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      Minimally-invasive tubular resection of thoracolumbar intradural schwannoma

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          Abstract

          Minimally invasive surgical (MIS) approaches to the spine are increasingly adopted for intradural pathology. In this setting, they may especially be useful to minimize risk of CSF leakage due to the decreased disruption to paraspinal musculature and minimal dead space. Herein, the authors demonstrate their technique for the resection of an intradural thoracolumbar schwannoma in a 30-year-old woman via an MIS approach using a nonexpandable tubular retractor. Salient points include the use of bayonetted instruments and the technique for dural closure in a small corridor. Indications for this technique are discussed in the context of a series of patients with intradural extramedullary lesions.

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          Comparison of open and minimally invasive surgery for intradural-extramedullary spine tumors.

          Albert Wong, Rishi Lall, Nader Dahdaleh … (2015)
          OBJECT Patients with symptomatic intradural-extramedullary (ID-EM) tumors may be successfully treated with resection of the lesion and decompression of associated neural structures. Studies of patients undergoing open resection of these tumors have reported high rates of gross-total resection (GTR) with minimal long-term neurological deficit. Case reports and small case series have suggested that these patients may be successfully treated with minimally invasive surgery (MIS). These studies have been limited by small patient populations. Moreover, there are no studies directly comparing perioperative outcomes between patients treated with open resection and MIS. The objective of this study was to compare perioperative outcomes in patients with ID-EM tumors treated using open resection or MIS. METHODS A retrospective review was performed using data collected from 45 consecutive patients treated by open resection or MIS for ID-EM spine tumors. These patients were treated over a 9-year period between April 2003 and October 2012 at Northwestern University and the University of Chicago. Statistical analysis was performed to compare perioperative outcomes between the two groups. RESULTS Of the 45 patients in the study, 27 were treated with the MIS approach and 18 were treated with the open approach. Operative time was similar between the two groups: 256.3 minutes in the MIS group versus 241.1 minutes in the open group (p = 0.55). Estimated blood loss was significantly lower in the MIS group (133.7 ml) compared with the open group (558.8 ml) (p < 0.01). A GTR was achieved in 94.4% of the open cases and 92.6% of the MIS cases (p = 0.81). The mean hospital stay was significantly shorter in the MIS group (3.9 days) compared with the open group (6.1 days) (p < 0.01). There was no significant difference between the complication rates (p = 0.32) and reoperation rates (p = 0.33) between the two groups. Multivariate analysis demonstrated an increased rate of complications in cervical spine tumors (OR 15, p = 0.05). CONCLUSIONS Thoracolumbar ID-EM tumors may be safely and effectively treated with either the open approach or an MIS approach, with an equivalent rate of GTR, perioperative complication rate, and operative time. Patients treated with an MIS approach may benefit from a decrease in operative blood loss and shorter hospital stays.
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            Minimally Invasive Microsurgical Resection of Primary, Intradural Spinal Tumors is Feasible and Safe: A Consecutive Series of 83 Patients.

            Maja Formo, Charlotte Halvorsen, Daniel Dahlberg … (2018)
            To date, the traditional approach to intraspinal tumors has been open laminectomy or laminoplasty followed by microsurgical tumor resection. Recently, however, minimally invasive approaches have been attempted by some.
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              Comparison of minimally invasive transspinous and open approaches for thoracolumbar intradural-extramedullary spinal tumors.

              Kunal Raygor, Khoi D. Than, Dean Chou … (2015)
              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.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Neurosurg Focus Video
                Journal ID (iso-abbrev): Neurosurg Focus Video
                Journal ID (publisher-id): Neurosurg Focus Video
                Title: Neurosurgical Focus: Video
                Publisher: American Association of Neurological Surgeons
                ISSN (Electronic): 2643-5217
                Publication date Collection: October 2023
                Publication date (Electronic): 1 October 2023
                Volume: 9
                Issue: 2 , Intradural Spinal Tumors
                Electronic Location Identifier: V19
                Affiliations
                [1 ]Department of Neurosurgery, University of California, Los Angeles, California; and
                [2 ]Department of Neurosurgery, University of California, San Francisco, California
                Author notes
                Correspondence Daniel C. Lu: University of California, Los Angeles, CA. dclu@ 123456mednet.ucla.edu .

                INCLUDE WHEN CITING DOI: 10.3171/2023.6.FOCVID2335.

                Disclosures Dr. Lu reported grants from Boston Scientific, Medtronic, and Abbott, outside the submitted work.

                Article
                Publisher ID: 2023.6.FOCVID2335
                DOI: 10.3171/2023.6.FOCVID2335
                PMC ID: 10580752
                PubMed ID: 37854661
                SO-VID: e8653669-7219-4d6a-bb33-a3dea1eab365
                Copyright © © 2023, The Authors
                License:

                This is an open access article distributed under the CC BY license ( http://creativecommons.org/licenses/by/4.0/).

                History
                Date received : 31 March 2023
                Date accepted : 21 June 2023
                Page count
                Figures: 0, Tables: 0, References: 6, Pages: 2
                Categories
                Subject: Article

                Keywords: minimally invasive,tubular,intradural extramedullary,idem,schwannoma
                Data availability:
                Keywords: minimally invasive, tubular, intradural extramedullary, idem, schwannoma

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