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Peng W, Zhuang Y, Cui W, Chen W, Chu R, Sun Z, Zhang S. Unilateral Biportal Endoscopy for the Resection of Thoracic Intradural Extramedullary Tumors: Technique Case Report and Literature Review. Int Med Case Rep J 2024; 17:301-309. [PMID: 38618188 PMCID: PMC11015842 DOI: 10.2147/imcrj.s444226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 03/28/2024] [Indexed: 04/16/2024] Open
Abstract
This study describes a patient with an intradural extramedullary (IDEM) tumor removed entirely using the unilateral biportal endoscopic technique (UBE), achieving satisfactory clinical outcomes. A 60-year-old woman had a diagnosis of meningioma with sensations and motor dysfunction in the lower extremities and perineum and gait disturbances for three years, which has worsened over the last month. Preoperative imaging data showed a sizeable IDEM tumor at the T10 level, significantly compressing the thoracic spinal cord to the right side, with 80% intraspinal encroachment. The IDEM tumor was removed entirely by UBE surgery. To the best of our knowledge, this study may be the first to report the application of UBE techniques for IDEM tumor treatment. In this case, UBE provides a magnified and clear surgical field, greater maneuverability, and a less invasive surgical procedure. The procedure objectives were pathological confirmation, spinal cord decompression, and complete tumor removal; all were met. The patient was satisfied with her dramatically improved clinical symptoms. UBE may be an alternative surgical treatment option for benign IDEM tumors presenting with symptomatic, especially the non-giant lateral and posterior tumors.
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Affiliation(s)
- Wei Peng
- Department of Spine Surgery, Wuxi Ninth People’s Hospital Affiliated to Soochow University, Wuxi, Jiangsu, People’s Republic of China
| | - Yin Zhuang
- Department of Spine Surgery, Wuxi Ninth People’s Hospital Affiliated to Soochow University, Wuxi, Jiangsu, People’s Republic of China
| | - Wei Cui
- Department of Spine Surgery, Wuxi Ninth People’s Hospital Affiliated to Soochow University, Wuxi, Jiangsu, People’s Republic of China
| | - Wenjin Chen
- Department of Spine Surgery, Wuxi Ninth People’s Hospital Affiliated to Soochow University, Wuxi, Jiangsu, People’s Republic of China
| | - Rupeng Chu
- Department of Spine Surgery, Wuxi Ninth People’s Hospital Affiliated to Soochow University, Wuxi, Jiangsu, People’s Republic of China
| | - Zhenzhong Sun
- Department of Spine Surgery, Wuxi Ninth People’s Hospital Affiliated to Soochow University, Wuxi, Jiangsu, People’s Republic of China
| | - Shujun Zhang
- Department of Spine Surgery, Wuxi Ninth People’s Hospital Affiliated to Soochow University, Wuxi, Jiangsu, People’s Republic of China
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Harary M, Chang D, Say I, Lu DC. Minimally-invasive tubular resection of thoracolumbar intradural schwannoma. NEUROSURGICAL FOCUS: VIDEO 2023; 9:V19. [PMID: 37854661 PMCID: PMC10580752 DOI: 10.3171/2023.6.focvid2335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 06/21/2023] [Indexed: 10/20/2023]
Abstract
Minimally invasive surgical (MIS) approaches to the spine are increasingly adopted for intradural pathology. In this setting, they may especially be useful to minimize risk of CSF leakage due to the decreased disruption to paraspinal musculature and minimal dead space. Herein, the authors demonstrate their technique for the resection of an intradural thoracolumbar schwannoma in a 30-year-old woman via an MIS approach using a nonexpandable tubular retractor. Salient points include the use of bayonetted instruments and the technique for dural closure in a small corridor. Indications for this technique are discussed in the context of a series of patients with intradural extramedullary lesions.
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Affiliation(s)
- Maya Harary
- Department of Neurosurgery, University of California, Los Angeles, California; and
| | - Diana Chang
- Department of Neurosurgery, University of California, Los Angeles, California; and
| | - Irene Say
- Department of Neurosurgery, University of California, San Francisco, California
| | - Daniel C. Lu
- Department of Neurosurgery, University of California, Los Angeles, California; and
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3
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Meyer M, Farah K, Aurélie T, Graillon T, Dufour H, Fuentes S. Management of Spinal Metastasis by Minimally Invasive Surgical Techniques: Surgical Principles and Indications-A Literature Review. J Clin Med 2023; 12:5165. [PMID: 37629207 PMCID: PMC10455891 DOI: 10.3390/jcm12165165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/27/2023] [Accepted: 08/04/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Spinal metastasis is becoming more frequent. This raises the topics of pain and neurological complications, which worsen the functional and survival prognosis of oncological population patients. Surgical treatment must be as complete as possible in order to decompress and stabilize without delaying the management of the oncological disease. Minimally invasive spine surgical techniques inflict less damage on the musculocutaneous plan than opened ones. METHODS Different minimally invasive techniques are proposed in this paper for the management of spinal metastasis. We used our experience, developed degenerative and traumatic pathologies, and referred to many authors, establishing a narrative review of our local practice. RESULTS Forty-eight articles were selected, and these allowed us to describe the different techniques: percutaneous methods such as vertebro/kyphoplasty, osteosynthesis, mini-open surgery, or that through a posterior or anterior approach. Also, some studies detail the contribution of new technologies, such as intraoperative CT scan and robotic assistance. CONCLUSIONS It seems essential to offer a lasting solution to a spinal problem, such as in the form of pain relief, stabilization, and decompression. Our department has embraced a multidisciplinary and multidimensional approach to MISS, incorporating cutting-edge technologies and evidence-based practices.
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Affiliation(s)
- Mikael Meyer
- Department of Neurosurgery, La Timone University Hospital, Assitance Publique Hopitaux Marseille, 13005 Marseille, France; (M.M.); (K.F.); (T.G.); (H.D.)
- Spine Unit, La Timone University Hospital, Assitance Publique Hopitaux Marseille, 13005 Marseille, France;
| | - Kaissar Farah
- Department of Neurosurgery, La Timone University Hospital, Assitance Publique Hopitaux Marseille, 13005 Marseille, France; (M.M.); (K.F.); (T.G.); (H.D.)
- Spine Unit, La Timone University Hospital, Assitance Publique Hopitaux Marseille, 13005 Marseille, France;
| | - Toquart Aurélie
- Spine Unit, La Timone University Hospital, Assitance Publique Hopitaux Marseille, 13005 Marseille, France;
- Department of Orthopedic Surgery, La Timone University Hospital, Assitance Publique Hopitaux Marseille, 13005 Marseille, France
| | - Thomas Graillon
- Department of Neurosurgery, La Timone University Hospital, Assitance Publique Hopitaux Marseille, 13005 Marseille, France; (M.M.); (K.F.); (T.G.); (H.D.)
- Spine Unit, La Timone University Hospital, Assitance Publique Hopitaux Marseille, 13005 Marseille, France;
| | - Henry Dufour
- Department of Neurosurgery, La Timone University Hospital, Assitance Publique Hopitaux Marseille, 13005 Marseille, France; (M.M.); (K.F.); (T.G.); (H.D.)
| | - Stephane Fuentes
- Department of Neurosurgery, La Timone University Hospital, Assitance Publique Hopitaux Marseille, 13005 Marseille, France; (M.M.); (K.F.); (T.G.); (H.D.)
