumors. Type 7 tumors need combined anterior and posterior approach. Forty-four consecutive patients with cervical dumbbell tumor were surgically treated. The pathology included schwannoma in 31 cases, neurofibroma in 9 and ganglioneuroma in 4. Based on PUTH classification, type 3 was diagnosed in 13 cases, type 5 in 17, type 6 in 8, and type 7 in 6. Tumors were unilateral in 41 cases, and bilateral in 3 cases. Five were tumor revision cases. Thirty patients underwent posterior approach, 7 had anterior approach, 1 had anterolateral approach, and 6 had combined approach. Gross total resection was achieved in all the patients. Tumors involved nerve roots were transected in 12 cases. Single vertebral artery was ligated in 3. The complications included cerebrospinal fluid leakage in 18 cases, esophagus injury in 1, Horner syndrome in 1, dysphagia in 2, dyspnea in 1 and deep infection in 1. Thirty-six cases (81.1%) had an average 61-month follow-up. Recurrence was found in only one case (2.8%). PUTH classification covers all tumor types and is easier to remember. It is practical and useful for determining the surgical approach. The recurrence rate decreases significantly after radial tumor resection. Revision surgeries are associated with more complications.

Upper cervical spinal cord tumors: review of 13 cases

Background.Clinical features of upper cervical spinal cord tumors are not clear because there have been too few published reports. The purpose of this study was to review the clinical features of these tumors. Methods.We reviewed 13 patients who underwent surgery for an upper cervical spinal cord tumor. Data regarding age, sex, duration and type of symptoms, levels, topographical locations, surgical results, and histological features were investigated retrospectively. Results.Of the 13 tumors, 5 were at C1/2, 7 at C2/3 and 1 at C1-3. Topographically, 9 of the 13 tumors were dumbbell shaped, and all 5 at C1/2 had this shape. The initial symptom was occipital pain in three patients, numbness or pain of the extremity in nine, and clumsiness of the upper extremity in one. The average duration from initial symptom to surgery was 14.9 months. There were no major surgical complications, but there were three cases of postoperative cervical kyphosis. These three patients underwent tumorectomy with total laminectomy of C2. Tumor recurrence was seen in three patients for reasons thought to be the same as tumors at other levels, being residual meningiomas lying ventral to the cord and extraforaminal neurinomas. Conclusions.Spinal cord tumors in the upper cervical region tend to progress as dumbbell tumors. As all the neurinomas had this shape (Eden type 2 or 3) at C1/2, this anatomy might favor progression to the extradural and extraforaminal spaces. However, it also allows total removal of the tumor via a posterior approach. To maintain postoperative cervical alignment, the surgeon should select the least invasive approach to the paraspinal muscles attached to the spinous process of C2.

Surgical treatment of dumbbell tumor of the cervical spine

Surgical treatment of dumbbell tumor of the cervical spine

Dumbbell-shaped peripheral primitive neuroectodermal tumor of the spine—case report and review of the literature

Primary spinal peripheral primitive neuroectodermal tumors (pPNETs) are extremely rare. Here, we present a case study of a 29-year-old male with a dumbbell-shaped pPNET at the T9-10 spine level, including details of his examination, surgical procedures applied, histological and genetic findings, and his subsequent treatment. We discuss the clinical course, the pathology and treatment for this disease, the surgical approach to thoracic dumbbell tumors and we review the literature. To our knowledge, this is the first report of a case of a dumbbell-shaped intradural and spinal peripheral PNET.

Microsurgical management of 53 jugular foramen schwannomas: lessons learned incorporated into a modified grading system

Due to the proximity and involvement of critical neurovascular structures, the resection of jugular foramen schwannomas can pose a formidable challenge. The authors review their experience in the microsurgical management of jugular foramen schwannomas and propose a modified grading scale to guide surgical management. All jugular foramen schwannoma cases treated by the senior author (T.F.) between 1980 and 2004 were retrospectively reviewed. The average age at presentation, surgical approach, tumor characteristics, cranial nerve (CN) deficits, and tumor recurrence rates were assessed. The authors present the following modified grading scale: Type A, intradural tumors; Type B, dumbbell-shaped tumors; and Type C, triple dumbbell tumors with a high cervical extension. The authors treated jugular foramen tumors in 129 patients during the study period. Of these, 53 patients (41%) had jugular foramen schwannomas. The mean patient age was 52 years (range 14-74 years); there were 12 male and 41 female patients. The mean follow-up period was 8.4 years. Patients presented most commonly with deficits of the vagus nerve, followed by vestibular/cochlear nerve and glossopharyngeal nerve deficits. Gross-total resection of the tumor was achieved in 48 patients (90.5%). New postoperative paresis in a previously normal CN was not seen; however, worsening of preoperative CN deficits was frequently noted. The highest incidence occurred with the glossopharyngeal and vagus nerves (30%), with 26% of the deficits being permanent. There were no deaths related to surgery in this series. Three patients (5.7%) experienced tumor recurrence. The microsurgical resection of jugular foramen schwannomas carries a risk of worsening preoperative CN deficits; however, these are often transient. Based on their experience, the authors have formulated a grading scale that predicts the optimal surgical approach to these lesions. Considerable technical training and microneuroanatomical knowledge of the region is required. The modified grading scale presented facilitates preoperative planning.

