The principles of surgical management in dumbbell tumors

Abstract

OBJECTIVE: Tumors located in posterior mediastinum that extends into spinal canal via intervertebral foramen are called as Dumb-bell or Sand-glass tumors. Most of these tumors are neurogenic in origin but sometimes other rare tumors can also form in this shape. Herein three neurogenic tumors of the mediastinum that extended into the spinal canal are presented METHODS: In all patients that have been operated in our clinic during 1992-1993, we preferred one-stage removal described by Akwari that consists of posterior laminectomy by neurosurgical team to free the tumor within the spinal cord followed by a posterolateral thoracotomy and excision of the tumor by thoracic surgeons in the same setting. RESULTS: All three patients are alive and free of symptoms after 23, 16 and 13 months respectively. According to the pathological examinations of the specimens in the three patients, the exact diagnosis were reported as neurofibroma, paraganglioma and pheochromocytoma respectively. CONCLUSIONS: In recent reports, a combined surgical approach is recommended for dumb-bell neurogenic tumors in posterior mediastinum. We also recommend a combined and one stage removal of dumb-bell neurogenic tumors if possible. A team-work of thoracic and neurosurgeons will minimize the morbidity and mortality after the surgical procedure, as well as giving the opportunity to remove the tumor totally in one session.