- Spine Unit, La Timone University Hospital, Assitance Publique Hopitaux Marseille, 13005 Marseille, France;
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Zhang G, Jia B, Wang P, Xu C, Liu J, Tang C, Jiang H, Tan X, Wu N. Pure endoscopic minimally invasive surgery with a non‑expandable tubular retractor for intradural extramedullary spinal tumors. Exp Ther Med 2023; 25:137. [PMID: 36845956 PMCID: PMC9947587 DOI: 10.3892/etm.2023.11836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 01/20/2023] [Indexed: 02/16/2023] Open
Abstract
Minimally invasive spinal surgery (MISS) for intradural extramedullary (IDEM) spinal tumors is a safe and effective surgical strategy. Currently, various tubular retractors are widely used in the MISS of IDEM spinal tumors, primarily relying on microscopic visualization. To the best of the authors' knowledge, there is no report of pure endoscopic surgery with parallel non-expandable tubular retractors for IDEM spinal lesions. The present study reports a case series of IDEM spinal tumors that were treated via pure endoscopic MISS with a parallel non-expandable tubular retractor. The extent of tumor resection was evaluated by comparing preoperative and postoperative magnetic resonance imaging (MRI). The initial and follow-up clinical conditions were assessed according to the visual analog scale for pain and the modified McCormick scale for neurological status. Postoperative MRI demonstrated that all cases had achieved a gross total resection. After the operation, the clinical symptoms of all patients were significantly improved and there were no serious postoperative complications. At the initial follow-up, the pain experienced by the patients was significantly reduced or had even disappeared, and the neurological deficit was improved by at least one grade on the modified McCormick scale. The present report indicates that pure endoscopic MISS with a parallel non-expandable tubular retractor may be an effective and safe surgical strategy for IDEM spinal tumor resection.
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Affiliation(s)
- Gang Zhang
- Department of Neurosurgery, Chongqing General Hospital, University of Chinese Academy of Sciences, Chongqing 401147, P.R. China,Graduate Institute, Chongqing Medical University, Chongqing 400016, P.R. China
| | - Bin Jia
- Department of Neurosurgery, Chongqing General Hospital, University of Chinese Academy of Sciences, Chongqing 401147, P.R. China
| | - Pan Wang
- Department of Neurosurgery, Chongqing General Hospital, University of Chinese Academy of Sciences, Chongqing 401147, P.R. China,Graduate Institute, Chongqing Medical University, Chongqing 400016, P.R. China
| | - Chaoling Xu
- Department of Neurosurgery, Chongqing General Hospital, University of Chinese Academy of Sciences, Chongqing 401147, P.R. China
| | - Jie Liu
- Department of Neurosurgery, Chongqing General Hospital, University of Chinese Academy of Sciences, Chongqing 401147, P.R. China,Graduate Institute, Chongqing Medical University, Chongqing 400016, P.R. China
| | - Chao Tang
- Department of Neurosurgery, Chongqing General Hospital, University of Chinese Academy of Sciences, Chongqing 401147, P.R. China,Graduate Institute, Chongqing Medical University, Chongqing 400016, P.R. China
| | - Haotian Jiang
- Department of Neurosurgery, Chongqing General Hospital, University of Chinese Academy of Sciences, Chongqing 401147, P.R. China,Graduate Institute, Chongqing Medical University, Chongqing 400016, P.R. China
| | - Xiaorong Tan
- Department of Neurosurgery, Chongqing General Hospital, University of Chinese Academy of Sciences, Chongqing 401147, P.R. China,Graduate Institute, Chongqing Medical University, Chongqing 400016, P.R. China
| | - Nan Wu
- Department of Neurosurgery, Chongqing General Hospital, University of Chinese Academy of Sciences, Chongqing 401147, P.R. China,Correspondence to: Professor Nan Wu, Department of Neurosurgery, Chongqing General Hospital, University of Chinese Academy of Sciences, 118 Xingguang Avenue, Liangjiang New Area, Chongqing 401147, P.R. China
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Kitumba D, Reinas R, Pereira L, Pinto V, Alves OL. Spinal Intradural Extramedullary Tumors: A Retrospective Analysis on Ten-Years' Experience of Minimally Invasive Surgery and a Comparison with the Open Approach. ACTA NEUROCHIRURGICA. SUPPLEMENT 2023; 135:357-360. [PMID: 38153493 DOI: 10.1007/978-3-031-36084-8_54] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
Spinal intradural extramedullary (ID-EM) tumors are pathologies widely treated through a classical open approach. However, minimally invasive surgery is gaining traction as a comparable treatment option because it carries less morbidity and may reduce healthcare costs.This study aimed to compare the clinical and functional outcomes of open versus minimally invasive approaches for patients with ID-EM tumors. We performed a retrospective analysis on prospectively collected data from patients with ID-EM tumors submitted to surgery. Baseline features and operative variables were compared, including surgery duration and estimated blood loss (EBL). Postoperative data covered tumor histology, length of stay (LOS), complication(s), and neurological status (Medical Research Council (MRC) scale) at the last follow-up.In total, 46 patients were included: 30 (65.2%) operated through an open approach and 16 (34.8%) through a minimally invasive surgical (MIS) approach. The predominant histology type was schwannomas (43.5%). Lesions more frequently affected the lumbar spine (34.8%). The tumor dimensions were similar in both cohorts. The minimally invasive approach was on average 76.7 min faster and correlated positively with less EBL (140 mL less than that of the open approach). Patients in the MIS group had shorter LOSs (5.63 days vs. 17.27 days) and had fewer postoperative complications. No significant difference in functional outcome was found.MIS is as effective as the traditional approach in achieving comparable functional outcomes, with advantages such as shorter surgery durations, less blood loss, and shorter hospital LOSs.
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Affiliation(s)
- D Kitumba
- Faculdade de Medicina, Universidade Agostinho Neto, Luanda, Angola
- Clínica Sagrada Esperança, Luanda, Angola
| | - R Reinas
- Department of Neurosurgery, Hospital Center of Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - L Pereira
- Department of Neurosurgery, Hospital Center of Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - V Pinto
- Department of Neurosurgery, Hospital Center of Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - O L Alves
- Department of Neurosurgery, Hospital Center of Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
- Department of Neurosurgery, Hospital Lusíadas Porto, Porto, Portugal
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Mo K, Gupta A, Laljani R, Librizzi C, Raad M, Musharbash F, Al Farii H, Lee SH. Laminectomy Versus Laminectomy with Fusion for Intradural Extramedullary Tumors: A Systematic Review and Meta-Analysis. World Neurosurg 2022; 164:203-215. [PMID: 35487493 DOI: 10.1016/j.wneu.2022.04.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 04/10/2022] [Accepted: 04/11/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The primary objective of our systematic review and meta-analysis was to systematically compare the reported outcomes between laminectomy and laminectomy with fixation/fusion (LF) for the treatment of intradural extramedullary tumors (IDEMTs). Our secondary objective was to compare the outcomes between different laminectomy exposure techniques. METHODS PubMed and Embase were queried for literature on laminectomy and LF for IDEMTs. Reports of transforaminal approaches, interlaminar approaches, corpectomy, pediatrics patients, intramedullary tumors, technical studies, animal or cadaver studies, and literature reviews were excluded. The outcome measures recorded were pain, neurologic function, functional independence, cerebrospinal fluid leak, and wound infection. Where possible, the laminectomy technique (partial laminectomy [PL] vs. total laminectomy [TL]) was specified. Stata, version 17, was used for the fixed effects inverse variance meta-analysis. RESULTS Of 1849 reports assessed, 17 were included. The meta-analysis revealed that laminectomy (PL or TL) resulted in higher rates of postoperative sagittal instability compared with LF (odds ratio, 1.81; P < 0.001). No differences in any other postoperative outcome were observed between laminectomy and LF (P = 0.44). The systematic review also revealed no differences in postoperative pain, neurologic function, or functional independence or disability between PL and TL. Some evidence suggested that TL might result in greater rates of sagittal instability compared with PL. CONCLUSIONS No differences between LF, PL, or TL in pain, neurologic deficit, functional independence, cerebrospinal fluid leak, or wound infection were reported. Laminectomy had greater odds of sagittal instability compared with LF. Patients with preoperative sagittal instability requiring extensive removal of the posterior spinal column to achieve adequate resection of large tumors might benefit from LF.
