A Novel Less Invasive Technique for the Excision of Large Intradural and Extradural Dumbbell Lumbar Schwannomas: The "Dual Approach".

Abstract

Large schwannomas with intradural and extradural extensions are often challenging surgical lesions. A variety of approaches, usually requiring large exposures, removal of facets and pars interarticularis, and spinal stabilization, have been described. The aim of this study is to describe the "dual approach," a less invasive technique for the excision of these lesions. A large intradural and extradural schwannoma with paraspinal extension (Eden type II) was removed by a unilateral approach-midline, pars and facet sparing and no supplemental instrumentation. Complete excision was achieved through the described approach, with minimal removal of bone and soft tissue disruption. There were no intraoperative or perioperative complications and no evidence of residual tumor or instability/deformity. The dual approach is a novel and unique technique that allows complete and safe removal of large intradural and extradural dumbbell tumors through a less invasive approach and no need for instrumentation.