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首页> 外文期刊>Neurosurgical focus >Minimally invasive removal of lumbar intradural extramedullary lesions using the interlaminar approach
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Minimally invasive removal of lumbar intradural extramedullary lesions using the interlaminar approach

机译：使用层间入路微创清除腰椎硬膜外髓内病变

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OBJECT Posterior midline laminectomy or hemilaminectomy has been successfully applied as the standard microsurgical technique for the treatment of spinal intradural pathologies. However, the associated risks of postoperative spinal instability increase the need for subsequent fusion surgery to prevent potential long-term spinal deformity. Continuous efforts have been made to minimize injuries to the surrounding tissue resulting from surgical manipulations. The authors report here their experiences with a novel minimally invasive surgical approach, namely the interlaminar approach, for the treatment of lumbar intraspinal tumors. METHODS A retrospective review was conducted of patients at the Second Affiliated Hospital of Zhejiang University School of Medicine who underwent minimally invasive resection of lumbar intradural-extramedullary tumors. By using an operative microscope, in addition to an endoscope when necessary, the authors were able to treat all patients with a unilateral, paramedian, bone-sparing interlaminar technique. Data including preoperative neurological status, tumor location, size, pathological diagnosis, extension of resections, intraoperative blood loss, length of hospital stay, and clinical outcomes were obtained through clinical and radiological examinations. RESULTS Eighteen patients diagnosed with lumbar intradural-extramedullary tumors were treated from October 2013 to March 2015 by this interlaminar technique. A microscope was used in 15 cases, and the remaining 3 cases were treated using a microscope as well as an endoscope. There were 14 schwannomas, 2 ependymomas, 1 epidermoid cyst, and 1 enterogenous cyst. Postoperative radiological follow-up revealed complete removal of all the lesions and no signs of bone defects in the lamina. At clinical follow-up, 14 of the 18 patients had less pain, and patients' motor/sensory functions improved or remained normal in all cases except 1. CONClUSIONS When meeting certain selection criteria, intradural-extramedullary lumbar tumors, especially schwannomas, can be completely and safely resected through a less-invasive interlaminar approach using a microscope, or a microscope in addition to an endoscope when necessary. This approach was advantageous because it caused even less bone destruction, resulting in better postoperative spinal stability, no need for facetectomy and fusion, and quicker functional recovery for the patients. Individualized surgical planning according to preoperative radiological findings is key to a successful microsurgical resection of these lesions through the interlaminar space.
机译：目的后路中线椎板切除术或半椎板切除术已成功地用作治疗脊椎硬膜内病变的标准显微外科技术。但是，术后脊椎不稳的相关风险增加了后续融合手术的必要性，以防止潜在的长期脊柱畸形。为了使外科手术对周围组织的伤害最小化，已经进行了持续的努力。作者在这里报告了他们使用新型微创手术方法（即层间方法）治疗腰椎内肿瘤的经验。方法回顾性分析浙江大学医学院附属第二医院微创切除腰椎硬膜外硬膜外肿瘤的患者。通过使用手术显微镜，必要时除内窥镜外，作者还能够使用单侧，正中，保留骨的层间技术治疗所有患者。通过临床和影像学检查获得了包括术前神经系统状况，肿瘤位置，大小，病理诊断，切除范围，术中失血量，住院时间和临床结局等数据。结果从2013年10月至2015年3月，采用这种层间技术治疗了18例诊断为腰椎硬膜外硬膜外肿瘤的患者。 15例使用显微镜，其余3例使用显微镜和内窥镜治疗。发生神经鞘瘤14例，室管膜瘤2例，表皮样囊肿1例，肠源性囊肿1例。术后放射学随访显示，所有病变均已完全清除，且椎板无骨缺损迹象。在临床随访中，18例患者中有14例疼痛减轻，除1例外，所有患者的运动/感觉功能均得到改善或保持正常。结论当符合某些选择标准时，硬膜外延髓性腰椎肿瘤，尤其是神经鞘瘤可以使用显微镜或必要时使用内窥镜之外的显微镜通过侵入性小的层间方法完全安全地切除。这种方法是有利的，因为它引起更少的骨破坏，从而导致更好的术后脊柱稳定性，不需要小平面切除术和融合术，并且患者的功能恢复更快。根据术前放射学发现进行个性化手术计划是成功通过层间间隙对这些病变进行显微手术切除的关键。

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