Resection of thoracic dumbbell neurinomas: single postero-lateral approach or combined posterior and transthoracic approach?

Dumbbell tumours are those with an intraspinal and a paraspinal component, connected through a frequently enlarged and eroded intervertebral foramen. Most dumbbell tumours are located in the thoracic spine, and most of them are schwannomas. The extraspinal tumour extension is usually larger than the intraspinal tumour part, but the intraspinal tumour component commonly causes the typical symptoms: local pain and symptoms from spinal cord compression in the thoracic spine. Diagnosis is best established by magnetic resonance imaging with and without contrast agent injection. Controversy exists as to whether to remove thoracic dumbbell tumours using a single posterior approach with posterolateral extension or using a combined posterior and transthoracic approach. We report the removal of a dumbbell neurinoma at T6/7 using a single posterior midline approach with laminectomy and costo-transversectomy and review the literature regarding the approaches to thoracic dumbbell tumours.