Cervical Spine Instability following Resection of Benign Intradural Extramedullary Tumours in Children

Furtado, Sunil V.; Murthy, Ganesh; Hegde, Alangar S.

doi:10.1159/000329626

Cited by 10 publications

(10 citation statements)

References 30 publications

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“…46 For those lesions affecting the foraminal regions, an additional ipsilateral facetectomy might be required. 13,24 Therefore, in view of the increased risks of spinal instability and deformities associated with these radical operations, especially when the cervical or lumbar spine is operated on, reconstructive fusion procedures are usually required. 15,19,38,39,48 One unique anatomical feature of the lamina of the lumbar spine is its relatively wide wedge-shaped interlaminar space, widest at the center while narrowed at either end.…”

mentioning

confidence: 99%

Minimally invasive removal of lumbar intradural extramedullary lesions using the interlaminar approach

Zhu

Ying

Chen

et al. 2015

FOC

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OBJECT Posterior midline laminectomy or hemilaminectomy has been successfully applied as the standard microsurgical technique for the treatment of spinal intradural pathologies. However, the associated risks of postoperative spinal instability increase the need for subsequent fusion surgery to prevent potential long-term spinal deformity. Continuous efforts have been made to minimize injuries to the surrounding tissue resulting from surgical manipulations. The authors report here their experiences with a novel minimally invasive surgical approach, namely the interlaminar approach, for the treatment of lumbar intraspinal tumors. METHODS A retrospective review was conducted of patients at the Second Affiliated Hospital of Zhejiang University School of Medicine who underwent minimally invasive resection of lumbar intradural-extramedullary tumors. By using an operative microscope, in addition to an endoscope when necessary, the authors were able to treat all patients with a unilateral, paramedian, bone-sparing interlaminar technique. Data including preoperative neurological status, tumor location, size, pathological diagnosis, extension of resections, intraoperative blood loss, length of hospital stay, and clinical outcomes were obtained through clinical and radiological examinations. RESULTS Eighteen patients diagnosed with lumbar intradural-extramedullary tumors were treated from October 2013 to March 2015 by this interlaminar technique. A microscope was used in 15 cases, and the remaining 3 cases were treated using a microscope as well as an endoscope. There were 14 schwannomas, 2 ependymomas, 1 epidermoid cyst, and 1 enterogenous cyst. Postoperative radiological follow-up revealed complete removal of all the lesions and no signs of bone defects in the lamina. At clinical follow-up, 14 of the 18 patients had less pain, and patients' motor/sensory functions improved or remained normal in all cases except 1. CONClUSIONS When meeting certain selection criteria, intradural-extramedullary lumbar tumors, especially schwannomas, can be completely and safely resected through a less-invasive interlaminar approach using a microscope, or a microscope in addition to an endoscope when necessary. This approach was advantageous because it caused even less bone destruction, resulting in better postoperative spinal stability, no need for facetectomy and fusion, and quicker functional recovery for the patients. Individualized surgical planning according to preoperative radiological findings is key to a successful microsurgical resection of these lesions through the interlaminar space.

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confidence: 99%

Minimally invasive removal of lumbar intradural extramedullary lesions using the interlaminar approach

Zhu

Ying

Chen

et al. 2015

FOC

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“…Техника и тактика лечения данной патологии разработаны в 80-х годах ХХ века [3,6,31,32]. Боль-шинство нейрохирургов рекомендуют тотальную ре-зекцию опухоли во всех возможных случаях [20,24,26,34]. Также отмечают возможность стерео-таксического радиохирургического лечения ЭМО.…”

Section: Discussionunclassified

“…Необходимость использования минимально инвазивных хирургиче-ских доступов для сохранения ортопедической ста-бильности продемонстрирована S. Furtado и соавт. [20] на основе оценки частоты послеоперационной кифотической деформации у детей после ламин-эктомии на уровне шейного отдела позвоночника.…”

Section: Discussionunclassified

Factors affecting the outcome of surgical management for extramedullary spinal cord tumors: a multicenter study

Byvaltsev¹,

Сороковиков²,

Ларионов³

et al. 2014

Vopr. neirokhir.

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“…These approaches led to problems in terms of large wounds with high infection rates and possible bleeding sources 4,17,18,23 and also predisposed patients to spinal instability 4,25 and deformities, 14,15 like the "swan neck" that was observed especially in young patients who underwent multilevel laminectomy. 7,8 This led to an increase in reports of the use of additional spinal instrumentation to solve this problem. 3,22,25,29 However, with technology advancing, several studies have indicated that it may be possible to achieve an equivalent quality of resection with minimally invasive OBJECTIVE Spinal tumors account for 2%-4% of all tumors of the central nervous system and can be intramedullary, intradural extramedullary, or extradural.…”

Section: Neurosurg Focus 43 (2):e5 2017mentioning

confidence: 99%

Keyhole approaches to intradural pathologies

Mende

Krätzig

Mohme

et al. 2017

Neurosurgical Focus

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OBJECTIVESpinal tumors account for 2%–4% of all tumors of the central nervous system and can be intramedullary, intradural extramedullary, or extradural. In the past, wide approaches were used to obtain safe access to these tumors, as complete resection is the goal in treating most tumor entities. To reduce surgical complications due to large skin incisions and destabilizing laminectomies, minimally invasive approaches were established. In this study, the authors share their experience with mini-open approaches to intradural tumor pathologies.METHODSThe authors retrospectively reviewed cases involving patients with intramedullary and intradural extramedullary lesions treated between 2009 and 2016. They present their surgical mini-open approach to the spinal cord as well as unique characteristics, key steps, and postsurgical complications for specific tumor subgroups (meningioma, neuroma, and intramedullary tumors).RESULTSA total of 245 intradural tumors were surgically treated during the study period. Of these lesions, 151 were intradural extramedullary meningiomas (n = 79) or neuromas (n = 72). Nine (12.5%) of the neuromas were dumbbell neuromas. Ninety-four tumors were intramedullary. The mean age of the patients was 51.4 years, and 53.9% were female. The mean duration of follow-up was 46.0 months.All meningiomas and neuromas could be resected using a mini-open keyhole approach, but only 5.3% of the intramedullary lesions could be accessed using this technique. Of the 94 patients with intramedullary tumors, 76.6% required a laminotomy, 7.4% required a hemilaminectomy, and 10.6% required a 2-level laminectomy. Only 2 of the patients with intramedullary tumors needed stabilization for progressive cervical kyphosis during follow-up. None of the other patients developed spinal instability after undergoing surgery via the mini-open (keyhole/interlaminar) approach. There were significantly more surgery-associated complications in the large exposure group than in the patients treated with the mini-open approach (19.1% vs 9.6%, p < 0.01).CONCLUSIONSIntradural extramedullary and in selected cases intramedullary pathologies may safely be resected using a mini-open interlaminar approach. Avoiding laminectomy, laminotomy, and even hemilaminectomy preserves spinal stability and significantly reduces comorbidities, while still allowing for complete resection of these tumors.

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Cervical Spine Instability following Resection of Benign Intradural Extramedullary Tumours in Children

Cited by 10 publications

References 30 publications

Minimally invasive removal of lumbar intradural extramedullary lesions using the interlaminar approach

Minimally invasive removal of lumbar intradural extramedullary lesions using the interlaminar approach

Factors affecting the outcome of surgical management for extramedullary spinal cord tumors: a multicenter study

Keyhole approaches to intradural pathologies

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