Microsurgical unilateral approaches for spinal tumour surgery: Eight years' experience in 256 primary operated patients

Chiou, Shang-Ming; Eggert, H. R.; Laborde, G.; Seeger, Wolfgang

doi:10.1007/bf01403599

Cited by 103 publications

(87 citation statements)

References 16 publications

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“…This approach has been modified with hemilaminectomy and partial facetectomy to reduce the risk of postoperative pain and subsequent spinal deformity. 2,7,13 The use of MIS approaches has been well described for the treatment of degenerative spinal disease. These techniques are now being adopted and modified for the treatment of intradural pathology.…”

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confidence: 99%

Minimally invasive approach for the treatment of intradural spinal pathology

Gandhi

German²

2013

FOC

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Object A wide variety of spinal intradural pathology traditionally has been treated from a midline posterior laminectomy using standard microsurgical techniques. This approach has been successful in treating the pathology; however, it carries a risk of postoperative complications including CSF leakage, wound infection, and spinal instability. The authors describe a minimally invasive surgical (MIS) approach to treating spinal intradural pathology with a low rate of postoperative complications. Methods Through a retrospective review of a prospectively collected surgical database, the authors identified 26 patients who underwent 27 surgeries via an MIS approach for intradural pathology of the spine. Using a tubular retractor system and an operative microscope, the authors were able to treat all patients with a unilateral, paramedian, and muscle-splitting technique. They then collected data regarding operative blood loss, length of stay, imaging characteristics, and outcomes. Results Eight cervical, 8 thoracic, and 11 lumbar intradural pathological entities, which included 14 oncological lesions, 4 Chiari I malformations, 4 arachnoid cysts, 3 tethered cords, 1 syrinx, and 1 chronic visceral pain, were treated via an MIS approach. The average blood loss was 197 ml and the average hospital stay was 3 days. One patient had to return to the operating room for noninfectious wound dehiscence. One patient required reoperation 18 months after the initial surgery for recurrence of the initial pathology. There was no CSF leak, no infection, and no spinal instability associated with the initial surgery on follow-up. Conclusions Intradural spinal pathology can be safely and effectively treated with MIS approaches without an increased risk of neurological injury. This approach may also offer a reduced postoperative length of stay, risk of CSF leak, and risk of future spinal instability.

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confidence: 99%

Minimally invasive approach for the treatment of intradural spinal pathology

Gandhi

German²

2013

FOC

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“…In literature to reduce the surgical trauma to the spinal column and allow the complete removal of intraspinally located space-occupying lesions at the same time, various less invasive surgical techniques are described [9,18,20,25,37,44,49].…”

Section: Discussionmentioning

confidence: 99%

Less invasive approaches for the treatment of cervical schwannomas: our experience

et al. 2011

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Purpose The purpose of our paper is to illustrate our experience with minimally invasive approaches for the treatment of cervical schwannomas. Moreover, a brief review of the literature was conducted. Methods All data regarding patients treated for cervical schwannomas were retrospectively revised. Site, size and extension of the lesions and preoperative neurological status were obtained through re-examination of neuroimaging and clinical records. Postoperative clinical examinations and radiological images were available for all patients. The clinical course was documented using the visual analog scale (VAS), Karnofsky score (KPS) and the Klekamp-Samii score system. Results Sixteen patients harboring cervical schwannomas were treated from 2003 to 2009. Hemilaminectomy was performed in eight cases, subtotal hemilaminectomy in four cases, interlaminar fenestration in two cases, osteoplastic hemilaminotomy and laminoplasty in one case each. Postoperative neuroimaging revealed complete removal of the lesion and no signs of spinal instability. At discharge, neurological improvement was observed in 14 patients and all patients demonstrated reduction of VAS score and improvement of KPS and Klekamp-Samii's score. Conclusions Minimal access procedures are increasingly gaining popularity but their use is poorly described in the treatment of cervical tumors. Less invasive approaches may effectively be used instead of traditional laminectomy in the treatment of cervical tumors, especially schwannomas, providing less iatrogenic traumatism and preventing postsurgical spinal instability. Modern neuroimaging allows adequate preoperative planning and microsurgical techniques provide adequate execution of the surgical act. The procedure has to be tailored case by case considering the specific lesional features and the individual anatomical situation.

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“…Hemilaminectomy combined with microsurgical techniques should be given priority over standard laminectomy in the surgical management of extramedullary lesions arising in the spinal canal. 17,18 For this reason we selected hemilaminectomy which was wide enough to permit incision of the dura mater and resection of the intradural cyst. In a 7-year follow-up of this case, a normal intensity of the compressed vertebral body and no deterioration of the kyphotic deformity was observed.…”

Section: Discussionmentioning

confidence: 99%

Intradural arachnoid cyst associated with thoracic spinal compression fracture: 7-year follow up after surgery

2001

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Study design: A case report with long-term follow after a surgical procedure. Objectives: To describe a case of intradural arachnoid cyst secondary to a compression fracture in the thoracic spine and to report long-term results after surgical treatment with hemilaminectomy. Setting: Osaka, Japan. Methods: A 68-year-old man who had a traumatic intradural arachnoid cyst following an adjacent compression fracture of T5 underwent surgery. Intraoperatively, after recognition of intradural arachnoid cyst with an echogram following hemilaminectomy, the dural sac was incised and the arachnoid cyst was resected under microscopic observation. Results: At 7 years after the operation, the low intensity within the vertebral body of the compression fracture had resolved and the spinal cord remained in its normal shape and position. No progression of kyphotic deformity was detected. Conclusion: A compression fracture of the thoracic spine can be associated with an intradural arachnoid cyst. Microscopic resection via hemilaminectomy for the cyst showed a good result in a 7-year follow up. Spinal Cord (2001) 39, 599 ± 601

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Microsurgical unilateral approaches for spinal tumour surgery: Eight years' experience in 256 primary operated patients

Cited by 103 publications

References 16 publications

Minimally invasive approach for the treatment of intradural spinal pathology

Minimally invasive approach for the treatment of intradural spinal pathology

Less invasive approaches for the treatment of cervical schwannomas: our experience

Intradural arachnoid cyst associated with thoracic spinal compression fracture: 7-year follow up after surgery

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