Abstract
Background Data: Intradural-extramedullary (IDEM) tumors represent two-thirds of spinal cord tumors. As IDEM tumors are mostly benign, advocated approaches for surgical excision of these lesions should aim for total excision of the lesion with avoiding unnecessary disruption of spinal stability. Study design: This is a retrospective case series. Purpose: To assess the feasibility and advantages of a minimally invasive hemilaminectomy approach for excising IDEM spinal tumors. Patients and Methods: This study was conducted in our institution to review retrospectively cases of IDEM spinal tumors that underwent a minimally invasive hemilaminectomy approach from January 2016 to January 2019. Twenty-six patients who presented with twenty-seven tumors fulfilled our criteria and were included in this study. The history of all patients was taken and they were subjected to clinical examination and preoperative MRI with contrast. Frankel scale was used to assess the neurological status of the affected limbs and Visual Analogue Scale (VAS) for the evaluation of associated radicular pain. Regular follow-up visits were arranged for our cases one month after surgery and then every three months for at least 6 months. Results: Twenty-six patients with 27 tumors were included in this study, 15 females (57.7%) and 11 males (42.3%). The mean age of patients was 42.3 ± 12.8 years. This study included 15 schwannomas (55.6%), 4 neurofibromas (14.8%), and 8 meningiomas (29.6%). Gross total excision was achieved in 26 tumors (96%). Early mobilization and short hospital stay (1.38 ± 1.09) days were reported in all these cases. Complications reported in this study included one case of wound infection, one patient developed a CSF leak, and one patient experienced a mild deterioration of motor power. Conclusion: This study suggests that a minimally invasive hemilaminectomy approach offers an adequate, safe, and convenient corridor for the total excision of IDEM tumors. However, good patient selection, accurate preoperative and intraoperative tumor localization, and meticulous microsurgical resection are mandatory. (2020ESJ208)
Highlights
PATIENTS AND METHODSIn 1888, Sir Victor Horsley succeeded for the first time in excising an IDEM tumor which was located in the thoracic region
The use of the hemilaminectomy approach has become more popular among spine surgeons, traditional full laminectomy is still a common practice for surgical excision of spinal tumors and has stood the test of time, despite causing massive tissue damage, blood loss, and prolonged hospital stays, especially when multiple levels are included
Twenty-seven tumors in 26 patients were evaluated in this study
Summary
In 1888, Sir Victor Horsley succeeded for the first time in excising an IDEM tumor which was located in the thoracic region This dated more than forty years before the invention of myelography, and unsurprisingly, the diagnosis of this case was delayed until the patient became paraplegic before being operated on via an extensive laminectomy with wound complication till full recovery after 1 year.[6] Recently, the field of spinal oncology witnessed outstanding advancements in both spinal imaging and surgical techniques. Regular outpatient follow-up visits were arranged one month after surgery and every three months In each visit, both residual and new pain VAS scores and Frankel grade for spinal cord function were evaluated during clinical assessment for all patients. Wilcoxon’s signed-rank test was applied for statistical data analysis
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