Spinal Dumbbell Tumors Research Articles

A Complete Facet Resection and Cervical Pedicle Screw Placement Enhances Both Gross Total Resection and Motion Preservation for the Cervical Spinal Dumbbell Tumor

To describe single-index-level fusion surgery using a cervical pedicle screw (CPS) after the complete facet resection of spinal dumbbell tumors and to compare it with partial facet resection without fusion. We retrospectively reviewed patients who underwent surgery for dumbbell-shaped cervical spine tumors. They were categorized into the fused group (complete facet resection with fusion using CPS) and the unfused group (partial facet resection without fusion). We compared demographics, tumor characteristics, resection rates (gross total, subtotal, or partial), and regrowth rates between the groups. Complete facet resection was performed for maximal tumor removal. In the fused group, single-index-level fusion was achieved using CPS. Despite tumor-associated erosion of the index vertebra's pedicle and/or lateral mass, the CPS was directly inserted into the vertebral body through an imaginary virtual pedicle without a lateral mass or pedicle purchase. A total of 34 patients underwent surgery for dumbbell-shaped cervical tumors; half were classified into each group. There were no significant differences in demographic or tumor characteristics, including Asazuma classification, or histological diagnosis (P > 0.05). However, the gross total resection rate was significantly higher in the fused group (16/17, 94.1% vs. 9/17, 52.9%; P value= 0.011). Tumor recurrence was observed in 3 (17.6%) patients in the unfused group; no recurrence (0%) occurred in the fused group. Complete facet resection with fusion using CPS significantly increased the gross total tumor removal rate, compared with partial resection without fusion. Therefore, CPS improved fusion surgery for maximal motion preservation, resulting in single-level fusion surgery.

Uniport video-assisted thoracoscopic surgery for thoracic Eden type IV dumbbell tumor.

Uniport video-assisted thoracoscopic surgery for thoracic Eden type IV dumbbell tumor.

Management of Spinal Dumbbell Tumors via a Minimally Invasive Posterolateral Approach and Carbon Fiber–Reinforced Polyether Ether Ketone Instrumentation: Technical Note and Surgical Case Series

Stand-alone minimally invasive approaches for the surgical management of spinal dumbbell tumors carry the risk of incomplete resections and impaired hemostasis. More-extensive approaches require subsequent instrumentation with metal artifacts impairing follow-up imaging. Here, we present a technical note on percutaneous instrumentation using carbon fiber-reinforced polyether ether ketone (CFR-PEEK) hardware combined with a minimally invasive posterolateral approach for tumor resection. We present a Technical Note and according case series of 7 patients with dumbbell tumors in the lumbar and thoracolumbar spine operated on between 2017 and 2020. CFR-PEEK pedicle screws and rods were inserted percutaneously. Afterwards, a dedicated self-standing retractor for posterolateral approaches was connected to the screws. Following a unilateral facetectomy, the tumor was resected in a microsurgical fashion. Clinical data are reported with respect to the Preferred Reporting Of CasE Series in Surgery (PROCESS) guidelines. Four patients presented with de novo tumors. Three patients were treated for residual tumor mass after previous surgeries. Gross total resection was achieved in all 7 cases, as demonstrated by early postoperative magnetic resonance imaging. Histopathology demonstrated 5 World Health Organization grade I schwannomas, 1 grade II hemangiopericytoma, and 1 cavernous hemangioma. No postoperative complications were observed. CFR-PEEK hardware allowed unambiguous visualization of the resection cavity on follow-up imaging. Resection of dumbbell tumors via a minimally invasive posterolateral approach and instrumentation with CFR-PEEK hardware allows maximal and safe resection. Due to lack of major metal artifacts, carbon fiber hardware improves the interpretation of follow-up imaging as well as planning of radiation if required for tumor recurrence.

A Case Series of Surgically Treated Spinal Dumbbell Tumors of Critical Parent Nerve Roots: To Cut or Not to Cut?

