J Neurol Surg A Cent Eur Neurosurg 2014; 75 - p55
DOI: 10.1055/s-0034-1383784

Minimally Invasive (Metrx) Resection of Intradural Spinal Lesions. A Series of 33 Consecutive Cases with Results and Complications

J. M. Duff 1, M. Levivier 1, L. Bobinski 1
  • 1Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland

Spinal intradural lesions have been classically treated using open surgical techniques from a direct posterior translaminar approach. This despite the localization of the lesion with respect to the spinal cord. This “one size fits all” strategy works for many lesions, but is very limiting for others, particularly ventrally located lesions.

Minimally invasive techniques allow for more flexibility in approach trajectories of almost 180° from one side to the other, while allowing for standard microsurgical techniques intradurally. The approaches are much reduced in size, are faster, and have minimal blood loss, with less muscle destruction.

Retrospective patient record review from 2004-2013. Inclusion criteria include intradural spinal pathologies treated using the minimal access techniques with clinical and radiological follow up.

33 cases included in this study in 32 patients (17 male and 15 female)

Ave age 50.4 years (20-80). 7 cases were in the cervical spine, 11 in the thoracic spine, and 15 cases were in the lumbosacral spine.

Extramedullary pathologies

  • meningioma 8

  • schwannoma 12

  • arachnoid cyst 2

  • ependymoma 4

  • neurofibroma 2

  • Intramedullary pathologies

  • C2 cavernoma 1

  • C2 anaplastic astrocytoma (AA) 1

  • C4 teratoma 1

  • T10 schwannoma 1

  • T12 hemangioblastoma 1

  • Mean follow up was 23.5 months (2-67).

All patients has postoperative MRI:

2 patients with intramedullary lesions: minimum residual teratoma stable at 5 years, AA with progressive disease but alive at 14 months after surgery.

Extramedullary: 2 patients with drop mets from ependymoma stable at 8 and 43 months after surgery. 1 patient with recurrent meningioma in the T1 foramen, successfully treated the radiotherapy. 1 patient with tumor left stuck to the anterior spinal artery at C6 with stable disease. Remaining 24 patients with no residual disease. 2 patients with arachnoid cysts had normal CSF flow.

Clinical complications (4 cases)

  • partial hemisensory less (C2 AA)

  • min gait imbalance (C2 cavernoma)

  • Persistent S2 sensory loss (S2 schwannoma)

  • Seroma (drained)

Conclusions: 1. Use of minimal access surgical techniques appears to be a safe alternative to standard open approaches. Advantages are rapidity of access and closure, less blood loss, faster recovery postoperatively. 2. These techniques allow standard microsurgical techniques for lesion resection, and may enhance resection with more favorable surgical trajectories.

These techniques can be used for highly selective intramedullary lesions.