Abstract
A woman in her 30s was incidentally found to have a mass in the lower lung field on a lumbar radiography when she visited a neighborhood clinic for back pain, and was referred to the Department of Respiratory Surgery of our hospital. Chest radiography revealed a well-defined, round mass of approximately 9 cm in diameter in the left lower lung field. Chest CT and MRI demonstrated a dumbbell-shaped tumor, destroying the vertebral body at the ninth intervertebral foramen and extending to the spinal canal. The tumor had not reached the spinal dura mater and was, thus, thought to be a neurilemmoma originating from the proximal intercostal nerve. Single-stage surgery was performed via a simultaneous posterior plus anterior approach. After the nerve root had been treated via the posterior approach, thoracoscopy-assisted thoracotomy with a 10-cm incision was performed through the fifth rib bed. However, one more thoracotomy incision was required because intra-thoracic manipulation was difficult due to the large diameter of the mass and its extensive adhesion, and the thoracoscope was used only as a supplementary approach. The patient's back pain resolved postoperatively. Although thoracoscopy-assisted surgery with an anterior approach is recommended for dumbbell-shaped tumors because it is minimally invasive and safe, we believe that thoracoscopy should be limited to supplementary use.