Dumbbell tumors present challenging cases, with either an incomplete tumor resection or a need to sacrifice nerve roots. Published literature suggests encouraging neurological outcomes after nerve root amputation. To determine the incidence of postoperative neurological deficits after amputating the parent nerve root. A retrospective consecutive analysis of all patients treated for dumbbell nerve sheet tumors with a reported amputation of the functional relevant parent nerve roots C5-Th1 and L3-S1. Among 21 evaluated patients, minor postoperative neurological motor function deterioration occurred in 4 patients (19%). Most patients recovered to the preoperative level at the follow-up examination, and only one patient retained a new Medical Research Council (MRC) scale of 4/5 for deltoid weakness. The majority of tumors were resected at the lumbar level (nerve root L3: 28.6%, L5: 19%). Gross total resection was achieved in 90.5% of patients. Neuropathic pain was reported in one third of the patients during the long-term follow-up. Amputating critical parent nerve roots during the dumbbell tumor resections seems to result in a low incidence of postoperative motor deficits and may offer an acceptable sacrifice in otherwise only incompletely resectable dumbbell tumors. The cross-innervation of neighboring nerve roots and its, probably, per-se-reduced functionality may be a possible mechanism for maintaining motor function.

Management of spinal dumbbell tumors via a minimally-invasive posterolateral approach and carbon fiber reinforced PEEK instrumentation: technical note and surgical case series

Management of spinal dumbbell tumors via a minimally-invasive posterolateral approach and carbon fiber reinforced PEEK instrumentation: technical note and surgical case series

Novel Single-Staged Posterior Retropleural Approach with Thoracoscopic Guidance for Resection of a Thoracic Dumbbell Schwannoma.

Dumbbell spinal cord tumors are infrequent pathologic entities. The optimal approach to safe surgical resection is ill-defined and must often be individualized. This is assisted with multiple tumor classification systems. Here, we describe a novel technique used to safely and successfully resect a large thoracic dumbbell schwannoma originating from the left T3 spinal nerve root with extension into the posterior mediastinum adjacent to the parietal pleura and thoracic aorta. A review of the literature was performed to study described surgical approaches to primary spinal dumbbell tumors. The decision-making process and preoperative imaging for operative planning are included. A detailed description of the procedure follows with intraoperative images. Gross total resection with no neurologic sequelae was achieved. Previously described operative techniques for resection of primary spinal dumbbell tumors with advantages and limitations of each are then reviewed. Gross total resection was safely achieved utilizing a single-staged posterior retropleural approach with anterior thoracoscopic guidance. The tumor was removed en bloc through a large posterior window. The prone position was utilized for the entire case with no intraoperative repositioning required. No intraoperative or immediate postoperative complications occurred. We report a novel approach to resecting a large primary spinal dumbbell tumor. A single-stage retropleural approach with anterior thoracoscopic guidance facilitated safe and successful gross total resection. Maintenance of the prone position throughout surgery allowed for reduced operative time, excellent anterior, and posterior visualization and no added patient morbidity. Repositioning to the lateral decubitus position may not be required in select cases.

Clinical Outcome and Prognostic Factors of Malignant Spinal Dumbbell Tumors.

Introduction To investigate the clinical outcome and prognostic factors of malignant spinal dumbbell tumors (m-SDTs). Methods We retrospectively reviewed the clinical outcome of 22 consecutive cases of m-SDTs and analyzed the prognostic factors associated with worse outcome. Results Nineteen of the 22 cases were managed with surgery (86%), and gross total resection (GTR) was achieved in four cases (21%). The duration of overall survival (OS) ranged from 3 to 140 months, with a median survival time of 15.3 months. The 5 year OS rate was 55.6%. In multivariate analysis, histological subtype (high-grade malignant peripheral nerve sheath tumor) (hazard ratio [HR] 14.9, p = 0.0191), GTR (HR 0.07, p = 0.0343), and presence of local recurrences (HR 11.2, p = 0.0479) were significant and independent predictors of OS. Conclusions On the basis of clinical data, we propose that GTR and prevention of local recurrence may improve the clinical outcome of m-SDTs.

Surgical Strategy for Spinal Dumbbell Tumors: A New Classification and Surgical Outcomes.

