Modified Minimally Invasive Surgical Approach to Cervical Neuromas with Intraforaminal Components: Hemi-semi-laminectomy and Supraforaminal Burr Hole (Modified Foraminotomy) Technique

Abstract

Objective: The aim of this study was to develop a minimal invasive approach suitable for exploring neuromas with an intraforaminal component in the cervical spine with the aim of preservation of as much of the mechanically relevant bone structures and facet joints as possible.

Methods: The authors used the hemi-semi-laminectomy combined with supraforaminal burr hole technique in 7 adult patients with neuroma extending inside the foramen in the region of the cervical spine.

Results: Under the operating microscope the operating field was sufficient for tumour removal according to the keyhole concept. The approach did not affect the extent of tumour resection, or neurological outcome. The affected nerve roots included C3 in 3 cases, C5 in 2, C4 and C6 in 1 case. The average follow-up was 9 months, with a range from 6 to 13 months. Histological results were as follows: 4 schwannomas and 3 neurofibromas.

Conclusion: This modified surgical approach fulfills the requirements of other minimal invasive techniques and helps to prevent damage to the crucial posterior stabilizers of the spine, and disintegration of the vertebral arches and facet joints is reduced. The approach is suitable for exploring and removing neuromas located in the spinal canal and the neuroforamen.

Key words

dumbbell tumour - intraforaminal approach - laminotomy - neuroma - surgical technique

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