Minimally Invasive Resection of a Cervical Anterolateral Meningioma: 2-Dimensional Operative Video

2018 ◽  
Vol 16 (4) ◽  
pp. 520-520
Author(s):  
Federico Landriel ◽  
Santiago Hem ◽  
Eduardo Vecchi ◽  
Claudio Yampolsky
Keyword(s):  
Spinal Cord ◽  
Minimally Invasive ◽  
Neck Pain ◽  
Video Recording ◽  
Tumor Resection ◽  
Spinal Tumors ◽  
Minimally Invasive Approach ◽  
En Bloc ◽  
Invasive Approach ◽  
Intradural Extramedullary

Abstract Intradural extramedullary spinal tumors were historically managed through traditional midline approaches. Although conventional laminectomy or laminoplasty provides a wide tumor and spinal cord exposure, they may cause prolonged postoperative neck pain and late kyphosis deformity. Minimally invasive ipsilateral hemilaminectomy preserves midline structures, reduces the paraspinal muscle disruption, and could avoid postoperative kyphosis deformity. A safe tumor resection through this approach could be complicated in large sized or anteromedullary located lesions. We present a surgical video of C3 antero located meningioma removed en bloc through a minimally invasive approach. The patient signed a written consent to publish video, recording, photograph, image, illustration, and/or information about him.

Minimally invasive lumbar intradural extramedullary tumor resection

2012 ◽  
Vol 33 (Suppl1) ◽  
pp. 1 ◽  
Author(s):  
Brian Lee ◽  
Patrick C. Hsieh
Keyword(s):  
Minimally Invasive ◽  
Tumor Resection ◽  
Surgical Techniques ◽  
Csf Leak ◽  
Minimally Invasive Approach ◽  
Invasive Approach ◽  
Extramedullary Tumor ◽  
Intradural Extramedullary ◽  
Dural Opening ◽  
Invasive Techniques

Intradural, extramedullary schwannomas have long been treated with open midline incision, laminectomy, and dural opening to expose and resect the lesion. While this technique is well established, today new surgical techniques can be utilized to perform the same procedure while minimizing pain, size of incision, and trauma to adjacent tissues. In cases of intradural surgery, minimally invasive surgery limits the degree of soft tissue disruption. As a result, there is significant decreased dead space within the surgical cavity that may decrease the rate of CSF leak complications. Minimally invasive techniques have continuously improved over the years and have reached a point where they can be used for intradural surgeries. In this case presentation, we demonstrate a minimally invasive approach to the lumbar spine with resection of an intradural schwannoma. Surgical techniques and the nuances of the minimally invasive approach to intradural tumors compared to the standard open procedure will be discussed. The video can be found here: http://youtu.be/XXrvAIq_H48.

Minimally invasive removal of thoracic and lumbar spinal tumors using a nonexpandable tubular retractor

2013 ◽  
Vol 19 (6) ◽  
pp. 708-715 ◽  
Author(s):  
Andre Nzokou ◽  
Alexander G. Weil ◽  
Daniel Shedid
Keyword(s):  
Minimally Invasive ◽  
Spinal Tumors ◽  
Subtotal Resection ◽  
Minimally Invasive Approach ◽  
Tubular Retractor ◽  
Invasive Approach ◽  
Duration Of Surgery ◽  
Intradural Extramedullary ◽  
Mini Open

