title: Unilateral, multilevel, interlaminar fenestration in the removal of a multisegment cervical intramedullary ependymoma.
abstract: BACKGROUND
  Laminectomy is the traditional approach to intramedullary ependymomas and may lead to spinal instability and spinal deformities. Hemilaminectomy and laminoplasty have been developed to preserve the spinal stability and have been found to be effective. Unilateral, multilevel, interlaminar fenestration is another approach that may have more advantages in preserving the spinal stability; however, it has rarely been used by now.
  
  
  OBJECTIVE
  Unilateral, multilevel, interlaminar fenestration was often used in the surgical treatment of degenerative lumbar stenosis; however, it was rarely used for tumors. The aim of this study was to discuss the characteristics and advantages of its use for a multisegment intramedullary ependymoma.
  
  
  METHODS
  Case report and literature review.
  
  
  METHODS
  The 22-year-old man suffered from muscular atrophy of the left hand and the right hand for a period of 1.5 years and 3 months, respectively, and the cervical magnetic resonance imaging revealed an intramedullary mass of C4-C7. A right, unilateral, multilevel, interlaminar fenestration of the C3-C7 was performed with the help of high-speed air drills, and a midline myelotomy was made under microscope. The tumor was removed totally using piecemeal resection.
  
  
  RESULTS
  The magnetic resonance imaging, obtained 1 year after the operation, revealed that there were no residual mass lesion and no spinal instability, and the patient acquired an excellent functional outcome. So, this technique proved to be safe and easy in this case.
  
  
  CONCLUSIONS
  Unilateral, multilevel, interlaminar fenestration allows good access to a long intraspinal segment, protects the structures essential to spinal stability as much as possible, preserves the spinal stability, and results in no additional injury to the spinal cord. It may be applicable to many other kinds of intraspinal tumors.
authors.affiliation: Department of Neurosurgery, Changzheng Hospital, Second Military Medical University, No. 415, Fengyang Rd, Shanghai 200003, China.
authors.forename: Tianhao
authors.initials: T
authors.lastname: Xie
authors.forename: Jun
authors.initials: J
authors.lastname: Qian
authors.forename: Xiaojun
authors.initials: X
authors.lastname: Wu
authors.forename: Yicheng
authors.initials: Y
authors.lastname: Lu
authors.forename: Guohan
authors.initials: G
authors.lastname: Hu
authors.forename: Chun
authors.initials: C
authors.lastname: Luo
mesh_terms: D002574:Cervical Vertebrae; D004806:Ependymoma / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D019637:Orthopedic Procedures / Q000379:methods*; D013120:Spinal Cord Neoplasms / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Intramedullary ependymoma; Laminectomy; Spinal surgery; Unilateral interlaminar fenestration