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Affiliation(s)
- Kevin Mo
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Arjun Gupta
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Department of Orthopaedic Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Rohan Laljani
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Christa Librizzi
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Micheal Raad
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Farah Musharbash
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Humaid Al Farii
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sang Hun Lee
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
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Robotic versus laparoscopic gastrectomy for gastric cancer: an umbrella review of systematic reviews and meta-analyses. Updates Surg 2021; 73:1673-1689. [PMID: 34031848 PMCID: PMC8500879 DOI: 10.1007/s13304-021-01059-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 04/19/2021] [Indexed: 02/07/2023]
Abstract
An umbrella review was performed to summarize literature data and to investigate benefits and harm of robotic gastrectomy (RG) compared to laparoscopic (LG) approach. To overcome the intrinsic limitations of laparoscopy, the robotic approach is claimed to facilitate lymph-node dissection and complex reconstruction after gastrectomy, to assure oncologic safety also in advanced gastric cancer. A literature search was conducted in PubMed, Cochrane and Embase databases for all meta-analyses published up to December 2019. The search strategy was previously published in a protocol. We selected fourteen meta-analyses comparing outcomes between LG and RG with curative intent in patients with diagnosis of resectable gastric cancer. We highlight that RG has a longer operation time, inferior blood loss, reduction in hospital stay and a more rapid recovery of bowel function. In meta-analyses with statistical significance the number of nodes removed in RG is higher than LG and the distal margin of resection is higher. There is no difference in terms of total complication rate, mortality, morbidity, anastomotic leakage, anastomotic stenosis, intestinal obstruction and in conversion rate to open technique. The safety and efficacy of robotic gastrectomy are not clearly supported by strong evidence, suggesting that the outcomes reported for each surgical technique need to be interpreted with caution, in particular for the meta-analyses in which the heterogeneity is large. Certainly, robotic gastrectomy is associated with shorter time to oral intake, lesser intraoperative bleeding and longer operation time with an acceptable level of evidence. On the other hand, the data regarding other outcomes are insufficient as well as non-significant, from an evidence point of view, to draw any robust conclusion.
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Singh PR, Pandey TK, Sharma RK, Ahmad F, Kumar A, Agarwal A. Tumor Occupancy Ratio-An Imaging Characteristic Prognosticating the Surgical Outcome of Benign Intradural Extramedullary Spinal Cord Tumors. Int J Spine Surg 2021; 15:570-576. [PMID: 33963026 DOI: 10.14444/8077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Intradural extramedullary (IDEM) spinal cord tumors are two thirds of all spinal tumors. We have prospectively analyzed the importance of the tumor occupancy ratio as a factor for predicting the course of the disease and in prognosticating the surgical outcome in patients with IDEM tumors. METHODS We prospectively analyzed 44 consecutive cases of IDEM tumors, diagnosed as cervical, thoracic, and lumbar IDEM tumors (excluding conus/cauda equina lesion) by magnetic resonance imaging (MRI), that were operated on at our institution between 2014 and 2016. We measured the tumor occupancy ratio and noted the sagittal and axial location of the tumor in the preoperative MRI and performed the laminectomy and unilateral medial facetectomy. A primary outcome has been noted according to the gait disability score in the preoperative period and in the follow-up period of 1 year. In the statistical analysis, categorical variables were compared using a chi-square test, and an analysis of variance and student t tests were used for the continuous variables. P < .05 was considered statistically significant. RESULTS The tumor occupancy ratio showed a significant association to the preoperative gait disability score (P < .001) and also predicted that the surgical outcome is much better in patients with tumors with a low tumor occupancy ratio than in patients with tumors with a high occupancy ratio (P < .001). No difference in the tumor occupancy ratio was noted in 2 different pathological tumors, and there was also no difference in the tumor occupancy ratio at different sagittal and axial locations of the tumor. CONCLUSION Tumor occupancy ratio has shown a significant impact on the preoperative course and also predicts the surgical outcome in patients with IDEM tumors. Hence, it is an important imaging characteristic to prognosticate the outcome in IDEM tumors and should be noted in each case.
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Affiliation(s)
- Prashant Raj Singh
- Department of Neurosurgery, All India Institute of Medical Sciences, Raipur, India
| | - Tarun Kumar Pandey
- Department of Neurosurgery, Vivekananda Polyclinic and Institute of Medical Sciences, Lucknow, India
| | | | - Faran Ahmad
- Department of Neurosurgery, Vivekananda Polyclinic and Institute of Medical Sciences, Lucknow, India
| | - Ankur Kumar
- Department of Neurosurgery, Vivekananda Polyclinic and Institute of Medical Sciences, Lucknow, India
| | - Abhay Agarwal
- Department of Neurosurgery, Vivekananda Polyclinic and Institute of Medical Sciences, Lucknow, India
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Wang ZC, Li SZ, Qu XF, Yin CQ, Sun YL, Wang YL, Wang J, Liu CJ, Cao ZL, Wang T. Application of open-door laminoplasty with ARCH plate fixation in cervical intraspinal tumors. BMC Surg 2021; 21:141. [PMID: 33740933 PMCID: PMC7980540 DOI: 10.1186/s12893-021-01140-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 03/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The open-door laminoplasty is an effective procedure for the treatment of cervical spondylotic myelopathy. However, little information is available about the surgical results of open-door laminoplasty in the treatment of intraspinal tumors. In the present study, we aimed to investigate the clinical effect of open-door laminoplasty with ARCH plate fixation in the treatment of cervical intraspinal tumors. METHODS This was a retrospective study. From January 2013 to May 2018, 38 patients (13 males and 25 females, the average age of 44 ± 17 years) with cervical intraspinal tumors underwent open-door laminoplasty with ARCH plate fixation in our hospital. The operation time, blood loss, pre- and postoperative visual analog scale (VAS), and Japanese Orthopedic Association (JOA) scores were determined. To determine the radiographic outcomes, cervical X-ray film and magnetic resonance imaging (MRI) were performed before and after the operation, and cervical X-ray sagittal film was used to measure Cobb angle. The clinical data before and after the operation were compared by t-test. RESULTS A total of 38 patients underwent a successful operation and demonstrated primary healing. The average operation time was 113 ± 12 min. The average blood loss was 120 ± 19 mL. All patients were followed up for 26.1 ± 2.8 months, and the final follow-up time was more than 24 months. VAS scores were much better at 24 months after operation compared with those before the operation, which were decreased from 6.1 ± 1.1 to 1.4 ± 0.7 (t = 32.63, P < 0.01). The JOA score was improved from 9.9 ± 1.5 to 15.5 ± 0.6 (t = - 18.36, P < 0.01), and the mean JOA recovery rate was 79% ± 11% at 24 months after the operation. There was no significant difference in Cobb angle between pre-operation and 24 months after the operation, which was 9.8 ± 2.6 and 10.3 ± 3.1 respectively (t = - 0.61, P > 0.05). Neither spinal malalignment on the coronal plane nor displacement of the laminoplasty flap was observed on postoperative cervical X-ray and MRI examinations at the final follow-up. CONCLUSIONS Open-door laminoplasty with ARCH plate fixation was a safe and effective surgical approach for the treatment of cervical intraspinal tumors.
