Background:Thoracic schwannomas are benign nerve sheath tumors that can cause neurological and respiratory symptoms depending on their location and extension. The optimal surgical approach remains debated, particularly regarding resection extent, complication rates, and postoperative morbidity.Methods:This retrospective multicenter study analyzed 106 patients treated between 2011 and 2024, classifying tumors according to the Eden system and comparing surgical strategies. Surgical variables, including operative time, blood loss, resection extent, recurrence rates, and complications classified by Clavien–Dindo, were analyzed.Results:Eden I and II schwannomas were treated with laminectomy (LCT) or hemilaminectomy (HLCT) and transpedicular approaches (TPD), achieving high gross total resection (GTR) rates with minimal complications. Eden III dumbbell tumors benefited from a combined neurosurgical–thoracic approach (LCT + VATS), which resulted in higher GTR rates (100% vs. 62%,p< 0.01) and lower dural complications compared to neurosurgical resection alone. Eden IV extraforaminal schwannomas were best managed with VATS, which was associated with lower intraoperative blood loss (p= 0.018), shorter surgical duration (p= 0.027), and reduced postoperative complications compared to open thoracotomy. Our findings confirm that minimally invasive techniques, particularly VATS and combined neurosurgical–thoracic approaches, optimize tumor resection while reducing morbidity. However, feasibility depends on institutional resources and multidisciplinary collaboration.Conclusions:This study provides a stratified comparison of surgical approaches tailored to Eden classification, aiming to identify the most effective and least morbid strategies for each lesion type. Future prospective studies should validate these findings, integrating preoperative functional assessments and long-term follow-up to better stratify surgical risk, personalize operative planning, and refine surgical decision making for thoracic schwannomas.
背景：胸段神经鞘瘤是一种良性神经鞘肿瘤，其引起的神经及呼吸系统症状取决于肿瘤的位置和扩展范围。目前关于最佳手术入路仍存在争议，特别是在切除范围、并发症发生率及术后发病率方面。 方法：本研究为一项回顾性多中心研究，分析了2011年至2024年间治疗的106例患者，依据Eden分型对肿瘤进行分类并比较不同手术策略。分析了手术相关变量，包括手术时间、术中失血量、切除范围、复发率以及按Clavien–Dindo分级的并发症。 结果：Eden I型和II型神经鞘瘤采用椎板切除术（LCT）、半椎板切除术（HLCT）或经椎弓根入路（TPD）治疗，实现了较高的肿瘤全切率（GTR）且并发症极少。对于Eden III型哑铃状肿瘤，神经外科-胸外科联合入路（LCT + VATS）相较于单纯神经外科切除，获得了更高的GTR率（100% vs. 62%，p < 0.01）和更低的硬膜相关并发症。Eden IV型椎间孔外神经鞘瘤最适合采用电视辅助胸腔镜手术（VATS）处理，与开胸手术相比，VATS术中失血量更少（p = 0.018）、手术时间更短（p = 0.027）、术后并发症发生率更低。我们的研究结果证实，微创技术，特别是VATS和神经外科-胸外科联合入路，能够在降低发病率的同时优化肿瘤切除。然而，其可行性取决于机构资源和多学科协作。 结论：本研究根据Eden分型提供了手术入路的分层比较，旨在为每种病变类型确定最有效且发病率最低的策略。未来的前瞻性研究应验证这些发现，整合术前功能评估和长期随访，以更好地分层手术风险、个体化手术规划，并优化胸段神经鞘瘤的手术决策。
肿瘤(癌症)患者之家