PDF(Pubmed)
Abstract：
\"Dumbbell\" tumors are described as benign neoplasms presenting both intraspinal and extraspinal extensions, connected through the intervertebral foramen (McCormick, 1996) [1]. About 90 % of such tumors are histologically classified as schwannomas that most frequently arise in the thoracic region (Takamura and et al., 1997) [2]. Diagnosis is usually achieved as soon as the dimensional increase of the intracanal portion results in nerve or spinal cord compression (Ishikawa and et al., 2002) [3]. How to obtain a complete surgical resection of tumors with large or ventrally located extraforaminal components with a minimally invasive approach is still debated (Payer and et al., 2006) [4]. The single-stage posterior removal of the tumor is the most performed approach for lesions presenting with a small extra-foraminal component (Payer and et al., 2006) [4]. However, due to the reduced visual surgical field and poor control of the surrounding structures that could be obtained with an operative microscopic (OM) view, the application of this approach still appears to be limited to lesions with a large extraspinal component. An alternative surgical approach is the lateral transthoracic transpleural approach, which, however, carries greater risks of complications and often requires assistance from a thoracic surgeon. During the last decade, the exoscope was developed as a hybrid optical instrument, standing between the OM and the endoscope, merging the pros and cons of both visualization technologies, providing a wide viewing angle, high-resolution images, and non-monoaxial view. In this work we present a case of a 60-years old male patient with a 6-month history of dorsal pain and mild left limb paresthesia resistant to conservative treatment in which for the first time a single stage exoscopic-assisted (Olympus ORBEYE 4K-3D exoscope) posterior approach was used to remove entirely a thoracic dumbbell schwannoma with large extraspinal involvement.
摘要：
“哑铃”肿瘤被描述为表现为脊柱内和脊柱外延伸的良性肿瘤，通过椎间孔连接(麦考密克，1996)[1]。大约90％的此类肿瘤在组织学上被分类为神经鞘瘤，最常见于胸部区域（Takamura等人。,1997年）[2]。通常，一旦肛门内部分的尺寸增加导致神经或脊髓压迫，就可以进行诊断（Ishikawa等。,2002）[3]。如何通过微创方法对具有大的或位于腹侧的椎间孔外组件的肿瘤进行完整的手术切除仍存在争议（Payer等。,2006年）[4]。单阶段后部切除肿瘤是表现出小的椎间孔外成分的病变的最有效方法（Payer和etal。,2006年）[4]。然而,由于手术视野减少和周围结构的控制不佳，可以通过手术显微镜（OM）视图获得，这种方法的应用似乎仍然仅限于脊柱外成分较大的病变。另一种手术方法是经胸膜侧入路，which,然而,具有更大的并发症风险，并且通常需要胸外科医生的帮助。在过去的十年里，外镜是作为混合光学仪器开发的，站在OM和内窥镜之间，融合了两种可视化技术的优缺点，提供宽视角，高分辨率图像，和非单轴视图。在这项工作中，我们介绍了一名60岁的男性患者，该患者有6个月的背痛病史和轻度的左肢体感觉异常，对保守治疗具有抵抗力，这是首次采用单阶段镜检查辅助（OlympusORBEYE4K-3D出镜）后入路完全切除了胸椎哑铃型神经鞘瘤，并有较大的脊柱外受累。