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Affiliation(s)
- Zhi-Chao Wang
- Department of Spine Surgery, Affiliated Hospital of Qingdao University, Jiangsu Road, Shinan District, Qingdao, 266000, China
| | - Shu-Zhong Li
- Department of Spine Surgery, Affiliated Hospital of Qingdao University, Jiangsu Road, Shinan District, Qingdao, 266000, China
| | - Xin-Fei Qu
- Department of Operating Room, Affiliated Hospital of Qingdao University, Qingdao, 266000, China
| | - Chu-Qiang Yin
- Department of Spine Surgery, Affiliated Hospital of Qingdao University, Jiangsu Road, Shinan District, Qingdao, 266000, China
| | - Yuan-Liang Sun
- Department of Spine Surgery, Affiliated Hospital of Qingdao University, Jiangsu Road, Shinan District, Qingdao, 266000, China
| | - Yue-Lei Wang
- Department of Spine Surgery, Affiliated Hospital of Qingdao University, Jiangsu Road, Shinan District, Qingdao, 266000, China
| | - Jie Wang
- Department of Spine Surgery, Affiliated Hospital of Qingdao University, Jiangsu Road, Shinan District, Qingdao, 266000, China
| | - Chen-Jing Liu
- Department of Spine Surgery, Affiliated Hospital of Qingdao University, Jiangsu Road, Shinan District, Qingdao, 266000, China
| | - Zhen-Lu Cao
- Department of Spine Surgery, Affiliated Hospital of Qingdao University, Jiangsu Road, Shinan District, Qingdao, 266000, China
| | - Ting Wang
- Department of Spine Surgery, Affiliated Hospital of Qingdao University, Jiangsu Road, Shinan District, Qingdao, 266000, China.
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Landriel F, Hem S, Vecchi E, Yampolsky C. Abordaje mínimamente invasivo para el tratamiento de tumores espinales intradurales extramedulares: Nota Técnica. Surg Neurol Int 2021. [DOI: 10.25259/sni_643_2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Objetivo:Describir la técnica de abordaje mínimamente invasiva para el tratamiento de tumores intradurales extramedulares en los diferentes segmentos espinales.Material y Métodos:Se detallan la planificación, posicionamiento, marcación, pasos técnicos del abordaje mínimamente invasivo, exéresis lesional y cierre de lesiones ID-EM a nivel cervical, dorsal, lumbar y sacro. Se proporcionan recomendaciones para descomplejizar maniobras quirúrgicas, acortar el tiempo operativo y evitar potenciales complicaciones.Conclusiones:El abordaje MISS es una opción segura y eficaz para el tratamiento quirúrgico de determinados tumores ID-EM.
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11
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Saekhu M, Siregar NC, Gunawan K, Nugroho SW. Nine-segment laminectomy is safe for the resection of a schwannoma extending from C-2 to T-3: a rare case report. MEDICAL JOURNAL OF INDONESIA 2020. [DOI: 10.13181/mji.cr.192844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Cervical spine schwannoma, which is long and entirely intracanal, is rare to be found. Its rarity and atypical feature leads to difficulty in diagnosing and managing cases because of the scarcity of available literature. The surgical removal of this type of schwannomas via multisegment laminectomy is a great challenge because of various risks of postoperative complications. This report describes cervical spine schwannoma that was initially was not suspected as schwannoma and was subject to surgical removal via nine-segment laminectomy. In one year after surgery, motor function returned to normal strength, no new neurological deficits occurred, and no kyphotic deformity, which is a common complication of multisegment laminectomy.
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Wang ZC, Li SZ, Sun YL, Yin CQ, Wang YL, Wang J, Liu CJ, Cao ZL, Wang T. Application of Laminoplasty Combined with ARCH Plate in the Treatment of Lumbar Intraspinal Tumors. Orthop Surg 2020; 12:1589-1596. [PMID: 32761845 PMCID: PMC7767693 DOI: 10.1111/os.12758] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 06/18/2020] [Accepted: 06/23/2020] [Indexed: 12/28/2022] Open
Abstract
Objective To investigate the bone fusion and clinical effect of laminoplasty combined with ARCH plate fixation in the treatment of lumbar intraspinal tumors. Methods This was a clinical study. From June 2017 to January 2019, 24 patients (seven males and 17 females, average age 40 ± 16 years) with lumbar intraspinal tumors underwent laminoplasty combined with ARCH plate fixation in our hospital. The bone fusion was evaluated by X‐ray and computed tomography (CT) scans that were taken 15.2 ± 2.17 months postoperatively. Each segment showed a bone bridge on one side, which was classified as “segmental partial fusion.” Each segment showed bilateral bone bridges, which were classified as “segmental complete fusion”. When all segments of the patient showed bilateral bone bridging so that the replanted lamina and the host lamina became a unit on the CT scan, it was defined as “complete fusion”. In addition, the operation time and blood loss were recorded. Fisher's exact test was used to analyze the potential influencing factors of bone healing, including age (≤40 years vs >40 years), gender, number of operated levels (single vs two). Paired t‐test was used to analyze pre‐ and postoperative Oswestry Disability Index (ODI) scale and low back and leg pain visual analog scale (VAS). Results A total of 33 segments of laminoplasty were successfully performed in 24 patients. The average operation time was 128 ± 18 minutes. The average blood loss was 110 ± 19 mL. All patients were followed up at least 12 months after operation (average, 15.2 ± 2.17 months). At the final follow‐up, according to the definition of this study, the proportion of “segmental partial fusion” and “segmental complete fusion” were 30.3% (10/33) and 69.7% (23/33), respectively. And the proportion of patients with “complete fusion” was 70.8% (17/24). Age, gender, and number of operated levels were not associated with the fusion (P = 1.0, 0.37, and 0.06, respectively). ODI and VAS were much better at 1 month after operation and the final follow‐up than those before the operation (P < 0.01). At 6 months after operation, the results of magnetic resonance imaging (MRI) showed that the supraspinous ligament was repaired, and there were no complications, such as spinal epidural scar recompression. Conclusions Laminoplasty combined with ARCH plate was a better surgical method, and 70.8% of the patients showed complete bone fusion and there was no case of bilateral nonunion.
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Affiliation(s)
- Zhi-Chao Wang
- Department of Spine Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Shu-Zhong Li
- Department of Spine Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yuan-Liang Sun
- Department of Spine Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Chu-Qiang Yin
- Department of Spine Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yue-Lei Wang
- Department of Spine Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Jie Wang
- Department of Spine Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Chen-Jing Liu
- Department of Spine Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Zhen-Lu Cao
- Department of Spine Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Ting Wang
- Department of Spine Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
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Wang X, Zhao HY, Lei DQ, Zhu WD, Zhou YC. An Analysis of Clinical Efficacy of Microsurgical Resection of Intradural Neoplasm by Unilateral Approach with Caspar Retractors. Med Princ Pract 2020; 29:231-237. [PMID: 31537007 PMCID: PMC7315204 DOI: 10.1159/000503554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 09/10/2019] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE This study aims to investigate the clinical efficacy of minimally invasive microsurgical resection of intraspinal tumors with the aid of Caspar retractors. MATERIALS AND METHODS A total of 125 intraspinal tumor patients with lesions smaller than 6 cm, who were treated at the Neurosurgery Department of our hospital from March 2010 to March 2016, were retrospectively analyzed. Among these, 73 patients underwent microsurgical resection of intraspinal tumors with the aid of Caspar retractors, while 52 patients underwent conventional laminectomy for resection of intraspinal tumors. Relevant indicators between both groups of patients were compared, including length of surgical incision, duration of surgery, postoperative drainage volume, time to first out-of-bed activity after surgery, postoperative hospitalization period, visual analog score (VAS) score, and Japanese Orthopedic Association (JOA) score, at 1 month after surgery. RESULTS Compared with the conventional laminectomy group, patients who underwent microsurgical resection with the aid of Caspar retractors had better outcomes in terms of length of surgical incision, postoperative drainage volume, time to first out-of-bed activity after surgery, postoperative hospitalization period, and VAS scores (p < 0.05). However, JOA scores at 1 month after surgery did not have any significant differences (p > 0.05). CONCLUSIONS The microsurgical resection of intraspinal tumors with the aid of Caspar retractors has advantages of small trauma, less bleeding, and faster recovery. It is a safe and efficacious method for treating small intraspinal tumors.
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Affiliation(s)
- Xuan Wang
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hong-Yang Zhao
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - De-Qiang Lei
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wen-De Zhu
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ying-Chun Zhou
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China,
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KrishnanKutty R, Sreemathyamma SB, Sivanandapanicker JL, Asher P, Prabhakar RB, Peethambaran A. Hemilaminectomy for Spinal Cord Intradural Tumors: An Institutional Experience. Asian J Neurosurg 2018; 13:760-765. [PMID: 30283540 PMCID: PMC6159102 DOI: 10.4103/ajns.ajns_106_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
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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Affiliation(s)
- Raja KrishnanKutty
- Department of Neurosurgery, Government Medical College, Thiruvananthapuram, Kerala, India
| | | | | | - Prasanth Asher
- Department of Neurosurgery, Government Medical College, Thiruvananthapuram, Kerala, India
| | | | - Anilkumar Peethambaran
- Department of Neurosurgery, Government Medical College, Thiruvananthapuram, Kerala, India
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Bhimani AD, Denyer S, Esfahani DR, Zakrzewski J, Aguilar TM, Mehta AI. Surgical Complications in Intradural Extramedullary Spinal Cord Tumors - An ACS-NSQIP Analysis of Spinal Cord Level and Malignancy. World Neurosurg 2018; 117:e290-e299. [DOI: 10.1016/j.wneu.2018.06.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 06/01/2018] [Accepted: 06/02/2018] [Indexed: 10/14/2022]
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"Microendoscopic" versus "pure endoscopic" surgery for spinal intradural mass lesions: a comparative study and review. Spine J 2018; 18:1592-1602. [PMID: 29452284 DOI: 10.1016/j.spinee.2018.02.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 02/05/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND CONTEXT Endoscopy is increasingly being used for minimal invasiveness and panoramic visualization, with unclear efficacy and safety among spinal intradural mass. OBJECTIVE The present study aims to compare microendoscopic and pure endoscopic surgery for spinal intradural lesions. MATERIALS AND METHODS Spinal intradural lesions operated using endoscopic or access ports were categorized into "microendoscopic" (predominant microscope use) or "pure endoscopic" (stand-alone endoscopy) surgery, and were studied with respect to clinico-radiological features, techniques, perioperative course, histopathology, clinical, and radiological outcome at minimum of 3 months. RESULTS Among 34 patients studied, the initial 15 had "microendoscopic" surgery, 16 had "pure-endoscopic" surgery, and 3 had "mixed" use. There were 18 nerve sheath tumors, 6 meningiomas, 6 cysts, 2 ependymomas, ranging in size from 1.5 to as large as 6.8 cm (21%≥4 cm), including 4 in craniovertebral junction (CVJ). Intermuscular or paraspinous approach was utilized, followed by small bony fenestration or interlaminar corridor. Even larger tumors could be excised using expandable ports or "sliding delivery" technique. Although visualization of sides and angles was better with endoscope, hemostasis and dural closure had steep learning curve, necessitating the use of microscope in the initial cases. Clinical improvement and radiological resolution could be achieved in all. There was no significant difference between the groups. The change in Nurick grade had significant correlation with only the dimension of lesion (p=.03) and preoperative grade (p=.05). CONCLUSIONS This is probably the first report of spinal endoscopy for intradural tumors in CVJ or as big as 7 cm. Endoscopy is effective and safe for even large tumors with better visualization of sides and angles, albeit with hemostasis and dural closure having initial learning curve. Wide heterogeneity of surgical terminologies in the literature on these procedures warrants consensus for uniform reporting.
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Chotai S, Zuckerman SL, Parker SL, Wick JB, Stonko DP, Hale AT, McGirt MJ, Cheng JS, Devin CJ. Healthcare Resource Utilization and Patient-Reported Outcomes Following Elective Surgery for Intradural Extramedullary Spinal Tumors. Neurosurgery 2018; 81:613-619. [PMID: 28498938 DOI: 10.1093/neuros/nyw126] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 04/28/2017] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Healthcare resource utilization and patient-reported outcomes (PROs) for intradural extramedullary (IDEM) spine tumors are not well reported. OBJECTIVE To analyze the PROs, costs, and resource utilization 1 year following surgical resection of IDEM tumors. METHODS Patients undergoing elective spine surgery for IDEM tumors and enrolled in a single-center, prospective, longitudinal registry were analyzed. Baseline and postoperative 1-year PROs were recorded. One-year spine-related direct and indirect healthcare resource utilization was assessed. One-year resource use was multiplied by unit costs based on Medicare national payment amounts (direct cost). Patient and caregiver workday losses were multiplied by the self-reported gross-of-tax wage rate (indirect cost). RESULTS A total of 38 IDEM tumor patients were included in this analysis. There was significant improvement in quality of life (EuroQol-5D), disability (Oswestry and Neck Disability Indices), pain (Numeric rating scale pain scores for back/neck pain and leg/arm pain), and general physical and mental health (Short-form-12 health survey, physical and mental component scores) in both groups 1 year after surgery (P < .0001). Eighty-seven percent (n = 33) of patients were satisfied with surgery. The 1-year postdischarge resource utilization including healthcare visits, medication, and diagnostic cost was $4111 ± $3596. The mean total direct cost was $23 717 ± $7412 and indirect cost was $5544 ± $4336, resulting in total 1-year cost $29 177 ± $9314. CONCLUSION Surgical resection of the IDEM provides improvement in patient-reported quality of life, disability, pain, general health, and satisfaction at 1 year following surgery. Furthermore, we report the granular costs of surgical resection and healthcare resource utilization in this population.
