Minimally Invasive Removal of Extra- and Intradural Spinal Tumors Using Full Endoscopic Visualization

Abstract

Study Design: Retrospective cohort study. Objective: To evaluate the clinical efficacy of minimally invasive endoscopic surgery in patients with spinal extradural and intradural-extramedullary tumors. Methods: This was a study of 15 consecutive patients with spinal extradural or intradural-extramedullary tumors up to 2 levels treated by minimal invasive surgery using a full endoscopic visualization and Caspar’s retraction system (for cervical, thoracic, and lumbar tumors) over a 4-year period between January 2015 to April 2019 at a tertiary center. Results: A gross total remove was achieved in all patients (100%), determined by postoperative contrast computed tomography scans and magnetic resonance imaging. There was no postoperative spinal instability. All patients had equal or better neurologic functions after surgery at follow-up. The average preoperative Nurick’s grade mean was 1.9 and the postoperative was 1.1. The average preoperative McCormick’s grade mean was 2.9 versus 1.3 in the postoperative period. Conclusions: Selective extradural or intradural-extramedullary tumors well localized and up to 2 levels can be safely and effectively treated by minimally invasive surgery using a full endoscopic visualization and the Caspar’s retractor. However, there is insufficient evidence to recommend this approach over the classical or other microsurgical approach described.

Pure endoscopic minimally invasive surgery with a non‑expandable tubular retractor for intradural extramedullary spinal tumors

“…The current study reported a patient series with IDEM spinal tumors treated via pure endoscopic MISS with a parallel non-expandable tubular retractor, in which the patients achieved good outcomes. All patients improved significantly in the postoperative period and had no serious postoperative complications, which is comparable with the results of previous studies ( 14 , 17 , 25 , 26 ). Therefore, pure endoscopic MISS with a parallel non-expandable tubular retractor may be an effective and safe surgical strategy for IDEM spinal tumor resection.…”

“…Previously, a number of cases (n≥5 per study) using MISS to treat IDEM spinal lesions have been reported and the surgical method used a pure endoscope with a retractor (as shown in Table III ). Caballero-García et al ( 25 ) described the use of an endoscope and a Caspar system in MISS for IDEM spinal tumors. Similarly, Zeng et al ( 26 ) reported endoscopic MISS surgery for the removal of IDEM spinal lesions with a Williams retractor.…”

Minimally Invasive Approaches for Lumbosacral Plexus Schwannomas

“…3b There have also been recent reports of endoscopic techniques for resection of intradural and extradural tumors. 4b,5b Ultimately, the goal in these approaches is to minimize pain and morbidity for patients and improve quality of life. This serves a benefit in degenerative disease and benign tumors but may have even more important implications in the cancer population where MIS techniques may lead to earlier adjuvant radiation and chemotherapy.…”

Unilateral Biportal Endoscopy for the Resection of Thoracic Intradural Extramedullary Tumors: Technique Case Report and Literature Review

“…Pure endoscopy has recently been reported to be an effective treatment for IDEM tumors, achieving positive results. [6][7][8] Unilateral biportal endoscopy (UBE) is a novel technique of minimally invasive spinal surgery (MISS) that allows free hand manipulation of instruments with a magnified clear view, which has been widely applied in spinal degenerative diseases, [9][10][11] extradural lesions and tumors 12,13 in recent years. UBE is more flexible, convenient, has minimal tissue damage, less blood loss, and causes less postoperative pain than conventional surgeries and uniaxial endoscopic approaches.…”