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El-Ghandour NMF. Commentary: C4 to C7 Laminoplasty for Resection of an Intradural Intramedullary Ependymoma: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2024:01787389-990000000-01100. [PMID: 38517184 DOI: 10.1227/ons.0000000000001129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 02/01/2024] [Indexed: 03/23/2024] Open
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Jiang L, Luo J, Gong H, Zhang F, Zhang L, Cheng L, Gao X, Zhang D, Liu T, Xiao J. Clinical and Biomechanical Study of Laminoplasty for Thoracic and Lumbar Intradural Tumors. J Clin Med 2023; 12:jcm12010355. [PMID: 36615155 PMCID: PMC9821651 DOI: 10.3390/jcm12010355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/20/2022] [Accepted: 12/29/2022] [Indexed: 01/04/2023] Open
Abstract
(1) Background: Primary intraspinal tumors account for 2-15% of all central nervous system (CNS) tumors. Most intraspinal tumors are benign, and about 40% of them occur intradurally, for which early surgery is the preferred treatment. Laminectomy with pedicle screw fixation is the conventional surgical treatment. However, laminectomy with pedicle screw fixation is likely to reduce the spinal range of motion (ROM), with many other complications, although it can maintain the stability of the spine. The aim of this study is to determine whether laminoplasty as a new surgical approach for thoracic and lumbar intradural tumors is superior to laminectomy in preserving spinal ROM, maintaining spinal stability and reducing postoperative complications. (2) Methods: We retrospectively analyzed 50 patients who received intradural tumor resection, including 23 who received traditional laminectomy with pedicle screw fixation and 27 who received new laminoplasty. Spinal ROM was evaluated by lumbar flexion/extension radiograph and biomechanical evaluation. Spinal stability was evaluated by imaging observations of the spinal Cobb angle and laminar bone fusion. Postoperative complications were evaluated according to cerebrospinal fluid (CSF) leakage and the length of hospital stay. (3) Results: Compared with the laminectomy group, patients in the laminoplasty group exhibited a better spinal ROM (31.6 ± 12.0° vs. 21.7 ± 11.8°, p = 0.013), a smaller Cobb angle (9.6 ± 4.3 vs. 12.5 ± 5.3, p = 0.034), a lower incidence of CSF leakage (4/14.8% vs. 11/47.8%, p = 0.015), and a shorter length of hospital stay (13.1 ± 1.8 vs. 15.1 ± 2.3 days, p = 0.001). Most patients in the laminoplasty group had satisfactory bone fusion. The biomechanical experiment also demonstrated that spinal ROM in laminoplasty was larger than that in the laminectomy group. (4) Conclusions: Compared with the traditional surgery, the new laminoplasty surgery can better maintain the stability of the spine, preserve spinal ROM, and reduce postoperative complications. It is a surgical method that can be clinically popularized.
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Affiliation(s)
- Lijun Jiang
- School of Medicine, Ningbo University, Ningbo 315211, China
- Orthopaedic Oncology Center, Department of Orthopedics, Changzheng Hospital, Naval Medical University, Shanghai 200003, China
| | - Jie Luo
- Orthopaedic Oncology Center, Department of Orthopedics, Changzheng Hospital, Naval Medical University, Shanghai 200003, China
| | - Haiyi Gong
- Orthopaedic Oncology Center, Department of Orthopedics, Changzheng Hospital, Naval Medical University, Shanghai 200003, China
| | - Fei Zhang
- Department of Orthopedics, Ningbo Beilun Orthopedic Hospital, Ningbo 315899, China
| | - Linxiang Zhang
- School of Medicine, Ningbo University, Ningbo 315211, China
- Orthopaedic Oncology Center, Department of Orthopedics, Changzheng Hospital, Naval Medical University, Shanghai 200003, China
| | - Linfei Cheng
- Orthopaedic Oncology Center, Department of Orthopedics, Changzheng Hospital, Naval Medical University, Shanghai 200003, China
| | - Xin Gao
- Orthopaedic Oncology Center, Department of Orthopedics, Changzheng Hospital, Naval Medical University, Shanghai 200003, China
| | - Dan Zhang
- Orthopaedic Oncology Center, Department of Orthopedics, Changzheng Hospital, Naval Medical University, Shanghai 200003, China
- Correspondence: (D.Z.); (T.L.); (J.X.)