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Affiliation(s)
- Silky Chotai
- Department of Orthopedics Surgery and Department of Neurological surgery, Spinal Column Surgical Quality and Out-comes Research Laboratory, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Scott L Zuckerman
- Department of Orthopedics Surgery and Department of Neurological surgery, Spinal Column Surgical Quality and Out-comes Research Laboratory, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Scott L Parker
- Department of Orthopedics Surgery and Department of Neurological surgery, Spinal Column Surgical Quality and Out-comes Research Laboratory, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Joseph B Wick
- Department of Orthopedics Surgery and Department of Neurological surgery, Spinal Column Surgical Quality and Out-comes Research Laboratory, Vanderbilt University Medical Center, Nashville, Tennessee
| | - David P Stonko
- Department of Orthopedics Surgery and Department of Neurological surgery, Spinal Column Surgical Quality and Out-comes Research Laboratory, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Andrew T Hale
- Department of Orthopedics Surgery and Department of Neurological surgery, Spinal Column Surgical Quality and Out-comes Research Laboratory, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Matthew J McGirt
- Department of Neurological Surgery, Carolina Neurosurgery and Spine Associates, Charlotte, North Carolina
| | - Joseph S Cheng
- Department of Orthopedics Surgery and Department of Neurological surgery, Spinal Column Surgical Quality and Out-comes Research Laboratory, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Clinton J Devin
- Department of Orthopedics Surgery and Department of Neurological surgery, Spinal Column Surgical Quality and Out-comes Research Laboratory, Vanderbilt University Medical Center, Nashville, Tennessee
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Villalonga JF, Cervio A. [Surgical treatment of intradural extramedullary lesions by hemilaminectomy]. Surg Neurol Int 2017; 8:S11-S17. [PMID: 29142776 PMCID: PMC5672658 DOI: 10.4103/sni.sni_253_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Accepted: 07/21/2017] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To evaluate the usefulness of hemilaminectomy as a surgical approach in patients with intradural-extramedullary tumors. METHODS Retrospective analysis of patients in which hemilaminectomy was as surgical approach in intradural-extramedullary tumors between June 2006 and December 2015. Demographics, preoperative symptoms, imaging characteristics, intraoperative findings, histological lineage, and postsurgical complications were analyzed. The average follow-up was 48.9 months (6-120 months). RESULTS Fifty-three patients underwent hemilaminectomy. Tumor was located in the cervical level in 5 cases, in the dorsal level in 24, and in the lumbar region in 24 cases. Histological analysis revealed 28 neuromas, 11 meningiomas, 7 ependymomas, and 7 "multiple injuries." Total resection without postsurgical neurologic deficit was possible in 96% of the patients. There were no recurrences on follow-up. CONCLUSION Hemilaminectomy is an effective approach for the resection of lateralized cervicodorsal intradural-extramedullary tumors. It can also be used to treat midline lesions located in the lumbar level.
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Affiliation(s)
- Juan F. Villalonga
- Departamento de Neurocirugía del Instituto FLENI, Buenos Aires, Argentina
| | - Andrés Cervio
- Departamento de Neurocirugía del Instituto FLENI, Buenos Aires, Argentina
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Mende KC, Krätzig T, Mohme M, Westphal M, Eicker SO. Keyhole approaches to intradural pathologies. Neurosurg Focus 2017; 43:E5. [DOI: 10.3171/2017.5.focus17198] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVESpinal tumors account for 2%–4% of all tumors of the central nervous system and can be intramedullary, intradural extramedullary, or extradural. In the past, wide approaches were used to obtain safe access to these tumors, as complete resection is the goal in treating most tumor entities. To reduce surgical complications due to large skin incisions and destabilizing laminectomies, minimally invasive approaches were established. In this study, the authors share their experience with mini-open approaches to intradural tumor pathologies.METHODSThe authors retrospectively reviewed cases involving patients with intramedullary and intradural extramedullary lesions treated between 2009 and 2016. They present their surgical mini-open approach to the spinal cord as well as unique characteristics, key steps, and postsurgical complications for specific tumor subgroups (meningioma, neuroma, and intramedullary tumors).RESULTSA total of 245 intradural tumors were surgically treated during the study period. Of these lesions, 151 were intradural extramedullary meningiomas (n = 79) or neuromas (n = 72). Nine (12.5%) of the neuromas were dumbbell neuromas. Ninety-four tumors were intramedullary. The mean age of the patients was 51.4 years, and 53.9% were female. The mean duration of follow-up was 46.0 months.All meningiomas and neuromas could be resected using a mini-open keyhole approach, but only 5.3% of the intramedullary lesions could be accessed using this technique. Of the 94 patients with intramedullary tumors, 76.6% required a laminotomy, 7.4% required a hemilaminectomy, and 10.6% required a 2-level laminectomy. Only 2 of the patients with intramedullary tumors needed stabilization for progressive cervical kyphosis during follow-up. None of the other patients developed spinal instability after undergoing surgery via the mini-open (keyhole/interlaminar) approach. There were significantly more surgery-associated complications in the large exposure group than in the patients treated with the mini-open approach (19.1% vs 9.6%, p < 0.01).CONCLUSIONSIntradural extramedullary and in selected cases intramedullary pathologies may safely be resected using a mini-open interlaminar approach. Avoiding laminectomy, laminotomy, and even hemilaminectomy preserves spinal stability and significantly reduces comorbidities, while still allowing for complete resection of these tumors.
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Formo M, Halvorsen CM, Dahlberg D, Brommeland T, Fredø H, Hald J, Scheie D, Langmoen IA, Lied B, Helseth E. Minimally Invasive Microsurgical Resection of Primary, Intradural Spinal Tumors is Feasible and Safe: A Consecutive Series of 83 Patients. Neurosurgery 2017; 82:365-371. [DOI: 10.1093/neuros/nyx253] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Accepted: 06/07/2017] [Indexed: 12/18/2022] Open
Abstract
Abstract
BACKGROUND
To date, the traditional approach to intraspinal tumors has been open laminectomy or laminoplasty followed by microsurgical tumor resection. Recently, however, minimally invasive approaches have been attempted by some.
OBJECTIVE
To investigate the feasibility and safety of minimally invasive surgery (MIS) for primary intradural spinal tumors.
METHODS
Medical charts of 83 consecutive patients treated with MIS for intradural spinal tumors were reviewed. Patients were followed up during the study year, 2015, by either routine history/physical examination or by telephone consultation, with a focus on tumor status and surgery-related complications.
RESULTS
Mean age at surgery was 53.7 yr and 52% were female. There were 49 schwannomas, 18 meningeomas, 10 ependymomas, 2 hemangioblastomas, 1 neurofibroma, 1 paraganglioma, 1 epidermoid cyst, and 1 hemangiopericytoma. The surgical mortality was 0%. In 87% of cases, gross total resection was achieved. The complication rate was 11%, including 2 cerebrospinal fluid leakages, 1 asymptomatic pseudomeningocele, 2 superficial surgical site infections, 1 sinus vein thrombosis, and 4 cases of neurological deterioration. There were no postoperative hematomas, and no cases of deep vein thrombosis or pulmonary embolism. Ninety-three percent of patients were ambulatory and able to work at the time of follow-up.
CONCLUSION
This study both demonstrates that it is feasible and safe to remove select, primary intradural spinal tumors using MIS, and augments the previous literature in favor of MIS for these tumors.
