Unilateral partial hemilaminectomy in the removal of a large spinal ependymoma

Balak, Naci

doi:10.1016/j.spinee.2007.07.001

Cited by 36 publications

(28 citation statements)

References 30 publications

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“…For these reasons, some authors have recently favored hemilaminectomy for resection of intraspinal lesions. 3,5,55,61,72 According to our review, the mean duration of preoperative symptoms was 29 months, substantially shorter than the 57-month average reported previously. 73 Furthermore, we found a statistically significant correlation between shorter duration of presurgical symptoms (≤ 3 months) and favorable clinical outcome.…”

contrasting

confidence: 62%

Surgical outcomes and natural history of intramedullary spinal cord cavernous malformations: a single-center series and meta-analysis of individual patient data

Badhiwala¹,

Farrokhyar

Alhazzani

et al. 2014

SPI

115

118

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Object Information pertaining to the natural history of intramedullary spinal cord cavernous malformations (ISCCMs) and patient outcomes after surgery is scarce. To evaluate factors associated with favorable outcomes for patients with surgically and conservatively managed ISCCMs, the authors performed a systematic review and metaanalysis of the literature. In addition, they included their single-center series of ISCCMs. Methods The authors searched MEDLINE, EMBASE, CINAHL, Google Scholar, and The Cochrane Library for studies published through June 2013 that reported cases of ISCCMs. Data from all eligible studies were used to examine the epidemiology, clinical features, and neurological outcomes of patients with surgically managed and conservatively treated ISCCMs. To evaluate several variables as predictors of favorable neurological outcomes, the authors conducted a meta-analysis of individual patient data and performed univariate and multivariate logistic regression analyses. Variables included patient age, patient sex, lesion spinal level, lesion size, cerebral cavernomas, family history of cavernous malformations, clinical course, presenting symptoms, treatment strategy (operative or conservative), symptom duration, surgical approach, spinal location, and extent of resection. In addition, they performed a meta-analysis to determine a pooled estimate of the annual hemorrhage rate of ISCCMs. Results Eligibility criteria were met by 40 studies, totaling 632 patients, including the authors' institutional series of 24 patients. Mean patient age was 39.1 years (range 2–80 years), and the male-to-female ratio was 1.1:1. Spinal levels of cavernomas were cervical (38%), cervicothoracic (2.4%), thoracic (55.2%), thoracolumbar (0.6%), lumbar (2.1%), and conus medullaris (1.7%). Average cavernoma size was 9.2 mm. Associated cerebral cavernomas occurred in 16.5% of patients, and a family history of cavernous malformation was found for 11.9% of evaluated patients. Clinical course was acute with stepwise progression for 45.4% of patients and slowly progressive for 54.6%. Symptoms were motor (60.5%), sensory (57.8%), pain (33.8%), bladder and/or bowel (23.6%), respiratory distress (0.5%), or absent (asymptomatic; 0.9%). The calculated pooled annual rate of hemorrhage was 2.1% (95% CI 1.3%–3.3%). Most (89.9%) patients underwent resection, and 10.1% underwent conservative management (observation). Outcomes were better for those who underwent resection than for those who underwent conservative management (OR 2.79, 95% CI 1.46–5.33, p = 0.002). A positive correlation with improved neurological outcomes was found for resection within 3 months of symptom onset (OR 2.11, 95% CI 1.31–3.41, p = 0.002), hemilaminectomy approach (OR 3.20, 95% CI 1.16–8.86, p = 0.03), and gross-total resection (OR 3.61, 95% CI 1.24–10.52, p = 0.02). Better outcomes were predicted by an acute clinical course (OR 1.72, 95% CI 1.10–2.68, p = 0.02) and motor symptoms (OR 1.76, 95% CI 1.08–2.86, p = 0.02); poor neurological recovery was predicted by sensory symptoms (OR 0.58, 95% CI 0.35–0.98, p = 0.04). Rates of neurological improvement after resection were no higher for patients with superficial ISCCMs than for those with deep-seated ISCCMs (OR 1.36, 95% CI 0.71–2.60, p = 0.36). Conclusions Intramedullary spinal cord cavernous malformations tend to be clinically progressive. The authors' findings support an operative management plan for patients with a symptomatic ISCCM. Surgical goals include gross-total resection through a more minimally invasive hemilaminectomy approach within 3 months of presentation.

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contrasting

confidence: 62%

Surgical outcomes and natural history of intramedullary spinal cord cavernous malformations: a single-center series and meta-analysis of individual patient data

Badhiwala¹,

Farrokhyar

Alhazzani

et al. 2014

SPI

115

118

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“…Recently, some authors tried to remove intramedullary tumors via hemilaminectomy or partial hemilaminectomy (Chiou et al, 1989;Yasargil et al, 1991;Balak, 2008). Because of the fact that most of the patients with intramedullary tumors were young and the tumors were generally located in cervical and lumbar spines, in which the patients were prone to complicate with postoperative deformity and instability of spine, Chiou et al (1989) argued that the feasibility of the hemilaminectomy should be considered in the management of intramedullary lesions.…”

Section: Indications Of the Limited Approachmentioning

confidence: 99%

“…Yasargil et al (1991) reported that extensive intramedullary tumors could also be resected through this approach. Balak (2008) claimed that the approach permitted the surgeon to manipulate the intradural contralateral side easily, and emphasized the need to consider the hemilaminectomy technique in intraspinal tumor surgery. However, the spinal cord will be very fragile due to depression of slow-growing intramedullary lesions, and its function can be easily injured by any incorrect traction forces of the spinal cord.…”

Section: Indications Of the Limited Approachmentioning

confidence: 99%

Unilateral hemilaminectomy for patients with intradural extramedullary tumors

Sun

Meng

Xie

et al. 2011

J. Zhejiang Univ. Sci. B

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Abstract:A modified hemilaminectomy was introduced in an attempt to explore the operative techniques and the values of the limited approach to spinal cord tumors. Forty-five consecutive patients with intradural extramedullary lesions, who underwent modified hemilaminectomy, were studied retrospectively. The intraspinal tumors were removed via the limited bone window with a 3.3-cm mean length (range: 2.0-6.5 cm) and a 1.2-cm mean width (range: 0.6-1.5 cm), in which the inner parts of the medial and lateral laminae were mostly undercut for wider view. Spinal lesions were cervical in 21 cases, thoracic in 12 cases, lumbar in 10 cases, and multiple in 2 cases. Forty-three cases were completely excised via hemilaminectomy alone. Two subjects with dumbbell neurinoma underwent two-stage tumor removal via anterolateral cervical approach following hemilaminectomy. With respect to neurological status, the percentage of good Frankel scale (D+E grade) was markedly improved from 22.2% on admission to 93.3% at follow-up. At the median 26-month follow-up evaluation by magnetic resonance imaging (MRI), none of the subjects showed spinal deformity or instability. By preserving musculoligamentous attachments and posterior bony elements as much as possible, the modified approach is minimally invasive and may be routinely used to remove intradural and extramedullary tumors, especially in patients with meningiomas and neurinomas.

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“…Both groups cited a desire to reduce the risk of postlaminectomy deformity as motivation for development of this approach, and both groups related experience with intramedullary and extramedullary tumors. Since then, numerous authors have reported experience using a hemilaminar approach to resect intradural, extramedullary tumors (2,3,12,16,20,23,24,26,27) and, to a much lesser extent, intramedullary tumors (2,16,26).…”

mentioning

confidence: 99%