THE PRINCIPLES OF SURGICAL-MANAGEMENT IN DUMBBELL TUMORS

Objective. Tumors located in posterior mediastinum that extends into s pinal canal via intervertebral foramen are called as Dumb-bell or Sand -glass tumors. Most of these tumors are neurogenic in origin but somet imes other rare tumors can also form in this shape. Herein three neuro genic tumors of the mediastinum that extended into the spinal canal ar e presented Methods. In all patients that have been operated in our cl inic during 1992-1993, we preferred one-stage removal described by Akw ari that consists of posterior laminectomy by neurosurgical team to fr ee the tumor within the spinal cord followed by a posterolateral thora cotomy and excision of the tumor by thoracic surgeons in the same sett ing. Results. All three patients are alive and free of symptoms after 23, 16 and 13 months respectively. According to the pathological exami nations of the specimens in the three patients, the exact diagnosis we re reported as neurofibroma, paraganglioma and pheochromocytoma respec tively. Conclusions. In recent reports, a combined surgical approach i s recommended for dumb-bell neurogenic tumors in posterior mediastinum . We also recommend a combined and one stage removal of dumb-bell neur ogenic tumors if possible. A teamwork of thoracic and neurosurgeons wi ll minimize the morbidity and mortality after the surgical procedure, as well as giving the opportunity to remove the tumor totally in one s ession.