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Affiliation(s)
- Maja Formo
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Charlotte Marie Halvorsen
- Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Neurosurgery, Oslo University Hospital, Oslo, Norway
| | - Daniel Dahlberg
- Department of Neurosurgery, Oslo University Hospital, Oslo, Norway
| | - Tor Brommeland
- Department of Neurosurgery, Oslo University Hospital, Oslo, Norway
| | - Hege Fredø
- Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Neurosurgery, Oslo University Hospital, Oslo, Norway
| | - John Hald
- Department of Neuro-radiology, Oslo University Hospital, Oslo, Norway
| | - David Scheie
- Department of Neuro-pathology, Oslo University Hospital, Oslo, Norway
- Department of Neuropatho-logy, Rigshospitalet, Copenhagen, Denmark
| | - Iver A Langmoen
- Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Neurosurgery, Oslo University Hospital, Oslo, Norway
| | - Bjarne Lied
- Department of Neurosurgery, Oslo University Hospital, Oslo, Norway
| | - Eirik Helseth
- Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Neurosurgery, Oslo University Hospital, Oslo, Norway
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Surgical Resection of Intradural Extramedullary Spinal Tumors: Patient Reported Outcomes and Minimum Clinically Important Difference. Spine (Phila Pa 1976) 2016; 41:1925-1932. [PMID: 27111764 DOI: 10.1097/brs.0000000000001653] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Analysis of prospectively collected longitudinal web-based registry data. OBJECTIVE To determine relative validity, responsiveness, and minimum clinically important difference (MCID) thresholds in patients undergoing surgery for intradural extramedullary (IDEM) spinal tumors. SUMMARY OF BACKGROUND DATA Patient-reported outcomes (PROs) are vital in establishing the value of care in spinal pathology. There is limited availability of prospective, quality studies reporting PROs for IDEM spine tumors. METHODS . A total of 40 patients were analyzed. Baseline, postoperative 3-month, and 12-month PROs were recorded: Oswestry Disability Index or Neck disability Index (ODI/NDI), Quality of life EuroQol-5D (EQ-5D), Short Form-12 (SF-12), Numeric Rating Scale (NRS)-pain scores. Responders were defined as those who achieved a level of improvement one or two, after surgery, on health transition index (HTI) of SF-36. Receiver-operating characteristic curves were generated to assess the validity of PROs, and the difference between standardized response means (SRMs) in responders versus nonresponders was utilized to determine the relative responsiveness of each PRO measure. MCID thresholds were derived using previously reported minimal detectable change approach. RESULTS A significant improvement across all PROs at 3-months and 12-months follow up was noted. The derived MCID thresholds were 13.9 points: ODI/NDI, 0.14 quality adjusted life years: EQ-5D, 2.8 points: SF-12PCS and 10.7 points: SF-12MCS, 1.9 points: NRS-back/neck pain, and 1.8 points: NRS-leg/arm pain. SF-12PCS was most accurate discriminator of meaningful improvement (area under the curve, AUC-0.83) and most responsive (SRM-1.36) to postoperative improvement. EQ-5D, ODI/NDI, NRS-pain scores were all accurate discriminator (AUC-0.7-0.8) and responsive measures (0.97-0.67) of meaningful postoperative improvement. SF-12MCS was neither a valid discriminator (AUC-0.48) nor a responsive measure (SRM: -1.5) of outcome. CONCLUSION Surgical resection of IDEM spinal tumors provides significant and sustained improvement in quality of life, general health, disability, and pain at 12-month after surgery. The surgically resected IDEM-specific clinically meaningful thresholds are reported. All the PROs reported in this study can accurately discriminate responders and nonresponder based on SF-36 HTI index except for SF-12 MCS. LEVEL OF EVIDENCE 3.
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Bhat AR, Kirmani AR, Wani MA, Bhat MH. Incidence, histopathology, and surgical outcome of tumors of spinal cord, nerve roots, meninges, and vertebral column - Data based on single institutional (Sher-i-Kashmir Institute of Medical Sciences) experience. J Neurosci Rural Pract 2016; 7:381-91. [PMID: 27365955 PMCID: PMC4898106 DOI: 10.4103/0976-3147.181489] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Context: In the absence of a community-based study on the spinal tumors in the Valley, medical records of the only Regional Neurosurgical Center are available. Aim: The aim of this study is to establish a hospital-based regional epidemiology of spinal tumors in the Valley since the data are derived from a single institution. Materials and Methods: A retrospective analysis of 531 malignant and nonmalignant tumors of spinal cord, its coverings and vertebrae, which were managed in a Regional Neurosurgical Center under a standard and uniform medical-protocol over 30-year period from 1983 to 2014. Results: The hospital-based incidence for all spinal tumors was 0.24/100,000 persons per year. The malignant spinal cord and vertebral tumors comprised 32.58% (173/531) of all tumors, and benign spinal cord and vertebral tumors comprised 67.42% (358/531). The extradural–intradural tumors such as metastatic lesions and primary malignant vertebral tumors were on rise with 16.38% (87/531) cases. The children below 18 years were 5.46% (29/531), of which 55.17% (16/29) were below 9 years. The most common primary bone malignancy was multiple myeloma (54.54% =12/22). Histopathologically, the most common metastatic deposit in the spinal canal was non-Hodgkin's lymphoma (24.61% =16/65). A mortality of 3.20% (17/531) was noted. Recurrences were noted in 4.90% (26/531), and adjuvant therapies were given to 16.38% (87/531) patients. Conclusion: The malignant spinal cord and vertebral tumors, especially metastatic deposits, are on rise in elderly population. The surgical outcome, in terms of recovery and spinal stability, of benign tumors, is comparatively better than malignant ones. The study reveals a low regional incidence (hospital-based) of spinal tumors.
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Affiliation(s)
- Abdul Rashid Bhat
- Department of Neurosurgery, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Altaf Rehman Kirmani
- Department of Neurosurgery, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Muhammed Afzal Wani
- Department of Neurosurgery, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Mohammed Haneef Bhat
- Department of Neurosurgery, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
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Zhu YJ, Ying GY, Chen AQ, Wang LL, Yu DF, Zhu LL, Ren YC, Wang C, Wu PC, Yao Y, Shen F, Zhang JM. Minimally invasive removal of lumbar intradural extramedullary lesions using the interlaminar approach. Neurosurg Focus 2016; 39:E10. [PMID: 26235008 DOI: 10.3171/2015.5.focus15182] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECT Posterior midline laminectomy or hemilaminectomy has been successfully applied as the standard microsurgical technique for the treatment of spinal intradural pathologies. However, the associated risks of postoperative spinal instability increase the need for subsequent fusion surgery to prevent potential long-term spinal deformity. Continuous efforts have been made to minimize injuries to the surrounding tissue resulting from surgical manipulations. The authors report here their experiences with a novel minimally invasive surgical approach, namely the interlaminar approach, for the treatment of lumbar intraspinal tumors. METHODS A retrospective review was conducted of patients at the Second Affiliated Hospital of Zhejiang University School of Medicine who underwent minimally invasive resection of lumbar intradural-extramedullary tumors. By using an operative microscope, in addition to an endoscope when necessary, the authors were able to treat all patients with a unilateral, paramedian, bone-sparing interlaminar technique. Data including preoperative neurological status, tumor location, size, pathological diagnosis, extension of resections, intraoperative blood loss, length of hospital stay, and clinical outcomes were obtained through clinical and radiological examinations. RESULTS Eighteen patients diagnosed with lumbar intradural-extramedullary tumors were treated from October 2013 to March 2015 by this interlaminar technique. A microscope was used in 15 cases, and the remaining 3 cases were treated using a microscope as well as an endoscope. There were 14 schwannomas, 2 ependymomas, 1 epidermoid cyst, and 1 enterogenous cyst. Postoperative radiological follow-up revealed complete removal of all the lesions and no signs of bone defects in the lamina. At clinical follow-up, 14 of the 18 patients had less pain, and patients' motor/sensory functions improved or remained normal in all cases except 1. CONClUSIONS When meeting certain selection criteria, intradural-extramedullary lumbar tumors, especially schwannomas, can be completely and safely resected through a less-invasive interlaminar approach using a microscope, or a microscope in addition to an endoscope when necessary. This approach was advantageous because it caused even less bone destruction, resulting in better postoperative spinal stability, no need for facetectomy and fusion, and quicker functional recovery for the patients. Individualized surgical planning according to preoperative radiological findings is key to a successful microsurgical resection of these lesions through the interlaminar space.
