Intracapsular Resection of Thoracic Extradural Schwannomas via the Isthmic Approach: Investigation of Clinical Feasibility With 41 Case Series

TL;DR

A new surgical method for removing thoracic spinal tumors shows high success rates with minimal invasiveness and good patient outcomes.

Contribution

The isthmic approach is introduced as a novel minimally invasive method for resecting thoracic extradural schwannomas.

Findings

All 41 patients achieved gross total resection with minimal blood loss and short hospital stays.

The isthmic approach significantly reduced operative time and incision length compared to traditional methods.

Postoperative pain scores improved significantly, indicating effective clinical outcomes.

Abstract

Thoracic spinal canal schwannomas can pose surgical challenges when extending into intra‐ and extra‐foraminal regions and the thoracic cavity. This article aims to elucidate the technical nuances and clinical feasibility of the isthmic approach for treating thoracic extradural schwannomas via intracapsular resection.

The surgical technique was meticulously outlined, and a retrospective analysis of 41 patients who underwent thoracic schwannoma resection via the isthmic approach between January 2014 and August 2022 was conducted. Parameters including gross total resection (GTR) rate, operative duration, estimated blood loss (EBL), incision length, and postoperative hospital stay were evaluated. Preoperative and postoperative neurosurgical functions were assessed using the modified McCormick functional schema and Visual Analogue Scale (VAS).

All patients achieved GTR, with an operative time of 125.37 ± 45.17 min, an average incision length of 6.56 ± 1.04 cm, and an estimated blood loss of 69.88 ± 86.54 mL. The average hospital stay was 6.76 ± 3.73 days. The VAS score significantly decreased postoperatively (preoperative vs. postoperative: 2.10 ± 0.85 vs. 1.32 ± 0.47, p < 0.001).

The isthmic approach via intracapsular resection is a promising method for treating extradural schwannomas extending into intra‐ and extra‐foraminal regions. This approach enhances total tumor resection rates, preserves spinal stability, and significantly reduces operative duration, incision length, and blood loss.

A novel minimally invasive surgical approach, the isthmic approach, was introduced for the treatment of thoracic extradural schwannomas. A retrospective analysis of 41 clinical cases demonstrated that this approach improves total tumor resection rates, preserves spinal stability, and significantly reduces operative time, incision length, and intraoperative blood loss.

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