title: One-stage resection of giant invasive thoracic schwannoma: case report and review of literature.
abstract: BACKGROUND
  Schwannomas comprise approximately 25% of all spinal tumors, being the third most frequent soft-tissue tumor after hemangiomas and lipomas. Grade 5 invasive giant schwannomas erode the vertebral bodies, involve 2 or more levels, and invade the myofascial planes. Because 3 compartments are involved, these tumors represent a surgical challenge and frequently require staged surgeries with a multidisciplinary surgical team.
  
  
  METHODS
  We report the case of a 62-year-old female who presented with intermittent upper back pain for 3 years. A magnetic resonance imaging scan of the thoracic spine showed a mass invading the vertebral body, pedicle, and lamina of T4 and part of T3 and T5. Needle biopsy confirmed the diagnosis of schwannoma. The patient underwent surgery using a parascapular extracavitary costotransversectomy approach.
  
  
  CONCLUSIONS
  Giant invasive spinal schwannomas are rare in the thoracic spine, and surgical approaches usually have entailed multiple-stage surgeries with the assistance of other surgical specialties. Our 1-stage complete surgical resection of a giant invasive spinal schwannoma used a parascapular costotransversectomy approach that maintained spinal stability and thus avoided the need for instrumentation.
authors.affiliation: Department of Neurosurgery, Ochsner Clinic Foundation, New Orleans, LA ; Department of Neurosurgery, Ochsner Clinic Foundation, New Orleans, LA.
authors.forename: Edison P
authors.initials: EP
authors.lastname: Valle-Giler
authors.affiliation: Department of Neurosurgery, Ochsner Clinic Foundation, New Orleans, LA ; Department of Neurosurgery, Ochsner Clinic Foundation, New Orleans, LA.
authors.forename: Juanita
authors.initials: J
authors.lastname: Garces
authors.affiliation: Department of Neurosurgery, Ochsner Clinic Foundation, New Orleans, LA.
authors.forename: Roger D
authors.initials: RD
authors.lastname: Smith
authors.affiliation: Department of Neurosurgery, Ochsner Clinic Foundation, New Orleans, LA.
authors.forename: Wale A R
authors.initials: WA
authors.lastname: Sulaiman
keywords: Instrumentation; laminectomy; neuroma; spinal fusion