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

• Published in: Clinical neurology and neurosurgery 2018-05, Vol.168, p.91-96
• Main Authors: Zairi, Fahed, Troux, Camille, Sunna, Tarek, Karnoub, Mélodie-Anne, Boubez, Ghassan, Shedid, Daniel
• Format: Article
• Language: English
• Subjects: Adult; Back pain; Back surgery; Biopsy; Diagnosis; Dumbbell tumor; Female; Hospitals; Humans; Lumbar Vertebrae - surgery; Lumbosacral Region - surgery; Male; Middle Aged; Minimally invasive; Minimally Invasive Surgical Procedures - methods; Neoplasm Recurrence, Local - surgery; Neuralgia; Neurilemmoma - surgery; Neurology; Patients; Peritoneum; Prospective Studies; Schwann cells; Schwannoma; Spinal Cord Neoplasms - surgery; Spine; Spine (lumbar); Surgery; Surgical techniques; Thoracic Vertebrae - surgery; Tumors
• ISSN: 0303-8467; 1872-6968
• DOI: 10.1016/j.clineuro.2018.03.005

•Schwannomas represent the majority of dumbbell tumors.•A prior biopsy is desirable, in young patients or in case of atypical radiological appearance.•The minimally invasive approach allows complete resection in trained hands.•The mini invasive approach allows to limit the iatrogenic instability. The 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. In 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. The mean operative time was 144 min (range 58–300 minutes) and the mean estimated blood loss was 250 ml (range 100–500 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 date. Lumbar dumbbell tumors can be safely and completely resected using a single-stage minimally invasive procedure, in a trained team.