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  • Title: Giant "Dumbbell" Thoracic Schwannoma: Radical Excision of Rare Lesion in One Surgical Time by Combined Neurosurgical and Thoracoscopic Approach.
    Author: Corazzelli G, Natale G, Cioffi V, Di Colandrea S, Fiorelli A, de Falco R, Bocchetti A.
    Journal: World Neurosurg; 2024 Apr; 184():38-39. PubMed ID: 38185456.
    Abstract:
    Dumbbell-shaped schwannomas are slow-growing tumors that are typically benign lesions. They account for 6%-14% of spinal neoplasms, with 30% having intradural and extradural components.1 A schwannoma is considered "giant" if it extends beyond the spine by >2.5 cm and involves more than 2 vertebral levels.2 The Eden classification categorizes these tumors into 4 types on the basis of the primary component.3 Surgery is recommended for individuals experiencing prolonged nerve damage and persistent neurogenic pain that cannot be managed.2 There are 3 surgical options for managing thoracic dumbbell schwannomas4: the single-stage posterior-only approach,5 the single-stage anterior-only approach,6 and the single-stage combined posteroanterior neurosurgical and video-assisted thoracoscopic approach. The latter option allows for the most comprehensive lesion control including vascular and nerve structures and optimal hemostasis control. It also avoids spinal instrumentation and provides certainty for complete tumor removal.7Video 1 shows a surgical procedure performed on a 58-year-old woman to remove a thoracic dumbbell neurinoma. The patient consented to the procedure and publication of her image. A simultaneous thoracoscopic and neurosurgical approach was performed. The surgical team successfully removed the schwannoma, and the patient's recovery was smooth, with no neurologic issues or pain. This case highlights the benefits of using a single-stage combined approach for treating Eden II and Eden III giant dumbbell thoracic schwannomas.
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