Removal of Intradural-Extramedullary Spinal Cord Tumors with Unilateral Limited Laminectomy

Sim, Jong-Eun; Noh, Seung-Jin; Song, Young‐Jin; Kim, Hyung-Dong

doi:10.3340/jkns.2008.43.5.232

Cited by 36 publications

(38 citation statements)

References 14 publications

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“…Efforts have been made to improve the surgical technique from extensive laminectomy and facetectomy, to laminoplasty, hemilaminectomy, or even semihemilaminectomy. 5,17,22,35,36,42 Although different surgical techniques have their own indications and contradictions, we should keep in mind that our priority sequence will always be the protection of the spinal cord and its function first, followed by prevention of postoperative spinal instability and deformity, and then minimization of the injuries to ligaments, muscle, and skin, if possible…”

Section: Discussionmentioning

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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Section: Discussionmentioning

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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“…Other authors 11 used unilateral subperiosteal dissection to reach the desired bone. In this approach, the aim is to remove just a sufficient amount of bone in a trajectory that is perpendicular to the entry point, which could even mean removing the lower part of the upper lamina and the upper part of the lower lamina to achieve the dural exposure targeted to cover the extent of the lesion.…”

Section: 6911mentioning

confidence: 99%

Hemilaminectomy approach for intradural extramedullary spinal tumors: an analysis of 164 patients

Turel¹,

D'Souza²,

Rajshekhar³

2015

FOC

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OBJECT The authors report their experience with the use of a minimally invasive hemilaminectomy approach for the excision of intradural extramedullary (IDEM) tumors of the spinal cord. METHODS Included were 164 consecutive patients (167 tumors in total), treated between January 2004 and December 2014, in whom the hemilaminectomy approach for IDEM spinal cord tumors was planned. The clinicoradiological data of patients presenting to Christian Medical College were analyzed retrospectively using a computerized chart-review method. Preoperative MRI localization was used in 51 cases. RESULTS The mean age (± SD) of the patients was 42.6 ± 16.6 years, and the mean duration of symptoms was 20.8 ± 27.8 months. The average tumor size was 2.4 ± 1.7 cm. Forty-four tumors were cervical, 5 were cervicothoracic, 72 were thoracic, 7 were thoracolumbar, and 39 were lumbar. Forty-two tumors were ventrally located, whereas 11 were ventrolateral; the rest were either dorsal or dorsolateral. The most common pathologies were schwannoma (110 cases) and meningioma (31 cases). Total excision was achieved for 93% of the tumors. The average duration of surgery was 1.6 ± 0.6 hours. CONCLUSIONS The hemilaminectomy approach to the removal of intradural tumors was quick and safe and resulted in minimal morbidity and no mortality. Preoperative MRI localization improved accuracy and reduced operating time by eliminating the need for intraoperative fluoroscopy.

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“…Si bien Schaller et al 23 reportaron que los meningiomas psamomatosos serían un factor de pobre pronóstico, en nuestra serie no hubo diferencias en las evoluciones postoperatorias entre los distintos subtipos histológicos.…”

Section: Discussionunclassified

Tratamiento Quirúrgico de los Meningiomas Espinales

Villanueva¹,

Santamaria²,

Villalonga³

et al. 2018

jbnc

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Objetivo: Presentar nuestra experiencia en el tratamiento quirúrgico de los meningiomas espinales. Material y métodos: Estudio descriptivo retrospectivo que incluye a 24 pacientes operados de meningiomas espinales durante el período Julio de 2009 a Diciembre de 2016. Se analizaron datos epidemiológicos, antecedentes personales, sintomatología preoperatoria, características radiológicas, hallazgos intraoperatorios, grado de resección, descripción histológica y evolución post operatoria. Resultados: Se operaron 24 pacientes siendo 83% de sexo femenino. En cuanto a la localización, 79% fueron dorsales, 17% cervicales y 4% lumbares. La anatomía patológica reveló meningiomas grado I (OMS) en todos los casos. En el 63% se abordó la lesión por hemilaminectomía, logrando en éstas un grado de resección satisfactorio (Simpson 2). El 66% de los pacientes presentaron mejoría clínica post operatoria, 30% sin cambios significativos y solo un caso (4%) de empeoramiento. El periodo de seguimiento promedio fue de 14,9 meses. Conclusión: La cirugía continúa siendo el tratamiento de elección en los meningiomas espinales. El abordaje por hemilaminectomía es una opción útil en lesiones con base de implantación lateral. Lesiones predominantemente ventrales, con componente cálcico y alteraciones motoras preoperatorias suelen presentar mayor complejidad quirúrgica y peor evolución.

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Removal of Intradural-Extramedullary Spinal Cord Tumors with Unilateral Limited Laminectomy

Cited by 36 publications

References 14 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

Hemilaminectomy approach for intradural extramedullary spinal tumors: an analysis of 164 patients

Tratamiento Quirúrgico de los Meningiomas Espinales

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