title: Image-guided thoracoscopic resection of thoracic dumbbell nerve sheath tumors.
abstract: BACKGROUND
  Surgical removal of dumbbell nerve sheath tumors (NSTs) remains challenging because these neoplasms occupy ≥ 2 spinal and extraspinal spaces. The presence of intraspinal extension, tumor dimension, and/or its location within the thoracic cavity have previously made the resection of these types of neoplasms difficult.
  
  
  OBJECTIVE
  To describe the feasibility of performing minimally invasive thoracoscopic surgery, as facilitated by an image guidance system (IGS), to achieve gross total resection of select dumbbell NSTs located in the thoracic spine.
  
  
  METHODS
  The 3 cases presented here contained small intraspinal or foraminal components. Preoperative symptoms included Horner syndrome and back and chest wall pain. We used IGS to help guide the complete thoracoscopic resection of select dumbbell NSTs, consisting of extradural, intraforaminal, and paravertebral tumor components, which previously would have been challenging with only a thoracoscopic approach.
  
  
  RESULTS
  IGS provided continuous intraoperative anatomic orientation to achieve gross total resection in all 3 cases. All surgical and postsurgical outcomes were satisfactory; preoperative symptoms improved or resolved; and no adverse events were observed.
  
  
  CONCLUSIONS
  Thoracic dumbbell NSTs that have small intraspinal or foraminal components could be resected thoracoscopically when facilitated by IGS. Image-guided thoracoscopic resection of such dumbbell tumors may not only improve the precision of resection, reduce recurrence, and avoid the need for spinal reconstruction but also obviate the need for more invasive or simultaneous posterior procedures. The IGS enhances the accuracy and safety of 2-dimensional thoracoscopic surgery and may reduce its learning curve.
authors: The Spine Center, Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California, USA.
authors: Samer
authors: S
authors: Ghostine
authors: Shoshanna
authors: S
authors: Vaynman
authors: James Scott
authors: JS
authors: Schoeb
authors: Helen
authors: H
authors: Cambron
authors: Wesley A
authors: WA
authors: King
authors: Srinath
authors: S
authors: Samudrala
authors: J Patrick
authors: JP
authors: Johnson
mesh_terms: D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018317:Nerve Sheath Neoplasms / Q000601:surgery*; D013120:Spinal Cord Neoplasms / Q000601:surgery*; D025321:Surgery, Computer-Assisted / Q000379:methods*; D013899:Thoracic Neoplasms / Q000601:surgery; D013904:Thoracic Vertebrae; D013906:Thoracoscopy / Q000379:methods*