Comparison of the lateral extracavitary and lateral thoracotomy surgical approaches for the treatment of thoracic spinal schwannomas.

Background: Thoracic spinal schwannomas are benign nervesheath tumors that can cause significant neurological impairment. Surgical resection remains the treatment of choice and gold standard for achieving gross total resection and preventing recurrence. The lateral extracavitary approach (LECA) and lateral thoracotomy (LT) are commonly used techniques; however, the relative advantages of these two approaches remain uncertain, and comparative data in the Mexican population are lacking. Methods: We performed a retrospective cohort study of adults undergoing LECA or LT for thoracic spinal schwannoma at the National Cancer Institute of Mexico (2011-2018). Patients were selected according to tumor location, extension, cardiopulmonary tolerance, and surgeon experience, as detailed in the study methods. Demographic, radiological, and perioperative data were collected. Outcomes included tumor size/volume, operative time, estimated blood loss (EBL), length of stay (LOS), pain (Visual Analog Scale, VAS), neurological outcome (American Spinal Injury Association grade), and complications. Statistical significance was set at Results: Forty-three patients were included (LECA Conclusion: In this single-center retrospective cohort, LECA was associated with reduced operative time, blood loss, LOS, and postoperative pain compared with LT. The potential benefits of LECA likely reflect improved exposure and reduced pleural morbidity inherent to the approach, though confounding by tumor size and patient selection cannot be excluded. Given the retrospective design and limited statistical power, findings should be interpreted cautiously and validated in prospective multicenter studies.