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J Neurol Surg A Cent Eur Neurosurg 2017; 78(03): 219-226
DOI: 10.1055/s-0036-1594014
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Endoscopic Management of Spinal Intradural Extramedullary Tumors

Vijay Singh Parihar
1   Department of Neurosurgery, NSCB Medical College and Hospital, Jabalpur, Madhya Pradesh, India
,
Nishtha Yadav
2   Department of Radiodiagnosis and Imaging, All India Institute of Medical Sciences, New Delhi, India
,
Yad Ram Yadav
1   Department of Neurosurgery, NSCB Medical College and Hospital, Jabalpur, Madhya Pradesh, India
,
Shailendra Ratre
1   Department of Neurosurgery, NSCB Medical College and Hospital, Jabalpur, Madhya Pradesh, India
,
Jitin Bajaj
1   Department of Neurosurgery, NSCB Medical College and Hospital, Jabalpur, Madhya Pradesh, India
,
Yatin Kher
1   Department of Neurosurgery, NSCB Medical College and Hospital, Jabalpur, Madhya Pradesh, India
› Author Affiliations
Further Information

Publication History

02 January 2016

14 September 2016

Publication Date:
12 December 2016 (online)

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Abstract

Introduction Posterior midline laminectomy is associated with risks of postoperative instability, spinal deformity, extensive bilateral subperiosteal muscle stripping, partial or total facetectomy especially in foraminal tumor extension, increased cerebrospinal fluid leakage, and wound infection. Minimally invasive approaches with the help of a microscope or endoscope using hemilaminectomy have been found to be safe and effective. We report our initial experience of 18 patients using the endoscopic technique.

Material and Methods A retrospective study of intradural extramedullary tumors extending up to two vertebral levels was studied. Pre- and postoperative clinical status, magnetic resonance imaging was done in all patients. The Destandau technique was used, and resection of ipsilateral lamina, medial part of the facet joint, base of the spinous process, and undercutting of the opposite lamina was performed. Dura repair was done using an endoscopic technique. Fibrin glue was used to reinforce repair in the later part of the study.

Results The sagittal and axial diameter of tumor ranged from 21 to 41 mm and 12 to 18 mm, respectively. There were four cervical, two cervicothoracic, five thoracic, three thoracolumbar, and four lumbar tumors, respectively. All 18 patients improved after total excision of tumor. Average duration of surgery and blood loss was 140 minutes and 60 mL, respectively. Postoperative stay and follow-up ranged from 3 to 7 days and 9 to 24 months, respectively.

Conclusion Although the study is limited by the small number of patients with a short follow-up and is a technically demanding procedure, endoscopic management of intradural extramedullary tumors was an effective and safe alternative technique to microsurgery in such patients.

Keywords

laminectomy - minimally invasive surgical procedures - neuroendoscopy - operative surgical procedure - spinal cord neoplasms
 

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