Object Resection of spinal tumors traditionally requires bilateral subperiosteal muscle stripping, extensive laminectomy, and, in cases of foraminal extension, partial or radical facetectomy. Fusion is often warranted in cases of facetectomy to prevent deformity, pain, and neurological deterioration. Recent reports have demonstrated safety and efficacy of mini-open removal of these tumors using expandable tubular retractors. The authors report their experience with the minimally invasive removal of extradural foraminal and intradural-extramedullary tumors using the nonexpandable tubular retractor. Methods A retrospective chart review of consecutive patients who underwent minimally invasive resection of spinal tumors at Notre Dame Hospital was performed. Results Between December 2005 and March 2012, 13 patients underwent minimally invasive removal of spinal tumors at Notre Dame Hospital, Montreal. There were 6 men and 7 women with a mean age of 55 years (range 20–80 years). There were 2 lumbar and 2 thoracic intradural-extramedullary tumors and 7 thoracic and 2 lumbar extradural foraminal tumors. Gross-total resection was achieved in 12 patients. Subtotal resection (90%) was attained in 1 patient because the tumor capsule was adherent to the diaphragm. The average duration of surgery was 189 minutes (range 75–540 minutes), and the average blood loss was 219 ml (range 25–500 ml). There were no major procedure-related complications. Pathological analysis revealed benign schwannoma in 8 patients and meningioma, metastasis, plasmacytoma, osteoid osteoma, and hemangiopericytoma in 1 patient each. The average equivalent dose of postoperative narcotics after surgery was 66.3 mg of morphine. The average length of hospitalization was 66 hours (range 24–144 hours). All working patients returned to normal activities within 4 weeks. The average MRI and clinical follow-up were 13 and 21 months, respectively (range 2–68 months). At last follow-up, 92% of patients had improvement or resolution of pain with a visual analog scale score that improved from 7.8 to 1.2. All patients with neurological impairment improved. The American Spinal Injury Association grade improved in all but 1 patient. Conclusions Intradural-extramedullary and extradural tumors can be completely and safely resected through a minimally invasive approach using the nonexpandable tubular retractor. This approach may be associated with even less tissue destruction than mini-open techniques, translating into a quicker functional recovery. In cases of foraminal tumors, by eliminating the need for facetectomy, this minimally invasive approach may decrease the incidence of postoperative deformity and eliminate the need for adjunctive fusion surgery.

Safety and Efficacy of Intradural Extramedullary Spinal Tumor Removal Using a Minimally Invasive Approach

2011 ◽  
Vol 68 (suppl_1) ◽  
pp. ons208-ons216 ◽  
Author(s):  
Richard J. Mannion ◽  
Adrian M. Nowitzke ◽  
Johnny Efendy ◽  
Martin J. Wood
Keyword(s):  
Minimally Invasive Surgery ◽  
Minimally Invasive ◽  
Invasive Surgery ◽  
Spinous Process ◽  
Tumor Resection ◽  
Minimally Invasive Techniques ◽  
Minimally Invasive Approach ◽  
Invasive Approach ◽  
Intradural Extramedullary ◽  
Invasive Techniques

Abstract BACKGROUND: Although minimally invasive surgery for intradural tumors offers the potential benefits of less postoperative pain, a quicker recovery, and the avoidance of long-term instability from multilevel laminectomy, there are concerns over whether one can safely and effectively remove intradural extramedullary tumors in a fashion comparable to open techniques and whether the advantages of minimally invasive surgery are clinically significant. OBJECTIVE: To review our early experience with minimally invasive techniques for intradural extramedullary tumors of the spine. METHODS: Thirteen intradural tumors (1 cervical, 6 thoracic, 6 lumbar) in 11 patients were operated on using a muscle-splitting, tube-assisted paramedian oblique approach with hemilaminectomy to access the spinal canal while preserving the spinous process and ligaments. Fluoroscopy and navigation were used to determine the surgical level in all thoracic and lumbar cases. RESULTS: Satisfactory tumor resection using standard microsurgical techniques was achieved in all but 1 case using a minimally invasive approach. Surgical time and intraoperative blood loss were favorable compared with our open technique cases. There was no postoperative morbidity with the minimally invasive approach, although in 2 patients with tumors in the mid- and upper thoracic spine, the surgical incision was inaccurately placed by 1 level. In 1 case, the approach was converted to open when the tumor could not be found, and postoperatively there was a cerebrospinal fluid leak with infection that required readmission. CONCLUSION: Intradural extramedullary tumors can be safely and effectively removed using minimally invasive techniques. The pros and cons of minimally invasive vs open surgery are discussed.

