Flexible endoscope visualization to assist in the removal of a string of 10 schwannomas at the cauda equina: technical case report

Abstract

<jats:p>Bead-like schwannomas at the cauda equina are rare but benign intraspinal tumors. They can involve multiple nerve roots and spread within the spinal canal, and open resection would cause significant trauma. The authors have successfully applied a novel minimally invasive technique for the total removal of such schwannomas. A 68-year-old woman presented with a 1-month history of left waist and leg pain. MRI demonstrated multiple intraspinal lesions located from L1 to S1. The diagnosis was bead-like schwannomas at the cauda equina. Two incisions were made at the T12 and L5 levels. A flexible endoscope was introduced into the spinal canal following hemisemilaminectomy under a microscope to identify the relationship between the tumors and the carrying nerves. After dissecting both cranial and caudal ends of the carrying nerve, the string of bead-like tumors was gently pulled out from the caudal end as a whole. The endoscope was reintroduced into the spinal canal to ensure complete tumor removal. The patient recovered quickly, and no tumor residual was found at postoperative MRI. Flexible endoscope–assisted visualization plus microscopic hemisemilaminectomy via 2 incisions is a feasible minimally invasive approach for selected patients with bead-like schwannomas at the cauda equina.</jats:p>

Comparison of Neuroendoscopic and Microscopic Surgery for Unilateral Hemilaminectomy: Experience of a Single Institution

“…Di et al similarly observed reductions in soft tissue injury, blood loss, incision length, postoperative pain, and hospitalization duration in patients who underwent the UHNV procedure ( 56 ). Besides, Ren et al reported that UHNV was an effective minimally invasive procedure that reduced the presence of residual tumors in treated patients ( 57 ). Overall, small bony fenestrations or enlarged interlaminar corridors offer a similar effect to tubular retractors, and using endoscopy with “tubular retractors” provides a better view than “tubular” microsurgery.…”