Neurosurgical focus: Video最新文献

Minimally invasive surgical (MIS) approaches to the spine are increasingly adopted for intradural pathology. In this setting, they may especially be useful to minimize risk of CSF leakage due to the decreased disruption to paraspinal musculature and minimal dead space. Herein, the authors demonstrate their technique for the resection of an intradural thoracolumbar schwannoma in a 30-year-old woman via an MIS approach using a nonexpandable tubular retractor. Salient points include the use of bayonetted instruments and the technique for dural closure in a small corridor. Indications for this technique are discussed in the context of a series of patients with intradural extramedullary lesions.

Spinal meningiomas represent 25%-45% of intradural spinal tumors and are commonly seen in the thoracic spine. Ventral midline spinal meningiomas in the thoracic spine are challenging lesions to resect given their location in relation to the spinal cord. Resection for symptomatic or growing lesions requires adequate bone removal to limit retraction of the spinal cord. Surgical adjuncts such as intraoperative navigation, robotics, and ultrasound can improve the efficiency of and safety for resection of these lesions. The authors present a case of a complete resection of a ventral thoracic meningioma using a T12 transpedicular approach with robot-assisted navigated pediculectomy and intraoperative ultrasonography.

A 58-year-old male was admitted to the authors' department due to cervicothoracic pain and disequilibrium. Physical examination evidenced sensory and motor deficits in the lower limbs. MRI evidenced an expansive intramedullary lesion compatible with ependymoma. The nuances of this surgical access and the management of intradural tumors are discussed.

This video demonstrates a gross-total resection of a multisegmental intradural extramedullary tumor using only multisegmental hemilaminectomy. The patient is a 21-year-old woman presenting with only backache. MRI of the lumbar spine demonstrates a large multisegmental heterogeneously enhancing intradural extramedullary tumor extending down from the eleventh dorsal vertebrae down to the fifth lumbar vertebrae. The surgical video demonstrates the technique of multisegmental hemilaminectomy and microsurgical resection of the tumor without posterior spinal instrumentation. Postoperatively, the patient had no neurological deficit and was discharged on postoperative day 5. Three-month postoperative MRI shows no residual disease or spinal deformity.

This video presents the case of a 44-year-old male with a 2-year history of pain in the left upper extremity that had worsened over the course of the last 6 months with associated weakened grip strength and had extended into his right arm. T2-weighted sagittal and axial MRI demonstrated an expansive nonenhancing solid intramedullary lesion extending from C5 to T1. The patient underwent a C5-T1 laminectomy and laminoplasty with near-complete resection of the intradural intramedullary subependymoma. At 3 months' follow-up, he reported doing well and had experienced significant improvement in motor strength with ongoing therapies.

The video demonstrates an operative approach to a recurrent cervical anaplastic ependymoma. MYCN-amplified anaplastic ependymomas are locally aggressive, recurrent, and have a high risk of iatrogenic injury. In this case, the patient presented with local, aggressive tumor expansion, arachnoid adhesions, and pial invasion ventral to the spinal cord. Subcapsular decompression minimized cord retraction from a dorsal approach. Removal of the tumor capsule was guided by bipolar stimulation paired with neuromonitoring. Local gross-total resection was achieved, and the patient had a postoperative improvement in his neurological deficits and myelopathy.