Laminectomy with Laminar Reconstruction for Resection of Intradural Tumors at the Thoracolumbar Junction: A Technical Note

OBJECTIVE

To introduce a new laminar reconstruction technique to treat primary spinal cord tumors.

METHODS

Laminectomy and laminoplasty techniques have been used to treat intradural spinal tumors. The advantage of laminectomy is its superior exposure of the spinal cord, whereas the advantage of laminoplasty is the reconstruction of the dorsal roof of the spine. In this technical note, we present a technique that combines a full laminectomy to maximize exposure, with a reconstructive technique to repair the lamina. This technique restores the posterior ligamentous complex to preserve spinal biomechanics.

RESULTS

In this illustrative case, a 55-year-old woman with severe back pain radiating to the right lower extremity was found to have an intradural tumor at the T12-L1 spinal level. Given the transitional level of the spine and potentially high biomechanical stresses on the posterior support structures, we used a T12 laminectomy to resect the tumor, followed by reconstruction using miniplates. The patient tolerated the surgery well, without any complications. She was discharged home and was doing well during the 3 months follow-up visit. Appropriate patient consent was obtained.

CONCLUSIONS

Laminectomy and laminar reconstruction allow maximum visualization and manipulation of the tumor, followed by restoration of the dorsal roof of the spinal ring, and is an effective technique for treating spinal cord tumors.

Spinal meningiomas

Spinal meningiomas are typically slow growing, benign lesions with the potential to cause significant morbidity if untreated. Their incidence is approximately 3 per 100,000 and they are more common in women than in men. Surgical resection has a relatively low complication rate and the potential for very favorable outcomes. Surgery remains the mainstay of treatment with radiation reserved for those who cannot tolerate the procedure or for recurrent disease. We describe the epidemiology, presentation, and treatment options for spinal meningiomas here as well as provide an example case.

Intradural spinal tumors: 10 - years surgical experience in a single institution

OBJECTIVES

The aim of the study is to present the therapeutic results of intradural tumor management over a 10 years period in a single institution.

PATIENTS AND METHODS

The study consists in a prospective case series of patients treated at the neurosurgery service of the Social Security Institute of Mexico State and Provinces (ISSSEMYM), between January 2006 and December 2016. All patients were provided with information about the procedure and signed informed consent and institutional board approved files review for this study.

RESULTS

Thirty-five patients with intradural tumor were treated between 2006-2016. Most frequent lesions were extramedullary (30 patients, 85.7%). Most frequent tumor was Schwannoma, with thoracic/thoraco-lumbar location, being the most frequent location. All patients underwent surgical treatment, with total gross resection accomplished in 19 patients (54.3%). Surgical complication rate was 11.4%. Spine instrumentation was necessary in 26 patients (74.3%) because of bone destruction by the tumor, or bone removal for approach. All patients with intramedullary lesions and 5 patients (16.7%) with extramedullary lesions received post-operative radiotherapy. During the follow-up, 8.5% of patients had recurrence/progression of residual disease.

CONCLUSIONS

Microsurgery is the treatment of choice for intradural spinal tumors, and gross total resection with low morbidity must be the surgical goal. When this is not possible, partial resection and adjuvant therapy with radiosurgery are a valid option. Patients most be long followed-up because of recurrence risk or disease progression.

A case of intradural osteosarcoma of the spine

BACKGROUND CONTEXT

Intradural-extramedullary spinal tumors and extradural osteosarcomas are both rare entities. Only one case of primary intradural-extramedullary osteosarcoma of the spine has been previously reported. This is the second reported case.

PURPOSE

To describe a case of primary intradural-extramedullary osteosarcoma of the spine associated with rapid clinical deterioration.

STUDY DESIGN

Case report of a 70-year-old woman who presented with a constellation of neurologic symptoms.

METHODS

Review of patient files, radiographic studies, surgical images, histopathology, and relevant literature.

RESULTS

The patient underwent tumor debulking but exhibited rapid, postsurgical, functional deterioration and died within 6 weeks. This case and the only previous case of its kind both occurred in individuals with a remote history of iophendylate (Myodil) myelogram.

CONCLUSIONS

Primary intradural-extramedullary extraosseous osteosarcoma of the spine is an exceedingly rare entity with no established management approach. Iophendylate myelography may be implicated in the etiology of this tumor type.