Currently, there are no standards in surgical treatment of dumbbell-shaped tumors of lumbo-foraminal region.
OBJECTIVE: To evaluate the effectiveness and long-term results of minimally invasive resection of dumbbell-shaped lumbar schwannomas Eden type 2 and 3 combined with transforaminal lumbar interbody fusion and transpedicular stabilization.
METHODS: A retrospective study included 13 patients (8 men and 5 women) with lumbar dumbbell tumors Eden type 2 and 3 who underwent minimally invasive facetectomy through posterolateral anatomical corridor, microsurgical tumor resection and MI TLIF. We analyzed intraoperative parameters, neurological functions (ASIA scale), clinical characteristics (ODI, SF-36), and complications. Resection quality and area of the multifidus muscle were assessed according to MRI data. All patients were followed-up throughout at least 3-year.
RESULTS: Surgery time was 147 min, blood loss - 118 ml, hospital-stay - 7 days. Clinical parameters significantly improved in the follow-up period: ODI score decreased from 72 to 12 (p=0.004), SF-36 PCS increased from 26.24 to 48.51 (p=0.006) and MCS score increased from 29.13 to 53.68 (p=0.002). According to MRI data, no tumor recurrences and severe muscle atrophy (>30%) were observed after 3 years in all cases. Superficial wound infection occurred in 1 (7.7%) case. There were normal neurological functions (ASIA type E) in all patients.
CONCLUSIONS: Minimally invasive facetectomy through posterolateral approach with MI TLIF technology can be used for safe and effective resection of dumbbell-shaped schwannomas Eden type 2 and 3.
В настоящее время отсутствуют стандарты в выборе способа оперативного лечения гантелеообразных опухолей, расположенных в пояснично-фораминальной области.
UNASSIGNED: Оценка эффективности и отдаленных результатов минимально инвазивного удаления гантелеобразных шванном поясничного отдела 2-го и 3-го типов по классификации Eden в сочетании с трансфораминальным поясничным спондилодезом и транспедикулярной стабилизацией (MI TLIF).
UNASSIGNED: В ретроспективное исследование включены 13 пациентов (8 мужчин и 5 женщин) с гантелеобразными опухолями поясничной локализации 2-го и 3-го типов по классификации Eden, которым осуществлялись минимально инвазивная фасетэктомия через заднебоковой анатомический коридор, микрохирургическое удаление опухоли и MI TLIF. Изучались операционные параметры, неврологические функции по шкале ASIA, клинические характеристики (ODI, SF-36), наличие осложнений. По результатам магнитно-резонансной томографии (МРТ) оценивали степень радикальности удаления опухоли и изменения площади многораздельной мышцы. Все пациенты находились под минимальным 3-летним наблюдением.
UNASSIGNED: Средние значения периоперационных данных составили: продолжительность операции 147 мин, объем кровопотери 118 мл, длительность госпитализации 7 дней. В катамнезе установлено значимое улучшение клинических параметров в среднем: функционального состояния по ODI c 72 до 12 (p=0,004), SF-36 PCS с 26,24 до 48,51 (p=0,006) и MCS с 29,13 до 53,68 (p=0,002). По данным МРТ, через 3 года после операции во всех случаях не выявлено рецидивов опухоли, а также выраженной мышечной атрофии (>30%). В 1 (7,7%) случае зарегистрирована поверхностная раневая инфекция. У всех пациентов сохранены нормальные неврологические функции (тип E по шкале ASIA).
UNASSIGNED: Для безопасного, эффективного и радикального удаления гантелеобразных шванном 2-го и 3-го типов по классификации Eden может быть использована минимально инвазивная фасетэктомия из заднебокового доступа с технологией MI TLIF.

Intracranial melanotic schwannoma is quite rare, and involvement of the trigeminal nerve is even rarer. Early diagnosis and surgical excision are the mainstays of management. These tumors have a high tendency to recur and there is high possibility of metastasis. Adjuvant radiotherapy should be considered since the prognosis is uncertain. A 23-year-old man started developing numbness over the left side of the forehead 9 months ago that progressed to involve the ipsilateral cheek. The patient started having diplopia on looking to the left side 8 months ago. His relatives noticed a change in his voice 1 month ago and he developed weakness in the right upper and lower limbs, which was gradually progressive. The patient had slight difficulty swallowing. After examination, we found involvement of multiple cranial nerves with pyramidal signs. Magnetic resonance imaging (MRI) was suggestive of an extra-axial lesion in the left cerebellopontine angle extending into the middle cranial fossa, which was having high T1 and T2 signal loss with contrast enhancement. We achieved near-total excision of the tumor via a subtemporal extradural approach. Trigeminal melanotic schwannoma is a rare occurrence constituting melanin-producing cells and Schwann cells. Rapid progression of symptoms and signs should prompt the suspicion of the possible malignant nature of the pathology. Extradural skull base approaches reduce the risk of postoperative deficits. Differentiating melanotic schwannoma from malignant melanoma is of utmost importance in planning of management.

UNASSIGNED: Spinal dumbbell-shaped tumors are rare, usually benign tumors with intraspinal and paravertebral components connected through intervertebral foramen. Complete excision is often performed through traditional open surgery (TOS). The efficacy and long-term outcomes of minimally invasive surgery (MIS) have not been reported to date in resection of dumbbell-shaped spinal tumors.
UNASSIGNED: The purpose was to evaluate the efficacy and long-term outcomes of minimally invasive resection combined with unilateral transforaminal intervertebral fusion (TIF) through comparing with TOS in the treatment of spinal dumbbell-shaped tumors.
UNASSIGNED: Fifteen patients underwent MIS and 18 patients underwent TOS. Thoracic dumbbell-shaped tumors were directly exposed after removal of costotransverse joints, adjacent rib components, unilateral hemilamina, and facet joints. Lumbar dumbbell-shaped tumors were completely exposed after removal of transverse processes, unilateral hemilamina, and facet joints. Whether for minimally invasive resection or traditional open removal, dumbbell-shaped tumors were completely excised and unilateral TIF was performed to guarantee spinal stability. All patients were followed up for 5 years at least.
UNASSIGNED: The mean length of surgical incision for two groups was 3.47 ± 0.37 vs. 6.49 ± 0.39 cm (p < 0.05). The average duration of the operation was 131.67 ± 26.90 vs. 144.17 ± 23.59 min (p > 0.05). The mean blood loss was 172.00 ± 48.79 vs. 285.83 ± 99.31 ml (p < 0.05). No blood transfusions were required in the two groups. The median length of hospitalization was 6 vs. 10 days (range: 5-8 vs. 7-14 days). The patients of two groups were monitored for an average of 65.93 ± 3.88 vs. 65.78 ± 3.56 months. At 5-year follow-up, all patients presented with normal neurological function (American Spinal Injury Association scale E). The Oswestry Disability Index in the MIS group decreased significantly more than the TOS group. No spondylolisthesis or spinal instability were found in the follow-up period. There was no recurrence of any spinal tumor 5 years after surgery.
UNASSIGNED: Spinal dumbbell-shaped tumors can be safely and effectively treated with minimally invasive resection combined with unilateral TIF. Compared with TOS, MIS offers a reduced length of surgical incision, blood loss, hospital stay, and postoperative pain. This surgical protocol might provide an alternative for the treatment of spinal dumbbell-shaped tumors.