Minimally invasive resection of large dumbbell tumors of the lumbar spine: advantages and pitfalls

Publication date: Available online 5 March 2018
Source:Clinical Neurology and Neurosurgery
Author(s): Fahed Zairi, Camille Troux, Tarek Sunna, Mélodie-Anne Karnoub, Ghassan Boubez, Daniel Shedid
ObjectivesThe surgical management of dumbbell tumors of the lumbar spine remains controversial, because of their large volume and complex location, involving both the spinal canal and the retro peritoneum. While sporadically reported, our study aims to confirm the value of minimally invasive posterior access for the complete resection of large lumbar dumbbell tumors.Patients and MethodsIn this prospective study, we included all consecutive patients who underwent the resection of a voluminous dumbbell tumor at the lumbar spine through a minimally invasive approach, between March 2015 and August 2017. There were 4 men and 4 women, with a mean age at diagnosis of 40.6 years (range 29-58 years). The resection was performed through a trans muscular tubular retractor by the same surgical team. Operative parameters and initial postoperative course were systematically reported. Clinical and radiological monitoring was scheduled at 3 months, 1 year and 2 years.ResultsThe mean operative time was 144 minutes (range 58 to 300 minutes) and the mean estimated blood loss was 250 ml (range 100 to 500 ml). Gross total resection was achieved in all patients. No major complication was reported. The mean length of hospital stay was 3.1 days (range 2 to 6 days). Histological analysis confirmed the diagnosis of grade 1 schwannoma in all patients. The mean follow up period was 14.9 months (range 6 to 26 months), and 5 patients completed at least 1-year follow-up. At 6 months the Macnab was excellent in 6 patients, good in one patient and fair in one patient because of residual neuropathic pain requiring the maintenance of a long-term treatment. No tumor recurrence was noted to dateConclusionLumbar dumbbell tumors can be safely and completely resected using a single-stage minimally invasive procedure, in a trained team.



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