European Journal of Cardio-Thoracic Surgery, Vol 10, 569-573, Copyright © 1996 by European Association for Cardio-thoracic Surgery
The principles of surgical management in dumbbell tumors
M Yuksel, N Pamir, F Ozer, HF Batirel and S Ercan
Department of Thoracic Surgery, Faculty of Medicine, Marmara University, Acibadem Istanbul, Turkey.
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.
