An Hourglass-Type Spinal Schwannoma Spreading to the Chest Treated with One-Stage Total Removal through Posterior Paravertebral Approach without Opening the Pleural Cavity (Clinical Observation)

Abstract

The article describes the treatment of a 20-year-old patient with a spinal hourglass schwannoma (neurinoma) in the thoracic spine, growing from the right Th3 spinal root, spreading into the thoracic cavity and compressing the apex of the right lung. The introduction presents the frequency of occurrence of such neoplasms among all spinal cord tumors. Complaints, neurological symptoms, neoplasm diagnosis methods and its clinical and radiological manifestations are presented. The article describes stages and techniques of total surgical removal of the spinal hourglass schwannoma through the posterior paravertebral minimally invasive approach without opening the pleural cavity and with using neurophysiological monitoring of spinal cord function performed at the Neurosurgical Clinic of the Novosibirsk Research Institute of Traumatology and Orthopaedics named after Ya.L. Tsivyan. The data of histological examination and MRI control in the early postoperative period are presented. The follow-up was carried out at 6 and 12 months after surgical treatment. The publications describing the surgical treatment of paravertebral tumors through different approaches, the technique of their removal, possible complications and methods of their prevention are analyzed, and the classification according to Eden (1941), which characterizes the type of tumor growth, is presented.

Keywords

• extramedullary tumor of the spinal cord
• schwannoma
• hourglass neurinoma
• thoracic spine
• pleural cavity
• intraoperative neurophysiological monitoring