Abstract
Background:
Myelopathy and nerve root dysfunction resulting from the imperceptible growth of intraspinal schwannomas have been well documented.[1] Thoracic spine schwannomas, in particular, have exceptional growth potential due to the presence of the posterior mediastinum and retropleural spaces accommodating insidious and often subclinical tumor expansion.[5] Extraspinal extension of these lesions, however, poses a distinct challenge for surgeons.[3,4]
Case Description:
Here, we provide a two-dimensional intraoperative video demonstrating the technical nuances concerning maximally safe resection of a partially cystic thoracic dumbbell schwannoma having extraspinal extension with associated bony remodeling of the T10 vertebral body and neural foramen in a middle-aged male. A posterolateral approach with T8–T12 fusion, retropleural thoracotomy, facetectomies, and pediculectomies allowed for gross total resection. No intraoperative or postoperative complications were observed, and the parietal pleura was kept intact throughout the surgery. In addition, the patient continued to have improved symptoms and was ambulatory at 6-month follow-up.
Conclusion:
Gross total resection of a partially cystic thoracic dumbbell schwannoma was achieved without complications. Our use of a preoperative three-dimensional reconstruction for surgical planning,[2] intraoperative ultrasound,[6] and a durable instrumentation construct were essential for a successful outcome. Moreover, great care was taken to avoid violating the tumor-parietal pleura plane, which would have resulted in postoperative respiratory complications.
Keywords: Intradural tumors, Intraoperative surgical video, Spine neurosurgery, Thoracic dumbbell schwannomas, Vertebral column schwannomas
[Video 1]-Available on:
Annotations[1-6]
00:00 – Clinical presentation.
00:19 – Pre-operative imaging.
00:43 – Key surgical steps.
00:48 – Surgical details.
04:28 – Post-operative imaging.
04:35 – Post-operative course.
Footnotes
How to cite this article: Ojukwu DI, Wilkinson BM, Dawson T, II, Galgano MA. Surgical technique: Posterior retropleural thoracotomy for resection of a T10 dumbbell schwannoma. Surg Neurol Int. 2024;15:15. doi: 10.25259/SNI_921_2023
Contributor Information
Disep I. Ojukwu, Email: disep.ojukwu@gmail.com.
Brandon M. Wilkinson, Email: wilkinsb@upstate.edu.
Timothy Dawson, Email: tcdawsonii@gmail.com.
Michael A. Galgano, Email: michael_galgano@med.unc.edu.
Ethical approval
Institutional Review Board approval is not required.
Declaration of patient consent
Patient’s consent not required as patient’s identity is not disclosed or compromised.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
Use of artificial intelligence (AI)-assisted technology for manuscript preparation
The authors confirm that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript and no images were manipulated using AI.
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Disclaimer
The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Journal or its management. The information contained in this article should not be considered to be medical advice; patients should consult their own physicians for advice as to their specific medical needs.
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