| | - Tielong Liu
- Orthopaedic Oncology Center, Department of Orthopedics, Changzheng Hospital, Naval Medical University, Shanghai 200003, China
- Correspondence: (D.Z.); (T.L.); (J.X.)
| | - Jianru Xiao
- Orthopaedic Oncology Center, Department of Orthopedics, Changzheng Hospital, Naval Medical University, Shanghai 200003, China
- Correspondence: (D.Z.); (T.L.); (J.X.)
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Zeng W, Jiang H, He S, Zhang Y, Yu B, Wang H, Wang C. Comparison of Neuroendoscopic and Microscopic Surgery for Unilateral Hemilaminectomy: Experience of a Single Institution. Front Surg 2022; 9:823770. [PMID: 35425804 PMCID: PMC9002179 DOI: 10.3389/fsurg.2022.823770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 03/04/2022] [Indexed: 12/12/2022] Open
Abstract
Objective This study was designed to compare the safety and efficacy of unilateral hemilaminectomy conducted under complete neuroendoscopic visualization (UHNV) relative to unilateral hemilaminectomy under total microscopic visualization (UHMV) for the treatment of patients diagnosed with intraspinal tumors. Methods In total, 41 patients undergoing intraspinal tumor resection at Northern Jiangsu People's Hospital were included in this study, including 20 and 21 patients in the UHNV and UHMV groups, respectively. Intraoperative parameters including incision length, operative duration, number of vertebral laminae removed and intraoperative blood loss, as well as indicators of curative efficacy such as total tumor resection rates and postoperative symptom improvement rates, and safety indicators including complication rates, recurrence rates, spinal deformity rates, spinal instability incidence, and length of stay (LOS), were compared between the two groups. Results In contrast to the UHMV group, patients in the UHNV group had a significantly shorter incision length and decreased intraoperative blood loss (P < 0.05), while the operative duration (P > 0.05) showed no statistical difference. Although the postoperative improvement and total tumor resection rates were enhanced, the difference was not statistically significant (P > 0.05). In comparison, the bedridden time and length of stay (LOS) were significantly shortened (P < 0.05) in the UHNV group. However, there were no significant differences in recurrence, incidence of complications, spinal deformity, and spinal instability (P > 0.05). Conclusion Collectively, our findings indicate that UHNV is not inferior to the UHMV approach. Moreover, due to its safe and minimally invasive nature, UHNV represents a promising alternative to UHMV as a treatment for patients with intradural extramedullary tumors.
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Affiliation(s)
- Wei Zeng
- Department of Clinical Medicine, School of Medicine, Yangzhou University, Yangzhou, China
| | - Haixiao Jiang
- Department of Clinical Medicine, School of Medicine, Yangzhou University, Yangzhou, China
| | - Shiwei He
- Department of Clinical Medicine, Dalian Medical University, Dalian, China
| | - Yukun Zhang
- Department of Clinical Medicine, Dalian Medical University, Dalian, China
| | - Bo Yu
- Department of Neurosurgery, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Hui Wang
- Department of Neurosurgery, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Cunzu Wang
- Department of Neurosurgery, Clinical Medical College of Yangzhou University, Yangzhou, China
- *Correspondence: Cunzu Wang
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Cofano F, Giambra C, Costa P, Zeppa P, Bianconi A, Mammi M, Monticelli M, Di Perna G, Junemann CV, Melcarne A, Massaro F, Ducati A, Tartara F, Zenga F, Garbossa D. Management of Extramedullary Intradural Spinal Tumors: The Impact of Clinical Status, Intraoperative Neurophysiological Monitoring and Surgical Approach on Outcomes in a 12-Year Double-Center Experience. Front Neurol 2020; 11:598619. [PMID: 33391161 PMCID: PMC7775672 DOI: 10.3389/fneur.2020.598619] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 11/19/2020] [Indexed: 12/15/2022] Open
Abstract