scholarly journals Minimally Invasive Approach to Spinal Tumors

2015 ◽  
Vol 5 (1_suppl) ◽  
pp. s-0035-1554599-s-0035-1554599
Author(s):  
Alvaro Silva ◽  
Carlos Thibaut ◽  
Manuel Valencia ◽  
Bartolome Marre ◽  
Ratko Yurac ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Spinal Tumors ◽  
Minimally Invasive Approach ◽  
Invasive Approach

Minimally invasive resection of spinal hemangioblastoma: feasibility and clinical results in a series of 18 patients

2019 ◽  
Vol 31 (6) ◽  
pp. 880-889 ◽  
Author(s):  
Marie T. Krüger ◽  
Christine Steiert ◽  
Sven Gläsker ◽  
Jan-Helge Klingler
Keyword(s):  
Postoperative Complications ◽  
Minimally Invasive ◽  
Tumor Resection ◽  
Clinical Results ◽  
Vascular Tumors ◽  
Open Approach ◽  
Minimally Invasive Approach ◽  
Invasive Approach ◽  
Spinal Hemangioblastoma ◽  
Vhl Disease

OBJECTIVEHemangioblastomas are benign, highly vascularized tumors that can occur sporadically or as part of von Hippel-Lindau (VHL) disease. Traditionally, spinal hemangioblastomas have been surgically treated via an open approach. In recent years, however, minimally invasive techniques using tubular retractors have been increasingly applied in spine surgery. Such procedures involve less tissue trauma but are also particularly demanding for the surgeon, especially in cases of highly vascular tumors such as hemangioblastomas. The object of this study was to evaluate the safety and efficacy of minimally invasive resection of selected spinal hemangioblastomas.METHODSThe authors conducted a retrospective single-center study of all patients who, between January 2010 and January 2018, had been operated on for spinal hemangioblastoma via a minimally invasive approach performed at the surgeon’s discretion. The surgical technique is described and the pre- and postoperative neurological and imaging results were analyzed descriptively. The primary outcome was the postoperative compared to preoperative neurological condition (McCormick grade). The secondary outcomes were the extent of tumor resection and postoperative complications.RESULTSEighteen patients, 12 female and 6 male, harboring a total of 19 spinal hemangioblastomas underwent surgery in the study period. Seventeen patients had stable neurological findings with stable or improved McCormick grades (94.5%) at a mean of 4.3 months after surgery. One (5.5%) of the 18 patients developed progressive neurological symptoms with a worsened McCormick grade that did not improve in the long-term follow-up. Sixteen of the 18 patients had VHL disease, whereas 2 patients had sporadic spinal hemangioblastomas. In all patients, postoperative MRI showed complete resection of the tumors. No other surgery-related perioperative or postoperative complications were recorded.CONCLUSIONSA minimally invasive approach for the resection of selected spinal hemangioblastomas is safe and allows complete tumor resection with good clinical results in experienced hands.

Minimally Invasive Approach for Dorsal Arachnoid Web: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Corentin Dauleac ◽  
Henri-Arthur Leroy ◽  
Richard Assaker
Keyword(s):  
Spinal Cord ◽  
Minimally Invasive ◽  
Skin Incision ◽  
Minimally Invasive Approach ◽  
Tubular Retractor ◽  
Invasive Approach ◽  
Spinal Cord Herniation ◽  
Muscle Sparing ◽  
Magnetic Resonance Imaging Mri ◽  
Spinal Cord Decompression