Frontotemporal/Subtemporal Interdural Approach to Middle Fossa-Posterior

Trigeminal schwannomas arising from the gasserian ganglion many a time consist of two components: the body of the tumor in the interdural space of the Meckel's cave and a posterior extension through the porus trigeminus into the subarachnoid space of the posterior fossa. Recent innovations in skull base surgery have facilitated single-stage interdural removal of these dumbbell tumors. The procedure involves a safe peeling of the dura propria (meningeal layer of dura) of the middle fossa from the divisions of the trigeminal nerve with exposure of the lateral wall of the cavernous sinus, opening of the Meckel's cave, and opening of the porus trigeminus into the posterior fossa. From January 1984 to August 2007, out of the 52 patients with trigeminal schwannomas surgically managed, 19 were dumbbell-shaped with both middle and posterior fossa components. Sixteen of these were operated using the extra/interdural approach. Tumor could be radically removed in most of the patients and there was no operative mortality in this group. When the posterior fossa component was small, it could be easily removed through the expanded porus trigeminus without additional anterior petrosectomy. Operative videos of this novel approach will be shown.

Lumbar Spinal Osteoblastoma Mimicking a Dumbbell Radicular Schwannoma

Spinal dumbbell tumors originate from nerve roots, usually growing within the spinal canal, the neural foramen and the extraforaminal compartment in the paraspinal region. We report a case of a 20-year-old man who presented with back pain radiating to his left lower limb mostly when in a supine position. Magnetic resonance imaging of the lumbar spine showed a dumbbell lesion at the L5-S1 neural foramen, with enlargement of the foramen and extension into the left paraspinal compartment. Although MR imaging studies were strongly suggestive of a dumbbell radicular schwannoma, the histological diagnosis was an osteoblastoma of the lumbar spine originating from the left L5 pedicle with intracanalicular, intraforaminal and extracanalicular extension. The presentation, imaging studies, intervention, pathology and differential diagnosis are described.

MINIMALLY INVASIVE THORACOSCOPIC RESECTION OF PARASPINAL NEUROGENIC TUMORS

Abstract Objective: The posterior mediastinum is a common location for benign neurogenic tumors. They are frequently asymptomatic but can present with local compressive or neurological symptoms. Methods: Thoracoscopy is used increasingly over posterolateral thoracotomy for the removal of these lesions. Results: Complete resection of these tumors through a thoracoscopic approach is possible in most cases, but dumbbell tumors present as special challenges, which require a combined thoracoscopic and open posterior approach. Conclusion: In this article, we outline the technique of thoracoscopic resection of paraspinal neurogenic tumors through an operative video and a review of the literature to summarize the surgical outcomes of patients with these lesions.

Combined microneurosurgical and thoracoscopic resection for thoracic spine dumbbell tumors

Combined microneurosurgical and thoracoscopic resection for thoracic spine dumbbell tumors

Single stage complete excision of large thoracic dumbbell schwannoma by modified posterior approach

Background Dumbbell-shaped thoracic neurinomas represent a distinct type of tumor and can involve both the spinal canal and the posterior thoracic cavity. Successful management of posterior mediastinal dumbbell tumors depends on complete resection with adequate exposure. Case Description A 40-year-old woman presented with history of progressive weakness of both lower limbs for 5 months and was bedridden for the last 23 days. Magnetic resonance imaging showed a dumbbell-shaped lesion at the D-6 level, extending through the intervertebral foramen between the D-6 and D-7. Through an elliptical incision on the right side of the D-6, hemilaminectomy was performed, and in addition, resection of the transverse processes of the D-6 and D-7 was performed to gain wide exposure. After initial internal decompression, tumor could be removed completely. Conclusions The present method was easy to perform, secure, and less invasive, and was well tolerated by the patient.

