title: Safety and efficacy of intradural extramedullary spinal tumor removal using a minimally invasive approach.
abstract: BACKGROUND
  Although minimally invasive surgery for intradural tumors offers the potential benefits of less postoperative pain, a quicker recovery, and the avoidance of long-term instability from multilevel laminectomy, there are concerns over whether one can safely and effectively remove intradural extramedullary tumors in a fashion comparable to open techniques and whether the advantages of minimally invasive surgery are clinically significant.
  
  
  OBJECTIVE
  To review our early experience with minimally invasive techniques for intradural extramedullary tumors of the spine.
  
  
  METHODS
  Thirteen intradural tumors (1 cervical, 6 thoracic, 6 lumbar) in 11 patients were operated on using a muscle-splitting, tube-assisted paramedian oblique approach with hemilaminectomy to access the spinal canal while preserving the spinous process and ligaments. Fluoroscopy and navigation were used to determine the surgical level in all thoracic and lumbar cases.
  
  
  RESULTS
  Satisfactory tumor resection using standard microsurgical techniques was achieved in all but 1 case using a minimally invasive approach. Surgical time and intraoperative blood loss were favorable compared with our open technique cases. There was no postoperative morbidity with the minimally invasive approach, although in 2 patients with tumors in the mid- and upper thoracic spine, the surgical incision was inaccurately placed by 1 level. In 1 case, the approach was converted to open when the tumor could not be found, and postoperatively there was a cerebrospinal fluid leak with infection that required readmission.
  
  
  CONCLUSIONS
  Intradural extramedullary tumors can be safely and effectively removed using minimally invasive techniques. The pros and cons of minimally invasive vs open surgery are discussed.
authors.affiliation: Department of Neurosurgery, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia. richard.mannion@nhs.net
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Mannion
authors.forename: Adrian M
authors.initials: AM
authors.lastname: Nowitzke
authors.forename: Johnny
authors.initials: J
authors.lastname: Efendy
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Wood
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007796:Laminectomy / Q000379:methods; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation / Q000379:methods*; D013125:Spinal Neoplasms / Q000601:surgery*; D013131:Spine / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult