Minimally Invasive Extirpation of an Eden Type II Dumbbell-Shaped Mediastinal Tumor Using a Posterior and Uniportal Thoracoscopic Approach without Changing the Patient’s Position: A Case Report

TL;DR

A new minimally invasive surgical technique was used to remove a complex chest tumor without repositioning the patient, resulting in faster recovery and good outcomes.

Contribution

A single-stage, minimally invasive approach combining posterior and uniportal thoracoscopic surgery for Eden type II dumbbell-shaped schwannomas is introduced.

Findings

The tumor was successfully removed en bloc without patient repositioning.

The patient had an uneventful recovery and no recurrence at 6 months.

The approach reduced surgical trauma and improved cosmetic outcomes.

Abstract

Dumbbell-shaped posterior mediastinal tumors, most commonly schwannomas, sometimes extend through the intervertebral foramen into the spinal canal and often require a combined posterior and thoracic approach. Although complete resection is essential, reducing surgical invasiveness remains an important clinical priority. We report a case of an Eden type II dumbbell-shaped schwannoma that was successfully resected using a minimally invasive single-stage approach combining posterior surgery and uniportal thoracoscopic surgery, performed entirely in the prone position without intraoperative repositioning.

A 55-year-old man presented with intermittent anterior chest and back pain. Imaging revealed a 20-mm, dumbbell-shaped tumor at the left T9 intervertebral foramen with suspected intradural extension. A single-stage combined posterior and thoracoscopic resection was performed without intraoperative repositioning. Through an 8-cm posterior incision, hemilaminectomy, dural opening, internal decompression, and nerve root transection were conducted, allowing for mobilization of the tumor. Subsequently, a 3-cm uniportal thoracoscopic approach facilitated complete tumor extraction from the mediastinum. The tumor was removed en bloc, and pathology confirmed a benign schwannoma. The postoperative course was uneventful, and the patient was discharged on POD 4. At 6 months, he remained asymptomatic except for mild intercostal numbness, with no radiologic evidence of recurrence.

This case demonstrates the feasibility and efficacy of a minimally invasive technique for Eden type II dumbbell-shaped schwannoma, combining posterior and uniportal thoracoscopic approaches without patient repositioning. This approach reduced surgical trauma, shortened operative and recovery times, and offered excellent cosmetic and clinical outcomes, which may serve as a valuable option for selected patients requiring resection of dumbbell-type mediastinal tumors.

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