Effectiveness of radical resections in malignant dumbbell tumors of the thoracic spine: Review of three cases

We report postoperative evolution and prognosis after radical en bloc resection of three dumbbell-shaped neurogenic tumors. It was a malignant schwannoma in all cases. Patients were observed from 8 to 27 months postoperatively. All tumors were completely excised, with histologically controlled extratumoral resection limits. The surgical technique used is the one developed by the authors for extended Pancoast Tobias resections. The patients had been operated on previously with possible local contamination, and the previous surgical wound needed to be excised with the tumor en bloc. The patients died 8, 12, and 27 months postoperatively. This short series of three malignant dumbbell tumors dramatically shows that prognosis is undoubtedly more related to inadequate previous resection and to the tumor malignancy than to the surgical technique itself. The authors consider that the combined anteroposterior approach is the most efficient technique with minimum complications, even in major multilevel resections. Indications for such extended surgery include the inability to use adjuvant therapy and impending neurologic deficit.