One hundred twenty-four patients with spinal dumbbell tumors were analyzed retrospectively using a new classification. To recommend a novel classification of spinal dumbbell tumors based on the characteristics of surgical approach. Current classifications of cervical dumbbell tumor are excessively convoluted with an impractical number of variables or lack of quantitative indicators for the choice of surgical approach, and there are few classifications described in the literature which related to thoracic or lumbar dumbbell tumors. An ideal classification must be simple and reproducible based on commonly identified clinical and radiographic parameters. The clinical records of a series of 124 patients with spinal dumbbell tumors were analyzed retrospectively using a new classification. We divided the largest transverse section of the tumor into four areas, and different areas need different surgical procedures. Ninety-two patients were treated using the posterior approach alone, 13 patients underwent surgery by lateral cervical approach, and 19 cases were excised using combined anterior and posterior approach. Tumors total removal was 123 cases, with partial resection in one patient. Concomitant spinal fixation and fusion was performed in 18 patients. A total of 97 cases had follow-up with clinical and radiographic outcome variables ranged from 12 to 52 months (mean, 46.3 months). Eighty-eight patients (90.7%) had clinical improvement, whereas clinical status was the same in seven (7.2%), two patients (2.1%) demonstrated neurologic deterioration, and magnetic resonance imaging at last follow-up revealed no recurrence in any patient. The new classification of spinal dumbbell tumors is a simple way of identifying patients who require a different surgical approach. 4.

Dumbbell Scoring System: A New Method for the Differential Diagnosis of Malignant and Benign Spinal Dumbbell Tumors.

Retrospective diagnostic analysis. The aim of the study was to establish a new scoring system, the dumbbell scoring system (DSS), for preoperative evaluation of the malignant potential of spinal dumbbell tumors (SDTs). Among SDTs, benign tumors such as schwannomas occur frequently, whereas malignant SDTs, including malignant peripheral nerve sheath tumors, are uncommon. No scoring system has been developed to preoperatively diagnose the malignant potential of SDTs. We retrospectively reviewed the records of 59 consecutive patients with SDTs. The following imaging features were recorded: tumor size, tumor shape, tumor boundary, pattern of enhancement of intratumoral lesions (homogeneous or heterogeneous), cyst formation in the tumors on magnetic resonance imaging, and enlargement of neural foramina and scalloping or osteolytic destruction of surrounding bones on computed tomography. The prevalence of characteristic imaging features in malignant and benign SDTs were evaluated, and appropriate cut-off points for the DSS score were obtained using receiver operating characteristics. Twenty cases were confirmed to be malignant tumors. Pathological diagnoses of the malignant SDTs were as follows: 11 cases of malignant peripheral nerve sheath tumor; 3 cases of malignant lymphoma; and 1 case each of extraskeletal Ewing sarcoma, hemangiopericytoma, hemangioendothelioma, malignant myoepithelioma, neuroblastoma, and plasmacytoma. The DSS was based on four characteristic imaging features confirmed as significant predictors of malignant SDTs, namely, maximal diameter greater than 5 cm, irregularly lobulated tumor, tumor boundary indistinguishable from surrounding tissues, and osteolytic bone destruction. Malignant SDTs showed a higher DSS score (median 5.5 points) than did benign SDTs (median 0 point). The optimum cut-off value for the DSS score was 3 points, and the sensitivity and specificity for the diagnosis of malignant SDTs were 90% and 84.6%, respectively. This scoring system may be helpful for preoperative decision making. If the DSS score is equal to or higher than 3, biopsies was recommended to confirm the histological diagnosis. 4.

