Extended lateral parascapular approach for resection of a giant multi-compartment thoracic schwannoma

Background: Resection of giant thoracic schwannomas is challenging and usually requires a staged approach. The resection of the intraspinal component, usually via laminectomy, is done in one sitting and the intrathoracic component, via thoracotomy, follows at another. We describe the complete resection of a massive multi-compartmental thoracic schwannoma by an extended lateral parascapular approach. Method and findings: The tumor, which presented with local pain and scapular displacement, had intrathoracic paraspinal (10 × 5 × 4 cm), posterolateral upper thoracic paramuscular (19 × 7 × 4 cm), foraminal, and epidural components. It was removed at a single sitting, via a posterior extended lateral parascapular approach that did not require staged procedures, multiple incisions, or repositioning of the patient. This operation included resection of the thoracic, foraminal, and intraspinal components and posterior stabilization with pedicle screws and rods. There were no postoperative neurological complications. Conclusions: The extended lateral parascapular approach allows complete resection of giant multi-compartment schwannomas of the thoracic spine that extend from the canal into the thoracic cavity. It also permits posterior stabilization through the same incision used for tumor removal.