Minimally Invasive Resection of Spinal Tumors with Tubular Retractor: Case Series, Surgical Technique, and Outcome

Spinal intradural extramedullary tumors: microscopic keyhole resection with the focus on intraoperative neurophysiological monitoring and long-term outcome

“…Recently, Hernandez et al [ 19 ] retrospectively reviewed a cohort of eight patients who underwent unilateral hemilaminectomy using a Williams retractor, GTR was achieved in all cases and neurologic function appeared to have improved in most patients with an average Nurick score of 2 at initial consultation decreased to 0.71 after 2.4 months follow-up. Similarly, in a study by Balasubramanian et al [ 20 ], Forty-one consecutive spinal tumor cases were operated by the MISS-Key Hole technique using the tubular retractor system, GTR was achieved successfully in 39 cases (95.12%), and two patients with worsening of the neurological status were noted, which improved over a period of 6 months. In the present study, GTR was achieved in all cases, six patients (6.9%) experienced neurological deterioration immediately after surgery, which is well within the range of that reported for MIS surgery [ 15 – 20 ], and no patient was left with a permanent deficit compared with their preoperative status as a stable or improved McCormick grade exhibited in all cases in the long-term follow-up evaluation (mean 5.2 ± 2.9 years postoperatively).…”

“…To address this issue, application of intraoperative neurophysiological monitoring during IDEM tumor removal procedure has gained increasing popularity across the world. Traditional open laminectomy is the most commonly approach performed by spine surgeons for resection of these tumors; recently, application of MIS techniques in the treatment of IDEM tumors and other intradural pathologies have been reported by several authors [ 13 – 20 ]. However, literature data about the role of multimodal IONM in MIS for IDEM tumors are few.…”

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

“…Nzokou et al ( 20 ) reported on the minimally invasive removal of thoracic and lumbar spinal tumors using a non-expandable tubular retractor. Balasubramanian et al ( 21 ) reported a large series of spinal tumors operated by the keyhole technique using a non-expandable tubular retractor. Undeniably, compared with traditional open surgery, the tubular retractor technique suffers from poor exposure of the intraspinal field.…”

Comparison of the Clinical Efficacy of Transforaminal Endoscopy and Microtubular Technology for the Treatment of Lumbar Dumbbell-Shaped Tumors

“…For larger Eden type III tumors, it is necessary to establish 2 paravertebral muscle tubular paths (dual-tubular paths) to remove intraspinal and paravertebral tumors, which can protect the facet joints and isthmus, avoid excessive traction and separation of muscles, and reduce the risk factors for spinal instability. [22][23][24] However, for tumors with diameters > 5 cm or vascularized tumors, we still recommend open surgery or mini-open surgery. 13 For Eden III-IV lumbar dumbbell-shaped tumors, the EBL in the PAMT group was higher than that in the PTET group, but there was no significant difference in the operation time, JOA or VAS scores, or PHS.…”

“…In the PAMT approach, we achieved resection of intraspinal, foraminal, and paravertebral tumors by adjusting the position and angle of the paravertebral muscle path under the nonexpandable tubule (diameter, 14/16 mm). For larger Eden type III tumors, it is necessary to establish 2 paravertebral muscle tubular paths (dual-tubular paths) to remove intraspinal and paravertebral tumors, which can protect the facet joints and isthmus, avoid excessive traction and separation of muscles, and reduce the risk factors for spinal instability [ 22 – 24 ]. However, for tumors with diameters > 5 cm or vascularized tumors, we still recommend open surgery or mini-open surgery [ 13 ].…”