Extramedullary Intradural Spinal Tumors: a Review of Modern Diagnostic and Treatment Options and a Report of a Series

Arnautović, Kenan I.; Arnautovic, Aska

doi:10.17305/bjbms.2009.2755

Cited by 83 publications

(74 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…1,3,7,17,18 A traditional approach to lumbar intradural schwannomas involves a midline incision, bilateral muscle dissection, and removal of the posterior spinal elements. 2,3,6,14,33 Consequently, this approach might increase risks of postoperative spinal instability. Efforts have been made to improve the surgical technique from extensive laminectomy and facetectomy, to laminoplasty, hemilaminectomy, or even semihemilaminectomy.…”

Section: Discussionmentioning

confidence: 99%

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

Zhu

Ying

Chen

et al. 2015

FOC

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 99%

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

Zhu

Ying

Chen

et al. 2015

FOC

View full text Add to dashboard Cite

show abstract

“…The exact reason for this difference in extent of resection is unclear, although complicated involvement of multiple nerve roots with potential for local invasion into surrounding structures, including extradural compartments and the sacrum, may contribute to difficulties in obtaining GTR for myxopapillary ependymomas in advanced stages. 6,9,62,65,77,[80][81][82] Furthermore, while classic ependymomas of the spinal cord may be encapsulated with well-delineated borders making then amenable to microsurgical en bloc GTR, myxopapillary ependymomas of the cauda equina or filum terminale may be intimately associated with neural structures, requiring piecemeal resection and making complete microsurgical GTR more difficult. One study, for example, has shown that encapsulated myxopapillary ependymomas removed en bloc had a recurrence rate of 10%, while those removed either piecemeal or subtotally had a recurrence rate of 19%.…”

Section: Discussionmentioning

confidence: 99%

Prognosis by tumor location in adults with spinal ependymomas

Oh¹,

Kim²,

Kaur³

et al. 2013

SPI

View full text Add to dashboard Cite

Spinal ependymomas along different regions of spinal axis have different characteristics and clinical behaviors. Tumor grade, extent of resection, and PFS varied by tumor location (upper vs lower spinal regions), while OS did not. Recurrence rates were higher for the lower spinal cord tumors, despite a greater prevalence of lower WHO grade lesions, compared with upper spinal cord tumors, suggesting that tumor location along the spinal axis is an important prognostic factor.

show abstract

“…3 Cervical spine spur formation or non-blunted structure could not only cause symptoms similar to myelopathy but also induce obstruction of venous return from venules in vicinity. 4–7 This can lead to either extraversion or ischemic change of the blood vessels. It is still debated whether the aforementioned could serve a pathologic model for our patient.…”

Section: Discussionmentioning

confidence: 99%

Cervical spine intradural-extramedullary hematoma presenting as ipsilateral hemiparesis

Lin

2011

Neurol Int

View full text Add to dashboard Cite

A 75-year-old Taiwanese man suffered from acute onset of right-sided extremity weakness while talking to his neighbors. He was transferred to the hospital within three-hour time after symptom onset. Initial acute ischemic cerebral infarct was diagnosed based on his symptom and cerebral computed tomography. Thrombolytic therapy was held after his symptom improved promptly and could not excluded other etiology. Thorough history taking unraveled previous Chinese medicine clinic visit because of neck sore. However, he received limited improvement after several times of massage treatment. Magnetic resnance imaging (MRI) of the cervical spine demonstrated hematoma compressing right side intradural-extramedullary space at the C2/C3 level. Through his clinical course, muscle weakness was the sole neurological finding with sparing of sensory defects. Given the close anatomy relationship between sensory and motor lamina distribution in the cervical spinal cord, our patient presented a rare manifestation. Cases of cervical spine intradural-extramedullary hematoma are not often seen and only sporadic in the documented literature. We wish, through the report of this article, to inform the first- line physicians with the following information. Among the elderly, neck sore is a common symptom. Over- stretching or overt local massage is not suggested due to relatively fragile musculature. In the clinical diagnosis and localization of lesion, cerebral or cervical spine lesion could mimic with each other and manifest hemiparesis as their first symptom. Meticulous history taking, neurological/ physical examination and pertinent laboratory work-up should be done before initiation of intravenous thrombolytic therapy as it could cause catastrophic consequences if not used properly.

show abstract

Extramedullary Intradural Spinal Tumors: a Review of Modern Diagnostic and Treatment Options and a Report of a Series

Cited by 83 publications

References 20 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

Prognosis by tumor location in adults with spinal ependymomas

Cervical spine intradural-extramedullary hematoma presenting as ipsilateral hemiparesis

Contact Info

Product

Resources

About