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Br J Neurosurg. 2014 Jun;28(3):324-9. doi: 10.3109/02688697.2013.835372. Epub 2013 Sep 12.

Surgical strategy and results of treatment for dumbbell-shaped spinal neurinoma with a posterior approach.

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  • 1Department of Neurosurgery, Shinshu University School of Medicine , Matsumoto , Japan.

Abstract

OBJECTIVE:

Total removal of neurinomas is generally an achievable goal that yields good results; however, dumbbell-shaped neurinomas often present challenges for complete resection. Some extensive surgical approaches for complete removal have been reported to lead to severe complications. Therefore, the surgical strategy for dumbbell-shaped neurinomas is controversial.

METHODS:

Twelve patients with dumbbell-shaped neurinomas were surgically treated in our hospital over 5 years. We adopted a posterior approach to remove the intracanalicular portion of the neurinomas as completely as possible, intentionally leaving the foraminal portion unresected to prevent bony and vascular insult. We investigated the postoperative surgical results and complications and the regrowth rate of the remnant lesions.

RESULTS:

Postoperative residual tumours were identified in 6 of the 12 patients. The perioperative neurological findings between the two groups were almost the same. The recurrence rate was low. Severe surgery-related complications occurred in only one patient with mild and temporary motor weakness.

CONCLUSION:

Our strategy demonstrated low rates of recurrence and complications compared with those accompanying the extensive alternative approaches that have been reported previously. Our case series showed that subtotal removal of dumbbell-shaped neurinomas using a posterior approach is a safer, more effective, and more minimally invasive treatment.

KEYWORDS:

dumbbell type; posterior approach; spinal neurinoma; surgical strategy; tumour volume

[PubMed - indexed for MEDLINE]
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