Microsurgery for spinal dumbbell tumors

Objective To investigate the clinical classification and microsurgical treatment strategies of spinal dumbbell tumors. Methods From January 2008 to December 2014, the clinical manifestations and imaging features of 124 patients with intra-and extra-spinal tumors resected by microsurgery at the Department of Neurosurgery, Tianjin Medical University General Hospital were analyzed retrospectively.Four-zone tumor typing methodwas established to guide the choice of surgical approaches. Fifty-three patients were treated via the simple posterior midline laminectomy approach, 47 via the semi-laminectomy approach, 11 via the combined anterior and posterior approach, 8 via the lateral cervical approach, and 5 via the far lateral approach, in which 89 patients were treated with stage 1 spinal internal fixation or laminoplasty. Results In 124 patients with intra-and extra-spinal tumors, 121 were removed totally, 2 were removed near totally, and 1 was removed partially. Postoperative pathology suggested that 77 patients had neurilemmoma, 15 had neurofibroma, 11 had angiolipoma, 8 had lymphoma, 5 had angioma, 3 had meningioma, 3 had ganglioneuroma, 1 had cavernous hemangioma, and 1 small cell malignant tumor. The main bodies of the cervical tumors were located in the C area in 31 cases, in CB area in 8 cases, in CD area in 13 cases, in CBA area in 6 cases, in CDA area in 3 cases, in CABD area in 1 case, and the thoracic and lumbar tumors were located in C area in 62 cases. No surgical infection, cerebrospinal fluid leakage, and paraplegia patients were observed. They were followed up for 6 months to 3 years after procedure(mean 32.6+ 4.8 months). Postoperative limb motor function and sensory disturbance were improved significantly in 88 cases. There were no significant changes in 6 cases. The patients with new tumor after operation or regional expansion of sensory disturbance were in 3 cases. Conclusions The clinical classification of spinal dumbbell tumors has an important guiding significance for the selection of operative approaches. According to the classification of tumors, using the corresponding operation method may conduct tumor stage 1 total resection. Patients with bone destruction or intraoperative resection of small joints should perform spinal fixation simultaneously in order to maintain the stability of spines. Key words: Spinal cord neoplasms; Spine; Microsurgery

Malignant peripheral nerve sheath tumors presenting as spinal dumbbell tumors: clinical outcomes and characteristic imaging features.

To investigate the clinical outcomes and imaging features of malignant peripheral nerve sheath tumors (MPNSTs) presenting as spinal dumbbell tumors. We retrospectively reviewed the clinical outcomes and imaging features of consecutive cases of spinal dumbbell MPNSTs (n=8) and schwannomas (n=15). A maximal diameter>5 cm was more frequently seen in MPNSTs (88%) than in schwannomas (14%). Irregularly lobulated margins occurred frequently in MPNSTs (75%), but not in schwannomas (21%). Indistinguishable boundaries were observed in 63% of MPNSTs, but only 7% of schwannomas. Osteolytic bone destruction was found exclusively in MPNSTs (50% of MPNSTs vs. 0% of schwannomas). There is little clinical information relating to spinal dumbbell MPNSTs. We propose that the following imaging features are suggestive of spinal dumbbell MPNSTs: maximal diameter>5 cm, irregularly lobulated shape, boundary indistinguishable from surrounding tissues, and osteolytic bone destruction.

Clinical classification and selection of surgical approaches for cervical spinal dumbbell tumors

To explore the clinical classification and selection of surgical approaches for cervical spinal dumbbell tumors. The clinical data of 87 patients with cervical spinal dumbbell tumors undergoing surgical operations from January 2005 to December 2012 at our hospital were analyzed retrospectively. According to the size of inner and outer parts of tumors and the presence or absence of spinal bone damage, the cervical spinal dumbbell tumors were divided into 4 types of intraspinal predominant (I, n = 48), extraspinal predominant (II, n = 1), intrapinal and extraspinal without damage of spinal bone (III, n = 15) and intrapinal and extraspinal type with damage of spinal bone (IV, n = 7). Different surgical approaches were selected on the basis of tumor classification: posterior median-hemilamina approaches for type I tumors, lateral-muscle gap approaches for type II tumors, ateral-muscle gap-hemilamina or lateral-muscle gap-posterior median-hemilamina approaches for type III tumors, posterior far lateral-muscle gap-hemilamina or posterior median-muscle gap-hemilamina approaches plus posterior occipital cervical or cervical spinal bone graft fusion and internal fixation for type IV tumors. Among them, 83 cases underwent total resection and another 4 subtotal resection in one-stage operation. The postoperative follow-up period had a range of 9 months to 6 years (mean, 3.2 years). There was no recurrence of tumors for total resection and 1 case of tumor recurrence for subtotal resection. During the follow-up period, the clinical manifestations of 85 patients improved while another 2 deteriorated. And there was no occurrence of spinal deformity. Clinical classification of cervical spinal dumbbell tumor plays an important guiding role in the selection of surgical approaches. Adopting appropriate surgical approaches based on tumor type can not only improve the rate of total resection of tumor but also reduce the incidence of postoperative spinal deformity.

The Surgical Outcome of Spinal Dumbbell Tumors

The Surgical Outcome of Spinal Dumbbell Tumors

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.

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

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

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.