Feasibility of unilateral hemilaminectomy utilizing a Williams retractor for the resection of intradural-extramedullary spinal neoplasms

Hernandez, Nicholas S.; George, Keith M.; Yang, Michael; Nail, Jayde; Kryzanski, James; Riesenburger, Ron I.

doi:10.1016/j.neuchi.2021.07.003

Cited by 1 publication

(1 citation statement)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Furthermore, Wong et al [ 15 ] operated on 27 IDEM tumors using minimally invasive expandable retractor, they reported excellent outcomes with a 92.6% rate of GTR and no perioperative neurological deterioration. Recently, Hernandez et al [ 19 ] retrospectively reviewed a cohort of eight patients who underwent unilateral hemilaminectomy using a Williams retractor, GTR was achieved in all cases and neurologic function appeared to have improved in most patients with an average Nurick score of 2 at initial consultation decreased to 0.71 after 2.4 months follow-up. Similarly, in a study by Balasubramanian et al [ 20 ], Forty-one consecutive spinal tumor cases were operated by the MISS-Key Hole technique using the tubular retractor system, GTR was achieved successfully in 39 cases (95.12%), and two patients with worsening of the neurological status were noted, which improved over a period of 6 months.…”

Section: Discussionmentioning

confidence: 99%

Spinal intradural extramedullary tumors: microscopic keyhole resection with the focus on intraoperative neurophysiological monitoring and long-term outcome

Xiao

Dai

et al. 2023

J Orthop Surg Res

View full text Add to dashboard Cite

Objective Spinal schwannomas (SS) and spinal meningiomas (SM) account for most intradural extramedullary (IDEM) tumors. These tumors are usually benign lesions, which generally respond favorably to surgical excision. Few studies up to now tried to determine the long-term outcome after minimally invasive surgery (MIS) with multimodal intraoperative neurophysiological monitoring (IONM) for IDEM tumors. The aim of this study was to present one of the largest case series with special regard to IONM findings and long-term outcome after MIS-keyhole surgery with a tubular retractor system. Methods Between January 2013 and August 2018, 87 patients with IDEM tumors who underwent tumor removal surgery via MIS-keyhole approach under multimodal IONM were retrospectively reviewed. The neurological status was assessed using a modified McCormick grading scale pre- and postoperatively. Multimodal IONM consisted of motor evoked potentials (MEP), somatosensory evoked potentials (SEP), and electromyography (EMG). Both short-term and long-term clinical evaluations as well as patients’ medical files were retrospectively analyzed. Results Surgeries were performed for resection of SS in 49 patients and SM in 38 patients. Tumor locations were cervical in 16.1%, thoracic in 48.3%, thoracolumbar in 4.6%, lumbar 31%. Critical IONM changes were detected in 9 operations (10.3%) in which there were 2 SEPs, 5 MEPs, and 2 EMG events. Three IONM changes (2 MEPs, 1 EMG) were turned out to be transient change in nature since they were resolved in a short time when immediate corrective actions were initiated. Six patients with permanent IONM changes (2SEPs, 3MEPs, 1EMG event), all deficits had resolved during hospitalization or on short -term follow-up evaluation. Sensitivity, specificity, and positive and negative predicted values of IONM were 100, 96, 67, and 100%, respectively. Gross total resection rate was 100%, and a stable or improved McCormick grade exhibited in all patients. No tumor recurrence and no spinal instability were found in the long-term follow-up evaluation (mean 5.2 ± 2.9 years postoperatively). Overall, 94% of patients were either satisfied or very satisfied with their operation, and 93% patients reported excellent or good general clinical outcome according to Odom’s criteria. Conclusion MIS-keyhole surgery with multimodal IONM for IDEM tumors enables a high level of satisfaction and a satisfying long-term clinical and surgical outcome.

show abstract

Section: Discussionmentioning

confidence: 99%