Journal article
Image Merge Tailored Access Resection (IMTAR) of Spinal Intradural Tumors. Technical Report of 13 Cases.
- Maduri R Neurosurgical Service, Department of Clinical Neurosciences, University Hospital of Lausanne, Faculty of Biology and Medicine, Lausanne, Switzerland.
- Bobinski L Neurosurgical Service, Department of Clinical Neurosciences, University Hospital of Lausanne, Faculty of Biology and Medicine, Lausanne, Switzerland.
- Duff JM Neurosurgical Service, Department of Clinical Neurosciences, University Hospital of Lausanne, Faculty of Biology and Medicine, Lausanne, Switzerland. Electronic address: johnmichael.duff@gmail.com.
- 2016-06-12
Published in:
- World neurosurgery. - 2017
Fluoroscopy
Image-guided surgery
Intradural extramedullary
Minimal access surgical procedures
Myelopathy
Neuronavigation
Spinal canal
Spinal cord compression
Spinal cord neoplasm
Spine
Adult
Aged
Female
Fluoroscopy
Humans
Magnetic Resonance Imaging
Male
Middle Aged
Neurosurgical Procedures
Retrospective Studies
Spinal Cord Compression
Spinal Cord Neoplasms
Surgery, Computer-Assisted
Treatment Outcome
Young Adult
English
OBJECTIVE
Standard translaminar approaches for intradural extramedullary (IDEM) tumors require extensive soft tissue dissection and partial facet removal. Ventral lesions may necessitate wider bone resection with subsequent possible spinal instability. Any manipulation of an already compromised spinal cord may lead to neurological injury. We describe an image-guided minimal access technique for IDEM tumor resection.
METHODS
Retrospective chart review of 13 consecutive patients after institutional ethics committee approval. We superimpose preoperative magnetic resonance imaging data with intraoperative 3-dimensional fluoroscopic images, allowing to simultaneously visualize osseous anatomy and the soft tissue lesion using appropriate windowing. We then plan optimal angle of trajectory to the tumor, which defines the skin incision and the transmuscular trajectory. A tubular retractor is placed to span the tumor. Microsurgical tumor resection is then carried out using this angle of approach.
RESULTS
Thirteen patients (mean age. 57 years; male-to-female ratio, 10:3) were operated on during 28 months. Gross total resection was achieved in all patients. Neurological improvement occurred in 12 of the 13 patients. There was no neurological deficit outside of the expected sensory loss due to intentional nerve root sacrifice. No mechanical pain nor tumor recurrence were noted during the follow-up (mean, 16 months; range, 2-30 months).
CONCLUSIONS
Image merge tailored access resection appears to be at least equivalent in terms of tumor resection, blood loss, and complications to other tubular techniques. It may reduce risks of neurological deficit and spine instability. Image merge tailored access resection is a novel application of merging intraoperative fluoroscopic images with preoperative magnetic resonance images for tailored IDEM resection.
Standard translaminar approaches for intradural extramedullary (IDEM) tumors require extensive soft tissue dissection and partial facet removal. Ventral lesions may necessitate wider bone resection with subsequent possible spinal instability. Any manipulation of an already compromised spinal cord may lead to neurological injury. We describe an image-guided minimal access technique for IDEM tumor resection.
METHODS
Retrospective chart review of 13 consecutive patients after institutional ethics committee approval. We superimpose preoperative magnetic resonance imaging data with intraoperative 3-dimensional fluoroscopic images, allowing to simultaneously visualize osseous anatomy and the soft tissue lesion using appropriate windowing. We then plan optimal angle of trajectory to the tumor, which defines the skin incision and the transmuscular trajectory. A tubular retractor is placed to span the tumor. Microsurgical tumor resection is then carried out using this angle of approach.
RESULTS
Thirteen patients (mean age. 57 years; male-to-female ratio, 10:3) were operated on during 28 months. Gross total resection was achieved in all patients. Neurological improvement occurred in 12 of the 13 patients. There was no neurological deficit outside of the expected sensory loss due to intentional nerve root sacrifice. No mechanical pain nor tumor recurrence were noted during the follow-up (mean, 16 months; range, 2-30 months).
CONCLUSIONS
Image merge tailored access resection appears to be at least equivalent in terms of tumor resection, blood loss, and complications to other tubular techniques. It may reduce risks of neurological deficit and spine instability. Image merge tailored access resection is a novel application of merging intraoperative fluoroscopic images with preoperative magnetic resonance images for tailored IDEM resection.
- Language
-
- English
- Open access status
- closed
- Identifiers
-
- DOI 10.1016/j.wneu.2016.05.092
- PMID 27288581
- Persistent URL
- https://sonar.ch/global/documents/78749
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