Unilateral Hemilaminectomy for Intradural Lesions

Mobbs, Ralph J.; Maharaj, Monish; Phan, Kevin; Rao, Prashanth J.

doi:10.1111/os.12184

Cited by 15 publications

(15 citation statements)

References 28 publications

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“…There have been some reports of the use of the endoscope for assistance in the removal of spinal tumors but limited to very scarce patients series or case reports. 6,[23][24][25][26][27] The advantages of endoscope visualization in terms of illumination and vision angle have been demonstrated in other surgical approaches. Additionally, some structures like facet joints can be preserved.…”

Section: Discussionmentioning

confidence: 99%

Minimally Invasive Removal of Extra- and Intradural Spinal Tumors Using Full Endoscopic Visualization

Caballero-García

Linares-Benavides

Leitão

et al. 2020

Global Spine Journal

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Study Design: Retrospective cohort study. Objective: To evaluate the clinical efficacy of minimally invasive endoscopic surgery in patients with spinal extradural and intradural-extramedullary tumors. Methods: This was a study of 15 consecutive patients with spinal extradural or intradural-extramedullary tumors up to 2 levels treated by minimal invasive surgery using a full endoscopic visualization and Caspar’s retraction system (for cervical, thoracic, and lumbar tumors) over a 4-year period between January 2015 to April 2019 at a tertiary center. Results: A gross total remove was achieved in all patients (100%), determined by postoperative contrast computed tomography scans and magnetic resonance imaging. There was no postoperative spinal instability. All patients had equal or better neurologic functions after surgery at follow-up. The average preoperative Nurick’s grade mean was 1.9 and the postoperative was 1.1. The average preoperative McCormick’s grade mean was 2.9 versus 1.3 in the postoperative period. Conclusions: Selective extradural or intradural-extramedullary tumors well localized and up to 2 levels can be safely and effectively treated by minimally invasive surgery using a full endoscopic visualization and the Caspar’s retractor. However, there is insufficient evidence to recommend this approach over the classical or other microsurgical approach described.

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Section: Discussionmentioning

confidence: 99%

Minimally Invasive Removal of Extra- and Intradural Spinal Tumors Using Full Endoscopic Visualization

Caballero-García

Linares-Benavides

Leitão

et al. 2020

Global Spine Journal

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“…Minimally invasive approaches for intradural tumors have been found to be safe and effective. [1][2][3][4][5] A microscope 6 or endoscope 7 has been used recently in such cases. Minimally invasive surgical (MIS) approaches using expandable or nonexpandable tubular retractor 8 or interlaminar approaches 9 have been described to reduce trauma-related instability with comparable outcome.…”

Section: Introductionmentioning

confidence: 99%

“…Unilateral hemilaminectomy for intradural tumors using endoscopic assistance has been used successfully for intradural spinal tumors with preservation of musculoligamentous attachments and posterior bony elements. 7 We report our initial experience of 18 patients.…”

Section: Introductionmentioning

confidence: 99%

Endoscopic Management of Spinal Intradural Extramedullary Tumors

Parihar

Yadav

et al. 2016

J Neurol Surg A Cent Eur Neurosurg

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Posterior midline laminectomy is associated with risks of postoperative instability, spinal deformity, extensive bilateral subperiosteal muscle stripping, partial or total facetectomy especially in foraminal tumor extension, increased cerebrospinal fluid leakage, and wound infection. Minimally invasive approaches with the help of a microscope or endoscope using hemilaminectomy have been found to be safe and effective. We report our initial experience of 18 patients using the endoscopic technique. A retrospective study of intradural extramedullary tumors extending up to two vertebral levels was studied. Pre- and postoperative clinical status, magnetic resonance imaging was done in all patients. The Destandau technique was used, and resection of ipsilateral lamina, medial part of the facet joint, base of the spinous process, and undercutting of the opposite lamina was performed. Dura repair was done using an endoscopic technique. Fibrin glue was used to reinforce repair in the later part of the study. The sagittal and axial diameter of tumor ranged from 21 to 41 mm and 12 to 18 mm, respectively. There were four cervical, two cervicothoracic, five thoracic, three thoracolumbar, and four lumbar tumors, respectively. All 18 patients improved after total excision of tumor. Average duration of surgery and blood loss was 140 minutes and 60 mL, respectively. Postoperative stay and follow-up ranged from 3 to 7 days and 9 to 24 months, respectively. Although the study is limited by the small number of patients with a short follow-up and is a technically demanding procedure, endoscopic management of intradural extramedullary tumors was an effective and safe alternative technique to microsurgery in such patients.

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“…[ 8 9 ] Instability and deformity in the form of kyphosis are frequently associated with laminectomy. [ 3 10 ] Chronic subaxial pain due to epidural fibrosis and myelopathy secondary to kyphotic deformity are delayed sequelae of total laminectomy. The need for a second operation for instability following this approach has been reported in the range of 60% by Ogden et al .…”

Section: Discussionmentioning

confidence: 99%

Hemilaminectomy for spinal cord intradural tumors: An institutional experience

KrishnanKutty¹,

Sreemathyamma²,

Sivanandapanicker³

et al. 2018

Asian J Neurosurg

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Introduction: Laminectomy is the workhorse of spinal cord tumor surgery. This procedure is not without the debilitating sequelae of postoperative pain and delayed kyphosis. Hemilaminectomy is an alternate option to laminectomy which offers the advantage of preserving the posterior supporting structures of the spine on the contralateral side. In this study, we analyze the outcome of hemilaminectomy clinically with improvement in pain scores and Nurick's grade as well as radiologically by assessing for the development of delayed kyphosis. We also discuss the technique and operative nuances of hemilaminectomy in intradural extramedullary tumors of the spinal cord. Materials and Methods: All patients with intradural spinal cord tumors were included in the study. All patients underwent unilateral hemilaminectomy (UHL) depending on the laterality of the tumor on the preoperative magnetic resonance imaging. Preoperative neurologic status was assessed with Nurick's grade for tumors involving the cervicothoracic region tumors, and visual analog scale scores were recorded for tumors of Thoracic, Lumbar and Lumbosacral regions. The postoperative outcomes were assessed by improvement in respective scales on follow-up. The occurrence of delayed spinal deformity was assessed by follow-up X-rays. Any complications whether intraoperative or postoperative were recorded. Results: There were a total of 34 cases of intradural extramedullary tumors in this study. Patient population consisted of 11 males and 23 females. Total excision was achieved in 31 patients. In three patients, we were unable to achieve complete removal through UHL. In these patients the procedure was converted to total laminectomy. They were excluded from analysis. The distribution of the tumors was in cervical, cervicothoracic, thoracic, lumbar, and lumbosacral region. All patients presented with pain or varying degrees or neurologic deficits. Sixteen patients underwent UHL from the right side, while 18 from the left. There were no intraoperative complications. The neurological status and pain scores of all patients improved postoperatively at 3 and 6 months of follow-up. There was no radiological evidence of kyphosis of the involved segment. Conclusion: With a small learning curve, UHL is a good corridor for the removal of intradural extramedullary spinal cord tumors. This approach offers the advantage of less postoperative pain and no postoperative deformity.

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Unilateral Hemilaminectomy for Intradural Lesions

Cited by 15 publications

References 28 publications

Minimally Invasive Removal of Extra- and Intradural Spinal Tumors Using Full Endoscopic Visualization

Minimally Invasive Removal of Extra- and Intradural Spinal Tumors Using Full Endoscopic Visualization

Endoscopic Management of Spinal Intradural Extramedullary Tumors

Hemilaminectomy for spinal cord intradural tumors: An institutional experience

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