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Affiliation(s)
- Yong-Jian Zhu
- Department of Neurosurgery, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou
| | - Guang-Yu Ying
- Department of Neurosurgery, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou
| | - Ai-Qin Chen
- Department of Neurosurgery, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou
| | - Lin-Lin Wang
- Department of Physiology, Zhejiang University School of Medicine, Hangzhou; and
| | - Dan-Feng Yu
- Department of Neurosurgery, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou
| | - Liang-Liang Zhu
- Department of Neurosurgery, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou
| | - Yu-Cheng Ren
- Department of Neurosurgery, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou
| | - Chen Wang
- Department of Neurosurgery, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou
| | - Peng-Cheng Wu
- Department of Neurosurgery, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou
| | - Ying Yao
- Department of Neurosurgery, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou
| | - Fang Shen
- Department of Neurosurgery, Ningbo No. 2 Hospital, Ningbo, China
| | - Jian-Min Zhang
- Department of Neurosurgery, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou
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Toquart A, Graillon T, Mansouri N, Adetchessi T, Blondel B, Fuentes S. Prise en charge des métastases rachidiennes par technique chirurgicale mini-invasive : principes chirurgicaux, indications : revue de la littérature. Neurochirurgie 2016; 62:157-64. [DOI: 10.1016/j.neuchi.2015.12.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 11/15/2015] [Accepted: 12/10/2015] [Indexed: 11/26/2022]
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Avila MJ, Walter CM, Skoch J, Abbasifard S, Patel AS, Sattarov K, Baaj AA. Fusion after intradural spine tumor resection in adults: A review of evidence and practices. Clin Neurol Neurosurg 2015; 138:169-73. [DOI: 10.1016/j.clineuro.2015.08.020] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 08/19/2015] [Accepted: 08/22/2015] [Indexed: 12/17/2022]
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Fontes RBV, Wewel JT, O'Toole JE. Perioperative Cost Analysis of Minimally Invasive vs Open Resection of Intradural Extramedullary Spinal Cord Tumors. Neurosurgery 2015; 78:531-9. [DOI: 10.1227/neu.0000000000001079] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Abstract
BACKGROUND:
Minimally invasive spinal surgery (MIS) has emerged as a clinically effective tool but its cost-effectiveness remains unclear. No studies have compared MIS vs open surgical techniques for the treatment of intradural extramedullary (IDEM) tumors.
OBJECTIVE:
To analyze and compare open and MIS techniques for resection of IDEM tumors, with focus on perioperative costs.
METHODS:
Retrospective analysis of a prospectively collected database including 35 IDEM patients (18 open, 17 MIS). Perioperative data, hospital costs, and hospital and physician charges for in-hospital services associated with the index surgical procedure and readmissions within 90 days were compared.
RESULTS:
Mean estimated blood loss, operative time, preoperative hospital charges, and physician fees were similar between open and MIS techniques. Patient and tumor characteristics were similar between groups. MIS cases were associated with shorter intensive care unit and floor stay. There were 3 complications in the open group, requiring 2 readmissions and 1 reoperation. Hospital costs ($21 307.80 open, $15 015.20 MIS, P < .01), and postoperative ($75 383.48 open, $56 006.88 MIS, P < .01) and total charges ($100 779.38 open, $76 100.92 MIS, P < .01) were significantly lower in the MIS group. There were no tumor recurrences in either group. All patients except for one in the open group maintained or improved their Nurick score.
CONCLUSION:
Both MIS and open techniques were able to adequately treat IDEM tumors. Reductions in complication rate and intensive care unit and hospital stay led to a decrease in hospital costs of almost 30% in the MIS group. MIS resection of IDEM tumors is not only an effective and safe option, but allows faster hospital discharge and significant cost savings.
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Affiliation(s)
| | - Joshua T. Wewel
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois
| | - John E. O'Toole
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois
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Wong AP, Lall RR, Dahdaleh NS, Lawton CD, Smith ZA, Wong RH, Harvey MJ, Lam S, Koski TR, Fessler RG. Comparison of open and minimally invasive surgery for intradural-extramedullary spine tumors. Neurosurg Focus 2015; 39:E11. [DOI: 10.3171/2015.5.focus15129] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECT
Patients with symptomatic intradural-extramedullary (ID-EM) tumors may be successfully treated with resection of the lesion and decompression of associated neural structures. Studies of patients undergoing open resection of these tumors have reported high rates of gross-total resection (GTR) with minimal long-term neurological deficit. Case reports and small case series have suggested that these patients may be successfully treated with minimally invasive surgery (MIS). These studies have been limited by small patient populations. Moreover, there are no studies directly comparing perioperative outcomes between patients treated with open resection and MIS. The objective of this study was to compare perioperative outcomes in patients with ID-EM tumors treated using open resection or MIS.
METHODS
A retrospective review was performed using data collected from 45 consecutive patients treated by open resection or MIS for ID-EM spine tumors. These patients were treated over a 9-year period between April 2003 and October 2012 at Northwestern University and the University of Chicago. Statistical analysis was performed to compare perioperative outcomes between the two groups.
RESULTS
Of the 45 patients in the study, 27 were treated with the MIS approach and 18 were treated with the open approach. Operative time was similar between the two groups: 256.3 minutes in the MIS group versus 241.1 minutes in the open group (p = 0.55). Estimated blood loss was significantly lower in the MIS group (133.7 ml) compared with the open group (558.8 ml) (p < 0.01). A GTR was achieved in 94.4% of the open cases and 92.6% of the MIS cases (p = 0.81).
The mean hospital stay was significantly shorter in the MIS group (3.9 days) compared with the open group (6.1 days) (p < 0.01). There was no significant difference between the complication rates (p = 0.32) and reoperation rates (p = 0.33) between the two groups. Multivariate analysis demonstrated an increased rate of complications in cervical spine tumors (OR 15, p = 0.05).
CONCLUSIONS
Thoracolumbar ID-EM tumors may be safely and effectively treated with either the open approach or an MIS approach, with an equivalent rate of GTR, perioperative complication rate, and operative time. Patients treated with an MIS approach may benefit from a decrease in operative blood loss and shorter hospital stays.
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Affiliation(s)
- Albert P. Wong
- 1Department of Neurosurgery, Stanford University School of Medicine, Stanford, California
| | - Rishi R. Lall
- 2Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago
| | - Nader S. Dahdaleh
- 2Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago
| | - Cort D. Lawton
- 2Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago
| | - Zachary A. Smith
- 2Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago
| | - Ricky H. Wong
- 3Department of Neurosurgery, University of Chicago Pritzer School of Medicine, Chicago, Illinois
| | - Michael J. Harvey
- 2Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago
| | - Sandi Lam
- 4Department of Neurosurgery, Baylor College of Medicine, Houston, Texas; and
| | - Tyler R. Koski
- 2Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago
| | - Richard G. Fessler
- 5'Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois
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