Unilateral hemilaminectomy for patients with intradural extramedullary tumors

Sun, Caixing; Meng, Xiao; Xie, Shangnao; Ye, Yu; Yang, Hongjian; Wu, Baodong

doi:10.1631/jzus.b1000402

Cited by 25 publications

(33 citation statements)

References 27 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: 61%

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

116

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: 61%

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

116

118

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“…Sun et al . describe a potential use for UHIL in all lateral intradural lesions regardless of how ventral or lateral they sit; our dataset, although small, supports their proposal.…”

Section: Discussionsupporting

confidence: 78%

“…Furthermore, many studies have demonstrated a strong association between standard laminectomy and post‐operative complications; namely, spinal deformity and damage to dissected structures during the approach. This relationship is particularly strong in pediatric subjects. In this clinical article, we present the operative techniques for UHIL and an evaluation of the effectiveness of this approach through analysis of a consecutive case series.…”

Section: Introductionmentioning

confidence: 99%

Unilateral Hemilaminectomy for Intradural Lesions

Mobbs

Maharaj

Phan

et al. 2015

Orthopaedic Surgery

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“…Hemilaminectomy+microscopic excision is advantageous in the removal of cervical schwannoma. However, the hemilaminectomy approach provides a relatively narrow view of the spinal intracanalar regions [18]; so, large intradural extramedullary schwannomas that require resection are difficult to manage by hemilaminectomy+microscopic excision.…”

Section: Discussionmentioning

confidence: 99%

Treatment Results in the Differential Surgery of Intradural Extramedullary Schwannoma of 110 Cases

et al. 2013

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Study DesignA retrospective study of intradural extramedullary schwannoma.ObjectiveThe purpose of this study was to compare treatment results in the differential surgery of intradural extramedullary schwannoma.BackgroundA reference guide to the surgical procedures available to treat intradural extramedullary schwannoma has not yet been established.MethodsThe study retrospectively reviewed 110 patients: Group A: laminectomy+microscopic excision; Group B: hemilaminectomy+microscopic excision; Group C: laminectomy+microscopic excision+pedicle screw fixation. Researchers selected patients for this retrospective review by applying the following criteria: 1) back pain spread out from the tumor level, sensory and motor loss; 2) treatment by surgery; 3) clinical diagnosis made by physical examination, magnetic resonance imaging (MRI), and pathology; 4) a minimum clinical and radiologic follow-up of 12 months. The clinical outcomes were assessed by comparing the Visual Analogue Pain Scores (VAS) and the Japanese Orthopedic Association Scores (JOA score). The study also performed a cost-effectiveness analysis.ResultsCervical vertebrae: The estimated blood loss in Group B was significantly less than in Group C (P<0.05) (Table 1). Thoracic vertebrae: The duration of hospital stay and estimated blood loss in Group A was significantly less than in Group C (P<0.05) (Table 2, 3). Lumbar vertebrae: The resection rate in Group C was significantly higher than in Group A and Group B (P<0.05) (Table 4). Treatment in Group B was the least expensive, and therefore, the most cost-effective.ConclusionIn the case of appropriate surgical indications, the study suggests that hemilaminectomy+microscopic excision is advantageous in the removal of cervical schwannoma, and that laminectomy+microscopic excision is advantageous in the removal of thoracic schwannoma; lumbar intradural extramedullary schwannoma can be managed by laminectomy+microscopic excision+pedicle screw fixation.

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Unilateral hemilaminectomy for patients with intradural extramedullary tumors

Cited by 25 publications

References 27 publications

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

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

Unilateral Hemilaminectomy for Intradural Lesions

Treatment Results in the Differential Surgery of Intradural Extramedullary Schwannoma of 110 Cases

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