The results of surgical treatment of dumbbell tumors of the lumbosacral spine

INTRODUCTION. Surgical treatment of dumbbell tumors of the lumbar spine remains a discussible topic due to its complex location, affecting three conventional anatomical zones: the spinal canal, retroperitoneal space and foraminal canal. Many publications on the advantages and disadvantages of various treatment methods prove the need to develop a personalized approach to solving this issue. MATERIALS AND METHODS. The data of 47 (100 %) patients operated on for dumbbell tumors of the lumbosacral spine at the Polenov Neurosurgery Institute – the branch of Almazov National Medical Research Centre in the period from 2015 to 2020 were analyzed, divided into 3 study groups operated using: tubular retractor – 16 (34.4 %), Kaspar wound expander – 15   (31.2 %), Quadrant® wound expander – 16 (34.4 %). The average age of the patients was 48.7 (19–76 years), among them 27 (57.45 %) women and 20 (42.55 %) men. Access to the tumor and its resection were performed using a tubular retractor or a Kaspar wound expander by one surgical team. Patients were observed both face-to-face, with an assessment of neurological status, after 6 and 12 months, and remotely – an analysis of MRI studies after 3, 6, 12, 24 and 36 months. RESULTS. The average surgical intervention time in the tubular retractor group was 125 min, in the Kaspar wound dilator group – 148 min, in the Quadrant® wound dilator group – 134 min, the average blood loss was comparable in both groups and amounted to 210 (80–400 ml). Total tumor resection was achieved in 100 % of cases. The average duration of hospitalization was 6 days. Histological verification of the tumor tissue revealed a 3-to-1 ratio of schwannomas to neurofibromas (35 (74.47 %) schwannomas and 12 (25.53 %) neurofibromas). There was no recurrence of the tumor during the follow-up period. CONCLUSION. Dumbbell tumors of the lumbosacral region can be removed in one step, completely and safely for the patient using minimally invasive methods, regardless of the surgical access technique used.

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