Full-Endoscopic Resection of a Lumbar Intradural Tumor (Schwannoma): Video Case Report and Description of the Surgical Technique

Abstract

Endoscopic spinal surgery has gained increasing popularity over the past 10 years. Its muscle-preserving nature, reduction in postoperative pain, and lower complication rates have contributed to the growing number of surgeons adopting this technique year after year. This same progression has led to the application of the technique in oncological pathology, primarily for separation surgeries and biopsies of extradural lesions. However, reports in the literature on the use of this technique to treat intradural spinal tumors remain scarce. To present a case report of a patient with an intradural lesion, compatible with schwannoma, successfully removed using a fully endoscopic technique. A 46-year-old female patient presented with a long-standing history of low back pain and bilateral leg pain. The pain worsened over the past few months before her initial presentation. She also reported experiencing weakness in her feet and intermittent hypesthesia in her legs. Magnetic resonance imaging (MRI) showed a small intradural extramedullary tumor at the L1 level. Given the patient’s young age, the tumor location at the thoracolumbar junction, and the rather small tumor size, a full-endoscopic approach was selected and performed. A step-by-step video of the surgical technique is provided with the manuscript. The current follow-up period is 2.5 years, with the patient remaining asymptomatic. The most recent follow-up MRI, conducted 16 months after the surgery, indicated no signs of recurrence. To our knowledge, this is the first video report providing a step-by-step description of this procedure. More high-quality evidence is needed to properly evaluate the safety and outcomes of this technique.