Abstract A 67-yr-old patient presented with severe paraparesis and lower limb spasticity. The spinal cord magnetic resonance imaging (MRI) revealed the “scalpel sign” 1,2 at the T7 level, suggesting a diagnosis of a dorsal arachnoid web. This video demonstrates a microsurgical technique for the excision of a dorsal arachnoid web with a minimally invasive approach. A paramedian skin incision, understanding the muscular aponeurosis, was performed from T7 to T8. Then, we inserted the tubular dilators until the lamina, to perform a muscle-sparing approach. An expandable tubular retractor of adequate length was passed over the widest dilator and docked into place along the subperiosteal plane. The T7 lamina was drilled, and the resection of the superior and inferior adjacent spine levels was completed with a rongeur. Additional contralateral bone resection was performed after tubular retractor tilt to the midline.3 After dura mater opening, it was carefully suspended and the dorsal arachnoid leaflet was cut to drain the dorsolateral and lateral spinal cisterns.4 The dorsal arachnoid web was, first, disconnected from its lateral anchorages. It was then gently removed with microsurgical forceps, to help its microdissection from the spinal cord surface. At this step, peculiar attention was paid to limit the traction or displacements of the spinal cord and surrounding vessels. Once the dorsal arachnoid web was removed, the quality of the spinal cord decompression was confirmed by its re-expansion. In conclusion, the minimally invasive approach is a safe and appropriate technique for dorsal arachnoid web excision.2,5,6-7  The patient gave her informed and signed consent for the writing and publication of this article.  Image at 1:00 reused with permission from Castelnovo G et al, Spontaneous transdural spinal cord herniation, Neurology, 2014;82(14):1290.

Magnetic resonance imaging localization with cod liver oil capsules for the minimally invasive approach to small intradural extramedullary tumors of the thoracolumbar spine

2014 ◽  
Vol 21 (6) ◽  
pp. 882-885 ◽  
Author(s):  
Mazda K. Turel ◽  
Vedantam Rajshekhar
Keyword(s):  
Minimally Invasive ◽  
Operating Time ◽  
Thoracolumbar Spine ◽  
Cost Effective ◽  
Cod Liver Oil ◽  
Minimally Invasive Approach ◽  
Invasive Approach ◽  
Accurate Localization ◽  
Intradural Extramedullary ◽  
The Mean

Object Accurate intraoperative localization of small intradural extramedullary thoracolumbar (T-1 to L-3 level) spinal cord tumors is vital when minimally invasive techniques, such as hemilaminectomy, are used to excise these lesions. In this study, the authors describe a simple and effective method of preoperative MRI localization of small intradural extramedullary tumors using cod liver oil capsules. Methods Thirty-five patients with intradural tumors underwent preoperative MRI localization the evening prior to surgery. Patients were positioned prone in the MRI gantry, mimicking the intraoperative position. Nine capsules were placed in 3 rows to cover the lesion. This localization was used to guide the level for a minimally invasive approach using a hemilaminectomy to excise these tumors. Results The mean patient age was 51.5 ± 14.3 years, and the mean body mass index was 24.1 ± 3.5 kg/m2. Twenty-two tumors involved the thoracic spine, and 13 involved the upper lumbar spine from L-1 to L-3. The mean tumor size was 2.2 ± 1.0 cm. Localization was accurate in 34 patients (97.1%). Conclusions Accurate localization with the described method is quick, safe, cost-effective, and noninvasive with no exposure to radiation. It also reduces operating time by eliminating the need for intraoperative fluoroscopy.

scholarly journals Comparison of minimally invasive transspinous and open approaches for thoracolumbar intradural-extramedullary spinal tumors

2015 ◽  
Vol 39 (2) ◽  
pp. E12 ◽  
Author(s):  
Kunal P. Raygor ◽  
Khoi D. Than ◽  
Dean Chou ◽  
Praveen V. Mummaneni
Keyword(s):  
Blood Loss ◽  
Minimally Invasive ◽  
Tumor Resection ◽  
Spinal Tumors ◽  
Categorical Variables ◽  
Extramedullary Tumor ◽  
Significant Difference ◽  
Asia Score ◽  
Intradural Extramedullary ◽  
The Mean

OBJECT Spinal tumor resection has historically been performed via open approaches, although minimally invasive approaches have recently been found to be effective in small cohort series. The authors compare surgical characteristics and clinical outcomes of surgery in patients undergoing mini-open and open approaches for intradural-extramedullary tumor resection. METHODS The authors retrospectively reviewed 65 consecutive intradural-extramedullary tumor resections performed at their institution from 2007 to 2014. Patients with cervical tumors or pathology demonstrating neurofibroma were excluded (n = 14). The nonparametric Mann-Whitney U-test and Pearson chi-square test were used to compare continuous and categorical variables, respectively. Statistical analyses were performed using SPSS, with significance set at p < 0.05. RESULTS Fifty-one thoracolumbar intradural-extramedullary tumor resections were included; 25 were performed via the minimally invasive transspinous approach. There were no statistically significant differences in age, sex, body mass index, preoperative American Spinal Injury Association (ASIA) score, preoperative symptom duration, American Society of Anesthesiologists (ASA) physical status class, tumor size, or tumor location. There was no statistically significant difference between groups with respect to the duration of the operation or extent of resection, but the mean estimated blood loss was significantly lower in the minimally invasive surgery (MIS) cohort (142 vs 320 ml, p < 0.05). In each group, the 2 most common tumor pathologies were schwannoma and meningioma. There were no statistically significant differences in length of hospitalization, ASIA score improvement, complication rate, or recurrence rate. The mean duration of follow-up was 2 years for the MIS group and 1.6 years for the open surgery group. CONCLUSIONS This is one of the largest comparisons of minimally invasive and open approaches to the resection of thoracolumbar intradural-extramedullary tumors. With well-matched cohorts, the minimally invasive transspinous approach appears to be as safe and effective as the open technique, with the advantage of significantly reduced intraoperative blood loss.

Use of Intraoperative CO2 Laser for the Resection of a Ventral Intradural Extramedullary Cervical Spinal Tumor: 2-Dimensional Operative Video

2019 ◽  
Vol 18 (5) ◽  
pp. E161-E161
Author(s):  
Joseph A Osorio ◽  
Guillermo Victorino T Liabres ◽  
Catherine A Miller ◽  
Michael W McDermott ◽  
Praveen V Mummaneni
Keyword(s):  
Spinal Cord ◽  
Co2 Laser ◽  
Tumor Resection ◽  
Spinal Tumor ◽  
Cord Compression ◽  
Spinal Tumors ◽  
Laser Technique ◽  
Who Grade ◽  
Patient Consent ◽  
Intradural Extramedullary

Abstract Ventral spinal tumors are surgically challenging because the tumor resection should minimize spinal cord and nerve root manipulation to minimize morbidity, while providing access to a complete tumor resection. The CO2 laser has been useful in resection of central nervous system tumors, but little is described about the method used to resect spinal tumors.1 This video demonstrates the removal of a ventral cervical spinal meningioma using the CO2 laser. A 62-yr-old man presented with progressive paresthesias, gait instability, and urinary frequency. A 1-cm intradural extramedullary mass at C5 showed severe spinal cord compression. Patient consent was obtained prior to performing the procedure. A posterior lateral approach is shown, with a bone removal corridor created at C5 for accessing the tumor ventrally. A right-sided facetectomy and pediculectomy at C5 were performed being flush with the posterior vertebral body. A dural opening positioned laterally provided a working corridor between C5 and C6 nerve rootlets. Lateral portions of tumor were excised in wedge-shaped slices starting laterally and working medially. These slices created a successive and enlarging space to safely allow piecemeal tumor dissection and removal, while limiting retraction upon the spinal cord. The CO2 laser was used to cauterize the tumor capsule, create wedge resections of tumor, and coagulate the final dural attachment. The pathology was a meningioma WHO Grade I. The patient did well, with resolution of parasthesias and ataxia. The CO2 laser technique allowed for limited spinal cord retraction throughout the tumor resection and gross total resection of the tumor was achieved.

Minimally Invasive Approach for Wilms Tumor Treatment in a Small Child - A Case Report

Urology ◽  
2020 ◽  
Author(s):  
Alexandre Azevedo Ziomkowski ◽  
João Rafael Silva Simões Estrela ◽  
Nilo Jorge Carvalho Leão Barretto ◽  
Nilo César Leão Barretto
Keyword(s):  
Case Report ◽  
Minimally Invasive ◽  
Wilms Tumor ◽  
Small Child ◽  
Tumor Treatment ◽  
Minimally Invasive Approach ◽  
Invasive Approach
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