Minimally Invasive Microsurgical Removal of Giant Dumbbell Thoracic Neurofibroma: Usefulness of Current Technology for Minimizing the Approach-Illustrative Case and Technical Video.

Dumbbell-shaped thoracic tumors usually arise from neurogenic elements within the spinal canal and are characterized by involvement of both spinal canal and posterior thoracic cavity. The tumor mass becomes frequently very large growing inside and outside of the spinal canal, through the connection of the neural foramen, involving the surrounding structures. Most of the dumbbell tumors are peripheral nerve sheath tumors, of which neurofibromas and schwannomas represent the vast majority. Gross total resection is considered the treatment of choice and can be achieved through several combined thoracic-neurosurgical approaches. However, these operations have significant approach-related morbidity; therefore, in the last decades, thanks to the constant progress of technological devices, minimally invasive techniques have been increasingly used for the surgical management of spinal tumors. In this surgical video (Video 1), we present a minimally invasive, single-step posterolateral approach through a small costotransversectomy (centered with echography and fitted with spine navigation) for the surgical management of a giant dumbbell thoracic neurofibroma. The usefulness of current technology guiding the surgical procedure is underlined with special emphasis.