© Georg Thieme Verlag KG Stuttgart · New York
Modified Minimally Invasive Surgical Approach to Cervical Neuromas with Intraforaminal Components: Hemi-semi-laminectomy and Supraforaminal Burr Hole (Modified Foraminotomy) Technique
26 February 2009 (online)
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.
dumbbell tumour - intraforaminal approach - laminotomy - neuroma - surgical technique
- 1 Ozawa H, Kokubun S, Aizawa T. et al . Spinal dumbbell tumors: an analysis of a series of 118 cases. J Neurosurg Spine. 2007; 7 587-593
- 2 Lot G, George B. Cervical neuromas with extradural components: surgical management in a series of 57 patients. Neurosurgery. 1997; 41 813-820
- 3 Conti P, Pansini G, Mouchaty H. et al . Spinal neurinomas: retrospective analysis and long-term outcome of 179 consecutively operated cases and review of the literature. Surg Neurol. 2004; 61 34-43
- 4 Cherqui A, Kim DH, Kim SH. et al . Surgical approaches to paraspinal nerve sheath tumors. Neurosurg Focus. 2007; 22 E9
- 5 Tandon N, Vollmer DG. Cervical laminectomy. In: Fessler RG, Sekhar L, eds.
Atlas of neurosurgical techniques: spine and peripheral nerves. New York, Thieme Inc. 2006: 233-238
- 6 Katsumi Y, Honma T, Nakamura T. Analysis of cervical instability resulting from laminectomies for removal of spinal cord tumour. Spine. 1989; 14 1171-1176
- 7 Yasuoka S, Peterson HA, MacCarthy CS. Incidence of spinal column deformity after multilevel laminectomy in children and adults. J Neurosurg. 1982; 57 441-445
- 8 MacCormick PC. Surgical management of dumbbell tumors of the cervical spine. Neurosurg. 1996; 38 294-300
- 9 Kato Y, Kaneko K, Kataoka H. et al . Cervical hemilaminoplasty: technical note. J Spinal Disord Tech. 2007; 20 296-301
- 10 Raimondi AJ, Guiterrez FA, Rocco C Di. Laminotomy and total reconstruction of the posterior arch for spinal canal surgery in childhood. J Neurosurg. 1976; 45 550-560
- 11 Shikata J, Yamamuro T, Shimizu K. et al . Combined laminoplasty and posterolateral fusion for spinal canal surgery in children and adolescents. Clin Orthop Related Res. 1990; 259 92-99
- 12 Kehrli P, Bergamaschi R, Maitrot D. Open-door laminoplasty in pediatric spinal neurosurgery. Child Nerv Syst. 1996; 12 551-552
- 13 Tandon N, Vollmer DG. Cervical laminotomy. In: Fessler RG, Sekhar L, eds.
Atlas of neurosurgical techniques: spine and peripheral nerves. New York, Thieme Inc. 2006: 239-249
- 14 Wiedemayer H, Sandalcioglu IE, Aalders M. et al . Reconstruction of the laminar roof with miniplates for a posterior approach in intraspinal surgery: techniqueal considerations and critical evaluation of follow-up results. Spine. 2004; 29 E333-E342
- 15 Koch-Wiewrodt D, Wagner W, Perneczky A. Unilateral multilevel interlaminar fenestration instead of laminectomy or hemilaminectomy: an alternative surgical approach to intraspinal space-occupying lesions. J Neurosurg Spine. 2007; 6 485-492
- 16 Eggert HR, Scheremet R, Seeger W. et al . Unilateral microsurgical approaches to extramedullary spinal tumours: Operative techniques and results. Acta Neurochir. 1983; 67 245-253
- 17 Yasargil MG, Tranmer BI, Adamson TE. et al .Unilateral partial hemilaminectomy for the removal extra- and intramedullary tumors and AVMs. In: Symon L, ed.
Advances and technical standards in neurosurgery. Vol 18, Springer Verlag, Wien 1991: 113-132
- 18 Chiou Sh-M, Eggert HR, Laborde G. et al . Microsurgical unilateral approaches for spinal tumour surgery: Eight years experience in 256 primary operated patients. Acta Neurochir. 1989; 100 127-133
- 19 Sarioglu AC, Hanci M, Bozkus H. et al . Unilateral hemilaminectomy for the removal of the spinal space-occupying lesions. Minim Invas Neurosurg. 1997; 40 74-77
- 20 Banczerowski P, Vajda J, Veres R. Removal of intraspinal space-occupying lesions through unilateral partial approach, the “hemi-semi laminectomy”. Clin Neurosci/Ideggy Szle. 2008; 61 114-122
- 21 Banczerowski P, Vajda J, Veres R. Exploration and decompression of the spinal canal using split laminotomy and its modification, the “archbone” technique. Neurosurgery. 2008; 62 ((5 suppl 2)) ONS 432-440
P. Banczerowski, MD, PhD
National Institute of Neurosurgery
Amerikai út 57
Phone: +36/1/251 29 99
Fax: +36/1/251 56 78