Surgical consideration of the intraspinal component in extradural dumbbell tumors

Background The dumbbell tumor is considered a distinct group of tumors of the spinal nerve sheath owing to its intriguing clinical and radiological characteristics. More than half of dumbbell tumors are completely restricted to the extradural space, although preoperative MRI in some cases suggests the presence of intradural/extradural tumors. The aim of this retrospective investigation is to elucidate the clinical features and to suggest the surgical strategy to reduce the operating time and prevent additional complications in extradural type. Methods The medical records and radiological studies of 7 consecutive cases (4 male, 3 female, mean age 40.4 years) who underwent removal of the intraspinal component of their extradural dumbbell tumors between January 1996 and December 2005 were analyzed. Diagnosis and preoperative evaluation were performed with MRI and myelogram/CTs. Results The relationship of the tumor mass to dural sac in preoperative MRIs was so indistinct as to suggest an intradural mass in 5 cases. We found that extradural portion was covered with an attenuated dura and that the dural ring was invaginated into the intradural portion in these cases. Therefore, the author began with the epidural removal of the intraspinal and extraspinal component, followed by carefully extracting the intradural-like mass. Conclusions In conclusion, we suggest that invagination of the dural ring is the anatomical feature that may be confused with an intradural/extradural tumor during operations for extradural dumbbell tumors. Initial epidural mass removal, extraction of intradural/extradural tumors subsequent to dural opening, and affirmation of presence of intradural tumor remnant could save time during dumbbell tumor surgery.

Endoscopic Resection of Thoracic Paravertebral and Dumbbell Tumors

Endoscopic Resection of Thoracic Paravertebral and Dumbbell Tumors

Spinal dumbbell tumors: an analysis of a series of 118 cases

The authors analyzed a series of 118 cases of spinal dumbbell tumors to elucidate the feature of the tumors. Of 674 cases of spinal cord tumors, the incidence of dumbbell tumors was studied. The tumors were analyzed, and the authors focus on the distribution of age and sex, the pathological diagnoses, their locations, Eden classification, and the surgical methods used. The incidence of dumbbell tumors was 18%. The mean patient age was 43 years, which was younger than that for all spinal cord tumors (mean 50 years). There were 11 patients younger than 10 years of age. The rate of dumbbell tumors in the cervical spine was significantly higher than that of all spinal cord tumors. Fifteen (18%) of the 81 schwannomas were observed in the C-2 nerve root, thus having a higher incidence than those in the other nerve roots. In 99 cases (84%), the tumors were removed through a hemilaminectomy with or without a facetectomy and posterior fusion. Of 118 cases, 69% of the tumors were schwannomas, and malignant tumors were found in 10 cases (8.5%). Seven (64%) of 11 patients younger than 10 years of age had malignant tumors. Three patients older than 10 years of age had malignant tumors, thus accounting for 2.8% of the 107 older patients. The incidence of dumbbell tumors was 18%, and they are not uncommon. Malignant dumbbell tumors were more common in children younger than 10 years of age than in older patients.

Spinal dumbbell tumors: an analysis of a series of 118 cases

Spinal dumbbell tumors: an analysis of a series of 118 cases

Myelopathy in a 6-year-old girl caused by neurofibromatosis Type 1: a case report

Background context Even when there is radiological evidence of spinal involvement, young patients with neurofibromatosis Type 1 (NF-1) seldom have symptoms. We report the case of a child who developed rapidly progressive myelopathy. Purpose To describe a technique used to prevent postoperative spinal deformity and instability, after removal of a dumbbell-shaped tumor in a 6-year-old child. Study design Case report. Patient sample A 6-year-old female. Methods Retrospective case review. Results The patient underwent a resection of the cervical dumbbell tumor using an osteoplastic laminectomy technique to prevent postoperative spinal deformity. At 2-year follow-up, there was no clinical or radiographic evidence of complications or spinal kyphotic deformity. Conclusions The case of a 6-year-old girl with cervical myelopathy caused by NF-1 was reported. The tumor was removed after osteoplastic laminectomy, which could prevent postoperative kyphotic deformity.

Recurrent intracranial solitary fibrous tumor initially diagnosed as hemangiopericytoma

We describe a case of an intracranial solitary fibrous tumor that recurred three times consecutively in an 11-year period. A 72-year-old man presented with a headache and gait disturbance. Magnetic resonance imaging (MRI) revealed a dumbbell tumor at the left tentorium. The tumor was removed but recurred. The first diagnosis was hemangiopericytoma, but all specimens showed a "patternless pattern" and few reticulin fibers, which features were not compatible with hemangiopericytoma. All tumors showed immunoreactivity for CD34 and bcl-2. These results point to a solitary fibrous tumor (SFT) and not to hemangiopericytoma. We present here a hypercellular spindle-cell tumor that was very similar to hemangiopericytoma but is better diagnosed as SFT.

