title: Minimally invasive microsurgical treatment of cervical intraspinal extramedullary tumors.
abstract: Removal of intraspinal tumors by the classic posterior midline approach with laminectomy may cause damage to and instability of cervical segments. We investigated whether the less invasive hemilaminectomy or hemi-semi-laminectomy can achieve satisfactory clinical outcomes in 39 patients with intraspinal extramedullary tumors of the cervical spine. Twenty-seven patients were treated with conventional microsurgery using a posterior midline approach; and were compared to 12 patients treated with hemilaminectomy or hemi-semi-laminectomy using a posterior midline approach. Patients were retrospectively reviewed and their preoperative and postoperative clinical status was measured using the Frankel Grade. The surgical time for the 27 patients who underwent a classical laminectomy was 3±0.39 hours and blood loss was 123±34 mL. Twenty-five patients had their tumors removed entirely, and two patients had partial removal. Twenty-six patients were followed-up for between 38 months and 7 years (mean=5 years), of whom 23 improved and three remained in a stable condition. One patient with a meningioma had a tumor recurrence 3 years post-operatively and underwent further surgery. The surgical time for the hemilaminectomy or hemi-semi-laminectomy group was 2.5±0.3 hours and blood loss was 88±18 mL. All patients were followed-up for between 26 and 42 months (mean=31 months) and 11 recovered to an improved grade while one remained in a stable condition. No patient had a tumor recurrence. The hemilaminectomy or hemi-semi-laminectomy approach achieved similar clinical outcomes to the conventional posterior midline laminectomy approach and was also associated with a shorter operative time, decreased intraoperative blood loss, greater preserved ligament and bone structure and a reduced deformity rate.
authors.affiliation: Department of Neurosurgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai 200032, China.
authors.forename: Yong
authors.initials: Y
authors.lastname: Yu
authors.forename: Xiaobiao
authors.initials: X
authors.lastname: Zhang
authors.forename: Fan
authors.initials: F
authors.lastname: Hu
authors.forename: Tao
authors.initials: T
authors.lastname: Xie
authors.forename: Ye
authors.initials: Y
authors.lastname: Gu
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007796:Laminectomy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D013120:Spinal Cord Neoplasms / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult