[Removal of intraspinal space-occupying lesions through unilateral partial approach, the "hemi-semi laminectomy"].
OBJECTIVE
The conventional dorsal surgical approaches used in removal of intraspinal space-occupying lesions by unroofing the spinal canal, often result the destruction of dorsal bony structures, sacrifice the interspinosus/supraspinosus ligament complexes and stripping of the paraspinal muscles causing a pathologic biomechanical milieu may lead to spinal deformities, instability. Various less invasive techniques exist to save the integrity and to prevent the instability of the spinal column and allow removal of intraspinally located space-occupying lesions at the same time. The authors discuss the experiences with unilateral partial laminectomy approach in removal of intraspinally, mainly lateral, intra- or extradurally located pathologic lesions.


METHODS
The unilateral partial laminectomy, in which the laminas were preserved (hemi-semi laminectomy) was performed in 86 symptomatic patients to remove space-occupying intra- or extradurally located lesions of the cervical, thoracic and lumbar spinal canal. Symptoms were local or radicular pain, motor, sensory and vegetative disturbances.


RESULTS
Adequate surgery of the lesions located within the spinal canal was achieved in all patients using this approach. The hemi-semi laminectomy was performed at one spinal level in 68 patients, two levels in 15 and three levels in 3. The affected spine was the cervical in 16, the cervico-thoracic in 6, the thoracic in 35, the thoraco-lumbar in 10 and lumbar region in 19 cases. Histological results were as follows: 32 intradural meningiomas, 27 neurinomas, 10 ependymomas, 3 arachnoid cysts, 2 cavernomas and extradurally 4 epidural haemorrhage, 5 epidural abscesses and 3 dural vascular malformations.


CONCLUSIONS
The unilateral partial laminectomy (named hemi-semi laminectomy) approach for the mainly laterally located intra- or extradural lesions, confined to one side, allow to minimize resection of and injury to tissues not directly involved in the pathologic process, while affording a safe and thorough removal of space-occupying pathologies and decompression of neural structures located in a spinal canal. Two additional advantages come from this technique in cases of misjudged level or at re-operation.
Banczerowski
Péter
P
Országos Idegsebészeti Tudományos Intézet, Budapest. bancpet@oiti.hu
Vajda
János
J
Veres
Róbert
R
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016080:Arachnoid Cysts / Q000175:diagnosis / Q000601:surgery; D001165:Arteriovenous Malformations / Q000175:diagnosis / Q000601:surgery; D002574:Cervical Vertebrae; D003287:Contrast Media; D004388:Dura Mater / Q000098:blood supply; D004806:Ependymoma / Q000175:diagnosis / Q000601:surgery; D020802:Epidural Abscess / Q000175:diagnosis / Q000601:surgery; D005260:Female; D006392:Hemangioma, Cavernous / Q000175:diagnosis / Q000601:surgery; D046748:Hematoma, Epidural, Spinal / Q000175:diagnosis / Q000601:surgery; D006801:Humans; D021621:Imaging, Three-Dimensional; D007796:Laminectomy / Q000379:methods*; D008159:Lumbar Vertebrae; D008279:Magnetic Resonance Imaging; D008297:Male; D008577:Meningeal Neoplasms / Q000175:diagnosis / Q000601:surgery; D008579:Meningioma / Q000175:diagnosis / Q000601:surgery; D008875:Middle Aged; D009442:Neurilemmoma / Q000175:diagnosis / Q000601:surgery; D013125:Spinal Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D013130:Spinal Stenosis / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D013904:Thoracic Vertebrae; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D003287:Contrast Media