Continuous EMG Recordings and Intraoperative Electrical Stimulation for Identification and Protection of Cervical Nerve Roots During Foraminal Tumor Surgery

Spinal cord function is now routinely monitored with somatosensory evoked potentials (SEPs) and motor evoked potentials (MEPs) during surgery for intraspinal cervical dumbbell and foraminal tumors. However, upper extremity nerve roots are also at risk during these procedures. Anatomic relations are frequently difficult to interpret because the nerve roots may be displaced by the tumor. We used electrical stimulation with compound muscle action potential (CMAP) recordings at multiple sites to identify the location and course of the involved nerve root and to provide real-time information regarding the functional status of the roots to predict postoperative outcome. Ten patients were monitored during surgery for cervical dumbbell or foraminal tumors. SEPs and MEPs were monitored as a routine procedure. CMAPs were recorded from needle electrodes placed in the deltoid, biceps, triceps, and flexor carpi ulnaris muscles. Spontaneous electromyography (EMG) muscle activity was also continuously monitored. A handheld monopolar stimulation electrode was used to elicit evoked EMG responses to identify and trace the course of nerves in relation to the tumor. In four patients, the stimulation threshold was tested before and after tumor resection to predict postoperative nerve root function. Electrical stimulation with CMAP recording was successful in localizing nerve roots during tumor resection in all 10 patients. Monitoring predicted postoperative nerve root preservation after tumor removal in each case. It was possible to identify either by using low-level stimulation (<2.0 V) or by observing changes in spontaneous EMG amplitude if activation was present during surgical dissection. The monitoring of spontaneous muscle activity in response to direct or indirect surgical manipulation during tumor resection also provided continuous assessment of nerve root function and identified any physiologic disturbance induced by surgical manipulation. Electrical stimulation in the operating field and recording of CMAPs facilitated nerve root identification and predicted postoperative function during dissection and separation from ligamentous or neoplastic tissue in 10 patients. Electrical stimulation might also be useful to predict postoperative preservation of function when nerve root sacrifice is necessary and no motor response is detected intraoperatively.

副咽頭間隙に生じたダンベル型神経鞘腫の１例

A case of schwannoma extending from the parotid gland to the parapharyngeal space is presented. The patient was a 53-year-old woman. She was referred to us because of a swelling under the left auricle. CT scanning and MRI revealed a tumor extending from the deep lobe of the parotid gland into the parapharyngeal space, compressing the stylomandibular tunnel. This tumor was referred to as a “dumbbell tumor” because of its special shape. Such tumors are rare. The tumor was removed by an extraoral and mandibular swing approach. The histopathological diagnosis was schwannoma with a mixture of Antoni type A and B components. After sugery, no evidence of recurrence has been observed to date.

Ewing's Sarcoma in the Spinal Nerve Root: A Case Report and Review of the Literature

Ewing's sarcoma (ES) is a highly malignant tumor composed of uniform small round cells. Recently, a single biologic entity, Ewing's sarcoma family of tumors (ESFT) has been accepted. The entity includes ES, extraskeletal Ewing's sarcoma (EES) and primitive neuroectodermal tumor (PNET). ESFT cells have immunoreactivity for CD99, an antigen determined by the MIC2 gene. Most ESFT has the (11;22) (q24;q12) translocation. The translocation results in the fusion of the EWS gene with the transcription factor gene FLI1 which has been considered a hallmark of ESFT. We present an extremely unusual case with ESFT in a spinal nerve root mimicking a neurogenic dumbbell tumor. A male aged 20 years noticed pain in his right buttock. Magnetic resonance imaging (MRI) revealed a mass in the right L5/S intervertebral foramen and the lesions in the sacrum. Surgery was performed with a presumptive diagnosis of a nerve sheath tumor. At surgery, the tumor was located in the right L5 nerve root sleeve. The sacral lesions were observed closely. At one month after surgery, radiologically multiple lesions were detected in the pelvic bones. Microscopically the lesions from the root and ilium were composed of small round cells immunoreactive for CD99. Reverse transcription-polymerase chain reaction detected transcripts resulting from the fusion of the EWS gene with FLI1 genes in the iliac lesion. Immunoreactivity for CD99 and detection of the EWS-FLI1 hybrid transcripts are important for the correct diagnosis of ESFT arising in an unusual location.

Diagnosis and treatments of multi-level spinal dumbbell tumor

Diagnosis and treatments of multi-level spinal dumbbell tumor