Objective: Intradural Extramedullary (IDEM) tumors are usually treated with surgical excision. The aim of this study was to investigate the impact on clinical outcomes of pre-surgical clinical conditions, intraoperative neurophysiological monitoring (IONM), surgical access to the spinal canal, histology, degree of resection and intra/postoperative complications. Methods: This is a retrospective observational study analyzing data of patients suffering from IDEM tumors who underwent surgical treatment over a 12 year period in a double-center experience. Data were extracted from a prospectively maintained database and included: sex, age at diagnosis, clinical status according to the modified McCormick Scale (Grades I-V) at admission, discharge, and follow-up, tumor histology, type of surgical access to the spinal canal (bilateral laminectomy vs. monolateral laminectomy vs. laminoplasty), degree of surgical removal, use and type of IONM, occurrence and type of intraoperative complications, use of Ultrasonic Aspirator (CUSA), radiological follow-up. Results: A total number of 249 patients was included with a mean follow-up of 48.3 months. Gross total resection was achieved in 210 patients (84.3%) mostly in Schwannomas (45.2%) and Meningiomas (40.4%). IONM was performed in 162 procedures (65%) and D-wave was recorded in 64.2% of all cervical and thoracic locations (99 patients). The linear regression diagram for McCormick grades before and after surgery (follow-up) showed a correlation between preoperative and postoperative clinical status. A statistically significant correlation was found between absence of worsening of clinical condition at follow-up and use of IONM at follow-up (p = 0.01) but not at discharge. No associations were found between the choice of surgical approach and the extent of resection (p = 0.79), the presence of recurrence or residual tumor (p = 0.14) or CSF leakage (p = 0.25). The extent of resection was not associated with the use of IONM (p = 0.91) or CUSA (p = 0.19). Conclusion: A reliable prediction of clinical improvement could be made based on pre-operative clinical status. The use of IONM resulted in better clinical outcomes at follow-up (not at discharge), but no associations were found with the extent of resection. The use of minimally invasive approaches such as monolateral laminectomy showed to be effective and not associated with worse outcomes or increased complications.
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Affiliation(s)
- Fabio Cofano
- Unit of Neurosurgery, University Hospital of the City of Health and Science of Turin, Turin, Italy.,Ospedale Humanitas Gradenigo, Turin, Italy
| | | | - Paolo Costa
- Section of Clinical Neurophysiology, Centro Traumatologico Ortopedico Hospital, University Hospital of the City of Health and Science of Turin, Turin, Italy
| | - Pietro Zeppa
- Unit of Neurosurgery, University Hospital of the City of Health and Science of Turin, Turin, Italy
| | - Andrea Bianconi
- Unit of Neurosurgery, University Hospital of the City of Health and Science of Turin, Turin, Italy
| | - Marco Mammi
- Unit of Neurosurgery, University Hospital of the City of Health and Science of Turin, Turin, Italy
| | - Matteo Monticelli
- Unit of Neurosurgery, University Hospital of the City of Health and Science of Turin, Turin, Italy
| | - Giuseppe Di Perna
- Unit of Neurosurgery, University Hospital of the City of Health and Science of Turin, Turin, Italy
| | - Carola Vera Junemann
- Unit of Neurosurgery, University Hospital of the City of Health and Science of Turin, Turin, Italy
| | - Antonio Melcarne
- Unit of Neurosurgery, University Hospital of the City of Health and Science of Turin, Turin, Italy
| | - Fulvio Massaro
- Unit of Neurosurgery, University Hospital of the City of Health and Science of Turin, Turin, Italy
| | | | - Fulvio Tartara
- Unit of Neurosurgery, Istituto Clinico Città Studi (ICCS), Milan, Italy
| | - Francesco Zenga
- Unit of Neurosurgery, University Hospital of the City of Health and Science of Turin, Turin, Italy
| | - Diego Garbossa
- Unit of Neurosurgery, University Hospital of the City of Health and Science of Turin, Turin, Italy
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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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