title: [Paraspinal approach to lumbar foraminal tumor].
abstract: OBJECTIVE
  To treat lumbar foraminal tumors, the chosen operative approach depends on the tumor location and size. Although total facetectomy and the combined intra- and extraspinal canal approach provide a wide operative field, facet fusion is required and the procedure is invasive. We report the successful removal of Eden type IV tumors using only the paraspinal approach without complete facetectomy.
  
  
  METHODS
  We treated 4 patients with lumbar foraminal tumors. All were Eden type IV (neurofibroma, n=3; schwannoma, n=1) and all were removed via the paraspinal approach without total facetectomy and the intraspinal canal approach. Although total facetectomy was not needed to remove the intraforaminal component, phased foraminal expansion with a SONOPET (m&m Co., Ltd., Tokyo, Japan) device was required in all cases. Intratumoral decompression was performed with probe for tumor and PAL-I and EMG recordings were obtained with direct stimulation of the nerve root.
  
  
  RESULTS
  All tumors were completely removed via only the paraspinal approach; neither total facetectomy and fusion, nor the addional intraspinal approach was required. There was no tumor recurrence or lumbar instability during the follow-up period.
  
  
  CONCLUSIONS
  To remove the intraforaminal component of Eden type IV tumors, phased expansion of the foramen with a SONOPET and intratumoral decompression with CUSA and PAL-I are required and effective. Using these devices, this less invasive approach is useful for the treatment of patients with lumbar foraminal tumors of Eden type IV.
authors.affiliation: Department of Neurosurgery, Chiba Hokuso Hospital, Nippon Medical School, Japan.
authors.forename: Kyongsong
authors.initials: K
authors.lastname: Kim
authors.forename: Toyohiko
authors.initials: T
authors.lastname: Isu
authors.forename: Atsushi
authors.initials: A
authors.lastname: Sugawara
authors.forename: Junkyo
authors.initials: J
authors.lastname: Yusa
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009442:Neurilemmoma / Q000601:surgery*; D009455:Neurofibroma / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000379:methods*; D010027:Osteotomy / Q000295:instrumentation; D013116:Spinal Cord / Q000601:surgery*; D013120:Spinal Cord Neoplasms / Q000601:surgery*; D016896:Treatment Outcome