Evaluation of hemilaminectomy use in microsurgical resection of intradural extramedullary tumors

Hemilaminectomy for the removal of the spinal tumors: An analysis of 901 patients

Objective

We report our experience with the use of hemilaminectomy approach for the removal of benign intraspinal tumors.

Method

A retrospective review of 1,067 patients who underwent hemilaminectomy in our hospital between 2013 and 2019 was analyzed. Baseline medical data were collected. One hundred sixteen patients were excluded due to degenerative diseases, spinal bone tumors, and malignant tumors. The remaining 901 patients (916 tumors) were enrolled. The Dennis Pain Scale (DPS) was used to assess improvement in pain before surgery and during long-term follow-up. Neurological status was assessed using the American Spinal Injury Association (ASIA) impairment scale.

Results

The age of the patients was 48.7 ± 15.3 years, the duration of symptoms was 16.5 ± 32.0 months, and the tumor size was 2.6 ± 1.4 cm. Three hundred two tumors were located in the cervical region, 42 in the cervicothoracic region, 234 in the thoracic region, 57 in the thoracolumbar region, and 281 in the lumbar and lumbosacral region. Twenty-three tumors were ventrally located, 677 were dorsal or dorsolateral, 63 were intramedullary, 87 were epidural, and the rest were dumbbell-shaped. The most common pathologies were schwannomas (601, 66.7%) and meningiomas (172, 19.1%). Total excision was achieved at 97.8%. The operative time was 94.3 ± 32.6 min and the blood loss during surgery was 96.9 ± 116.5 ml. The symptom of pain improved in 87.0% of patients during long-term follow-up, neurological function improved in 68.3% and remained unchanged at 30.5%.

Conclusion

The hemilaminectomy approach was a rapid and safe procedure to remove intradural and extradural tumors. This approach has offered several advantages. It could be used for the resection of most extradural or intradural extramedullary lesions, even some intramedullary tumors.

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

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.

Abordaje mínimamente invasivo para el tratamiento de tumores espinales intradurales extramedulares: Nota Técnica

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.

Hemilaminectomy for Spinal Cord Intradural Tumors: An Institutional Experience

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.

[Surgical treatment of intradural extramedullary lesions by hemilaminectomy]

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.

Minimally invasive removal of lumbar intradural extramedullary lesions using the interlaminar approach

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.

The use of minimally invasive approaches to resect intradural extramedullary spinal cord tumors

AIM

To conduct a comparative analysis of outcomes in patients with extramedullary tumors operated on using a minimally invasive approach and traditional laminectomy.

MATERIAL AND METHODS

The study included 40 patients (13 males and 27 females) who underwent surgical treatment at the Department of Spinal Neurosurgery of the Burdenko Neurosurgical Institute. The mean age of patients was 47 years (range: 41-60 years). Tumors were located in the cervical, thoracic and lumbar spine. All patients were divided into two groups. In the control group, 20 patients underwent traditional laminectomy using a yard retractor or an Egorov-Freidin retractor. In the study group, 20 patients underwent hemilaminectomy using a retractor for minimally invasive surgery (Caspar and MAST Qudrant). The outcomes were evaluated 3, 6, and 12 months after surgery. The McCormik and VAS scales were used for the evaluation. MRI data were also evaluated.

RESULTS

Total tumor resection was reached in all cases. The mean surgery duration was 247 min (range: 180-320 min) for the first group and 105.25 min (range: 60-190 min) for the second one. The volume of blood loss was 297 mL (range: 100-600 mL) for the first group and 210 mL (50 to 400 mL) for the second group. The histological nature of the tumors was as follows: neurinoma, meningioma, and ependymomas of the cauda equina. The evaluation of the pain syndrome in the early postoperative period revealed that the pain syndrome intensity according to VAS was reduced in patients of the second group compared to that in patients of the first group. The evaluation using the McCormik scale revealed no obvious difference in the results between the study and control groups. MRI studies performed in the postoperative period showed no tumor recurrence.

CONCLUSION

Surgical treatment of patients with intradural extramedullary tumors can be safely and effectively performed using minimally invasive approaches. A potential reduction in surgery duration, intraoperative blood loss, the amount of anesthetic drugs and reduction in the pain syndrome in the early postoperative period allow us to conclude that, when performed by an experienced surgeon, the method of minimally invasive surgery may be an alternative to the traditional removal of an extramedullary tumor.