Article

Access to the text (HTML) Access to the text (HTML)
PDF Access to the PDF text
Service d'aide à la décision clinique
Advertising


Access to the full text of this article requires a subscription.
  • If you are a subscriber, please sign in 'My Account' at the top right of the screen.

  • If you want to subscribe to this journal, see our rates



Neurochirurgie
Volume 60, n° 6
page 344 (décembre 2014)
Doi : 10.1016/j.neuchi.2014.10.062
Réunion de la Société de Neurochirurgie de Langue Française, Montrouge, 7-10 décembre 2014

Image merged guided spine surgery for intradural tumors: Retrospective series of 7 cases
 

R. Maduri , L. Bobinski, J. Duff
 Lausanne, Switzerland 

Corresponding author.
@@#100979@@
Introduction

The incidence of rare intradural spinal cord tumors is 3 to 10 per 100,000 of population. Open bilateral laminectomy with partial or total facet removal is the standard surgical access for gross total resection (GTR) of such intradural tumors. Retrospective studies in adults revealed that for patients operated with bilateral laminectomy as well with less invasive procedures, the risk of developing postoperative deformity or worsening preoperative deformity is still significant. The this study describes integration of Minimally invasive Spine Surgery (MISS) techniques with preoperative MRI data and intraoperative 3 dimensional fluoroscopic images with the aim of planning skin incision according to a precise transmuscular trajectory, thus tailoring tumor access with minimal bone resection in patients with intradural extramedullary lesions.

Materials and methods

A retrospective review of 45 consecutive surgical cases of intradural tumors was carried out. Seven patients operated for intradural extramedullary tumors using the image merged guided MISS were selected. Preoperative MRI and intraoperative 3D fluoroscopic data were manually merged using Synergy Cranial 2.2 software and Stealth Merge 1.2. Accuracy of manual image merging was verified with anatomic landmarks as references. After a 3D fluoroscopic image acquisition using the merged data, a skin incision was planned according to the chosen entry point and the transmuscular trajectory was optimised for tumor access. Under microscopic and neuronavigation guidance, tailored bone resection and lesion removal were carried out.

Results

From December 2012 to August 2014, we performed MISS removal of intradural extramedullary spine tumors in seven patients, four male and three female as described above. Pre-operative Nurick score was 3 in three patients, 1 in two patients and 0 in other two cases. One patient presented with local hematoma that regressed in the immediate postoperative period. Follow up ranges from 2 to 14months (average 5.8months). Follow up neurological Nurick scores recording reveals a favorable neurological outcome with a score of 0 in six patients. Any patient showed postoperative neurological deterioration. Only one patient with a resected L1 Schwannoma complains of postoperative radicular pain, which is responsive to medical treatment. MRI confirms GTR in all cases.

Conclusion

The goal of treatment of intradural extramedullary lesions ismaximum tumor resection, adapting surgical approach to minimise manipulation of neural structures and reducing bone resection without comprising tumor resection. Image merged guided MISS is a safe and feasible procedure for tumor removal in patients with intradural extramedullary tumors. In the present study, we demonstrate that this technique allows the surgeon to define entry point, to tailor transmuscular trajectory and tumor access while minimizing bone removal and achieving GTR of intardural lesions.

The full text of this article is available in PDF format.


© 2014  Published by Elsevier Masson SAS.
EM-CONSULTE.COM is registrered at the CNIL, déclaration n° 1286925.
As per the Law relating to information storage and personal integrity, you have the right to oppose (art 26 of that law), access (art 34 of that law) and rectify (art 36 of that law) your personal data. You may thus request that your data, should it be inaccurate, incomplete, unclear, outdated, not be used or stored, be corrected, clarified, updated or deleted.
Personal information regarding our website's visitors, including their identity, is confidential.
The owners of this website hereby guarantee to respect the legal confidentiality conditions, applicable in France, and not to disclose this data to third parties.
Close
Article Outline
You can move this window by clicking on the headline