title: Modified paramedian transpedicular approach and spinal reconstruction for intradural tumors of the cervical and cervicothoracic spine: clinical experience.
abstract: METHODS
  Retrospective review of the medical, radiographic, surgical, and postoperative records of patients who underwent resection of multilevel intradural extramedullary spinal cord tumors of the ventral cervical and cervicothoracic spine via a modified paramedian transpedicular approach at the University of California, San Francisco, between 2003 and 2005.
  
  
  OBJECTIVE
  To assess the surgical, clinical, and radiographic outcomes of using the modified paramedian transpedicular approach to resect ventral intradural extramedullary spinal cord tumors of the ventral cervical and cervicothoracic spine.
  
  
  BACKGROUND
  A common theme of skull-base surgery for many years has been to remove the bone rather than retract neural elements. In this report, we demonstrate some possible advantages of taking a "spine-base" approach for resecting intradural extramedullary spinal cord tumors of the ventral cervical and cervicothoracic spinal canal, and present our clinical experience.
  
  
  METHODS
  All medical, surgical, and radiologic records were retrospectively reviewed. Clinical outcome was assessed for disability via the Neck Disability Index and for pain via the visual analog scale.
  
  
  RESULTS
  Fourteen patients (4 males and 10 females, average age 39.6 years, range 20-62) with intradural extramedullary spinal cord tumors involving multiple levels of the anterior cervical and cervicothoracic spine were identified. All patients presented with pain and/or radiculomyelopathy attributed to a ventral intradural extramedullary spinal cord tumor of the cervical or cervicothoracic spine that was resected via the modified paramedian transpedicular approach with partial dorsal corpectomy and posterior spinal reconstruction. The average follow-up period was 14.6 months (range 5-30). Gross total resection was achieved in all cases, and no patient required additional surgery via an anterior approach for residual tumor.
  
  
  CONCLUSIONS
  The modified paramedian transpedicular approach with partial dorsal corpectomy we describe here is a variation of traditional thoracic posterolateral transpedicular extracavitary approaches and offers direct access to lesions of the ventral cervicothoracic spinal canal. This approach avoids the morbidity of anterior transcervical, transoral, or transthoracic procedures, while providing a view of the entire ventral cervicothoracic canal, and can be performed safely and effectively in select patients.
authors.affiliation: Department of Neurological Surgery, University of California, San Francisco, CA 94143-0112, USA.
authors.forename: Frank L
authors.initials: FL
authors.lastname: Acosta
authors.forename: Henry E
authors.initials: HE
authors.lastname: Aryan
authors.forename: John
authors.initials: J
authors.lastname: Chi
authors.forename: Andrew T
authors.initials: AT
authors.lastname: Parsa
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Ames
mesh_terms: D000328:Adult; D002140:California; D002574:Cervical Vertebrae; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007796:Laminectomy / Q000009:adverse effects; D008279:Magnetic Resonance Imaging; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D009984:Orthopedic Fixation Devices; D019637:Orthopedic Procedures / Q000009:adverse effects / Q000295:instrumentation; D010146:Pain / Q000209:etiology* / Q000601:surgery; D018579:Patient Selection; D011843:Radiculopathy / Q000209:etiology* / Q000601:surgery; D012189:Retrospective Studies; D013118:Spinal Cord Diseases / Q000209:etiology* / Q000601:surgery; D013120:Spinal Cord Neoplasms / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D013904:Thoracic Vertebrae; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome