Combined surgical treatment of a giant peripheral nerve tumors of the “hourglass type” of the right cost-vertebral cornar

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Abstract

Paravertebral tumors of mediastinal localization — an extensive group of pathological processes, the surgical treatment of which is carried out by doctors of various specialties, such as neurosurgeons and surgical oncologists. Currently, thoracoscopic removal is considered to be the most preferred method of surgical treatment of these mass formations, in view of the least trauma, fewer complications, and a reduction in the time of postoperative recovery of patients. A clinical case of surgical treatment of a patient with a giant paravertebral tumor originating from the 4th thoracic root is presented. The tumor was an incidental finding during routine fluorography. There were no focal neurological symptoms. Taking into account the topographic and anatomical features of the volumetric formation, the patient underwent a combined two-stage surgical intervention, where the first stage was laminectomy and removal of the foraminal component of the tumor from the posterior approach, the second stage was single-port video-assisted thoracoscopic removal of the mediastinally located tumor fragment. The operation was performed under conditions of a collapsed lung on the side of the intervention. In the postoperative period, no neurological deficit was noted; according to the control introscopy, the tumor was removed completely. According to the results of histological examination – neurofibroma (Grade I).

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About the authors

Angelina V. Gorodnina

A.L. Polenov Russian Neurosurgical Institute — a Branch of Almazov National Medical Research Centre

Author for correspondence.
Email: angelinagorodnina@gmail.com

Neurosurgeon of Neurosurgery Department No. 1, Reseacher of Research Laboratory of Spinal and Peripheral Nervous System Neurosurgery

Russian Federation, Saint Petersburg

Andrei V. Kudziev

A.L. Polenov Russian Neurosurgical Institute — a Branch of Almazov National Medical Research Centre

Email: andro_p@gmail.com

Neurosurgeon of Neurosurgery Department No. 1

Russian Federation, Saint Petersburg

Aleksandr S. Nazarov

A.L. Polenov Russian Neurosurgical Institute — a Branch of Almazov National Medical Research Centre

Email: nazarow_alex@mail.ru

MD, PhD, Chief of Neurosurgery Department No. 1

Russian Federation, Saint Petersburg

Dar’ya E. Malyshok

A.L. Polenov Russian Neurosurgical Institute — a Branch of Almazov National Medical Research Centre

Email: dashadzhil@gmail.com

Neurologist of the Department of Clinical neurophysiology

Russian Federation, Saint Petersburg

Аndrei Yu. Оrlov

A.L. Polenov Russian Neurosurgical Institute — a Branch of Almazov National Medical Research Centre

Email: andrei@mail.ru

MD, PhD, Dr. Med. Sci., Head of the Department of Clinical neurophysiology

Russian Federation, Saint Petersburg

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Supplementary files

Supplementary Files
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1. Fig. 1. MRI of the thoracic spine, coronal view, the tumor is indicated by an arrow

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2. Fig. 2. MRI of the thoracic spine, sagittal (a) and coronal (b) projections, the tumor is indicated by arrows

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3. Fig. 3. MSCT of the thoracic spine, sagittal (a) and axial (b) projection. The tumor is indicated by arrows, the excavation of the posterior-right parts of the Th vertebral body and the right arch is visualized

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4. Fig. 4. Operations steps: а – position on the operational table during the thoracoscopic stage of the operation; b – operation is performed from one port (access point)

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5. Fig. 5. Intraoperative photo: performing the thoracoscopic stage, the collapsed lung is indicated by the white arrow, the tumor is indicated by the black arrow

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6. Fig. 6. The tumor was removed en bloc

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7. Fig. 7. MSCT of the thoracic spine after surgery. The Th5 arch defect is visualized on the 3D reconstruction (a, arrow), the space at the site of the removed tumor, hemostatic clips (b, arrow)

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8. Fig. 8. Histological picture of neurofibroma. The photograph shows a tumor of the peripheral nerve from cells with small oval nuclei and well-defined cellular processes, structures like “grated carrots” are demonstrated. Staining with hematoxylin and eosin, ×100

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Copyright (c) 2022 Gorodnina A.V., Kudziev A.V., Nazarov A.S., Malyshok D.E., Оrlov А.Y.

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