Combined Intrathoracic and Intraspinal Approach to a Neurogenic Dumbbell Tumour.

A neurogenic dumbbell tumour is a rare occurrence in which the tumour has an extension through an intervertebral foramen, acquiring an hourglass shape. Surgical strategies to resect these tumours are rapidly evolving, and there is no definite consensus on the approach, stages, and plan of surgery. Here, we present a case report on a dumbbell tumour that was successfully resected via laminectomy and video-assisted thoracoscopic surgery (VATS) approach. A 53-year-old lady had an incidental finding of a mediastinal mass from chest radiography. Computed tomography (CT) and magnetic resonance imaging (MRI) studies showed a neurogenic mass with extension into the posterior mediastinum via the T1/2 neural foramina. A multi-disciplinary operation was planned for the patient, starting with neurosurgery resecting the intraspinal portion via laminectomy. The posterior mediastinal portion of the mass was resected via the right VATS approach and was successfully resected entirely. Her operation was complicated with a cerebrospinal fluid (CSF) leakage, requiring a revisit surgery. She was subsequently discharged well. Histopathology examination of the resected mass confirmed the diagnosis of schwannoma. Surgical resection of a dumbbell tumour is challenging because it involves both the thoracic and neurosurgical fields. There is currently no consensus on the best way to approach a tumour. Multiple articles have discussed various approaches, such as single-stage versus two-stage surgery, VATS versus open incisions, and the plan or sequence of the surgery. Dumbbell tumours need to be assessed on a case-by-case basis, and a multidisciplinary approach involving both neurosurgery and cardiothoracic surgery in deciding the best surgical approach could ensure a successful resection.