title: Surgical strategy and results of treatment for dumbbell-shaped spinal neurinoma with a posterior approach.
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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Neurosurgery, Shinshu University School of Medicine , Matsumoto , Japan.
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Ito
authors.forename: Tatsuro
authors.initials: T
authors.lastname: Aoyama
authors.forename: Masafumi
authors.initials: M
authors.lastname: Kuroiwa
authors.forename: Tetsuyoshi
authors.initials: T
authors.lastname: Horiuchi
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Hongo
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000453:epidemiology / Q000209:etiology; D009442:Neurilemmoma / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology; D013125:Spinal Neoplasms / Q000601:surgery*; D016896:Treatment Outcome
keywords: dumbbell type; posterior approach; spinal neurinoma; surgical strategy; tumour volume