Anatomic Basis for Minimally Invasive Resection of Intradural Extramedullary Lesions in Thoracic Spine

Luis M. Tumialán, Nicholas Theodore, Mohan Narayanan, Frederick F. Marciano, Peter Nakaji

Research output: Contribution to journalArticle

Abstract

Objective Since the first resections of intradural extramedullary neoplasms, neurosurgeons have tended to preserve as much of the integrity of the spine as possible while ensuring a safe corridor to resect these lesions. A dimensional analysis of intradural lesions superimposed on a dimensional analysis of the thoracic canal would provide the anatomic basis for a minimal access approach. The authors report the results of such an analysis on a series of patients with intradural extramedullary lesions. Methods A retrospective analysis was undertaken of 26 thoracic intradural extramedullary lesions managed with open or minimally invasive resection. The size of each lesion was measured in the rostrocaudal, lateral, and anteroposterior dimensions and then averaged and compared with reported dimensions of the thoracic spinal canal. Results The mean (range) dimensions of the surgically resected thoracic lesions were 18.6 mm (10–25 mm) for rostrocaudal, 13.0 mm (7–18 mm) for lateral, and 13.6 mm (9–17 mm) for anteroposterior. No patient had any evidence of thoracic canal remodeling. Conclusions Thoracic intradural extramedullary lesions become symptomatic as they approach the limits of the thoracic canal, resulting in an inherent dimensional limitation in the rostrocaudal, lateral, and anteroposterior dimensions. Displacement of the spinal cord by the lesion to one side further favors a minimally invasive unilateral approach. A paraspinal unilateral hemilaminectomy approach with a 35 × 20 mm exposure centered over the lesion offers a safe surgical corridor for resection while preserving the posterior tension band, facet complexes, and paraspinal musculature.

LanguageEnglish (US)
Pagese770-e777
JournalWorld Neurosurgery
Volume109
DOIs
StatePublished - Jan 1 2018
Externally publishedYes

Fingerprint

Spine
Thorax
Spinal Canal
Spinal Cord
Neoplasms

Keywords

  • Anatomy
  • Intradural extramedullary neoplasm
  • Minimally invasive surgery
  • Resection
  • Spinal cord
  • Thoracic spine

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Anatomic Basis for Minimally Invasive Resection of Intradural Extramedullary Lesions in Thoracic Spine. / Tumialán, Luis M.; Theodore, Nicholas; Narayanan, Mohan; Marciano, Frederick F.; Nakaji, Peter.

In: World Neurosurgery, Vol. 109, 01.01.2018, p. e770-e777.

Research output: Contribution to journalArticle

Tumialán, Luis M. ; Theodore, Nicholas ; Narayanan, Mohan ; Marciano, Frederick F. ; Nakaji, Peter. / Anatomic Basis for Minimally Invasive Resection of Intradural Extramedullary Lesions in Thoracic Spine. In: World Neurosurgery. 2018 ; Vol. 109. pp. e770-e777
@article{1b3047e825fb4592b8fb95f29cce6616,
title = "Anatomic Basis for Minimally Invasive Resection of Intradural Extramedullary Lesions in Thoracic Spine",
abstract = "Objective Since the first resections of intradural extramedullary neoplasms, neurosurgeons have tended to preserve as much of the integrity of the spine as possible while ensuring a safe corridor to resect these lesions. A dimensional analysis of intradural lesions superimposed on a dimensional analysis of the thoracic canal would provide the anatomic basis for a minimal access approach. The authors report the results of such an analysis on a series of patients with intradural extramedullary lesions. Methods A retrospective analysis was undertaken of 26 thoracic intradural extramedullary lesions managed with open or minimally invasive resection. The size of each lesion was measured in the rostrocaudal, lateral, and anteroposterior dimensions and then averaged and compared with reported dimensions of the thoracic spinal canal. Results The mean (range) dimensions of the surgically resected thoracic lesions were 18.6 mm (10–25 mm) for rostrocaudal, 13.0 mm (7–18 mm) for lateral, and 13.6 mm (9–17 mm) for anteroposterior. No patient had any evidence of thoracic canal remodeling. Conclusions Thoracic intradural extramedullary lesions become symptomatic as they approach the limits of the thoracic canal, resulting in an inherent dimensional limitation in the rostrocaudal, lateral, and anteroposterior dimensions. Displacement of the spinal cord by the lesion to one side further favors a minimally invasive unilateral approach. A paraspinal unilateral hemilaminectomy approach with a 35 × 20 mm exposure centered over the lesion offers a safe surgical corridor for resection while preserving the posterior tension band, facet complexes, and paraspinal musculature.",
keywords = "Anatomy, Intradural extramedullary neoplasm, Minimally invasive surgery, Resection, Spinal cord, Thoracic spine",
author = "Tumial\{'a}n, {Luis M.} and Nicholas Theodore and Mohan Narayanan and Marciano, {Frederick F.} and Peter Nakaji",
year = "2018",
month = "1",
day = "1",
doi = "10.1016/j.wneu.2017.10.078",
language = "English (US)",
volume = "109",
pages = "e770--e777",
journal = "World Neurosurgery",
issn = "1878-8750",
publisher = "Elsevier Inc.",

}

TY - JOUR

T1 - Anatomic Basis for Minimally Invasive Resection of Intradural Extramedullary Lesions in Thoracic Spine

AU - Tumialán,Luis M.

AU - Theodore,Nicholas

AU - Narayanan,Mohan

AU - Marciano,Frederick F.

AU - Nakaji,Peter

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Objective Since the first resections of intradural extramedullary neoplasms, neurosurgeons have tended to preserve as much of the integrity of the spine as possible while ensuring a safe corridor to resect these lesions. A dimensional analysis of intradural lesions superimposed on a dimensional analysis of the thoracic canal would provide the anatomic basis for a minimal access approach. The authors report the results of such an analysis on a series of patients with intradural extramedullary lesions. Methods A retrospective analysis was undertaken of 26 thoracic intradural extramedullary lesions managed with open or minimally invasive resection. The size of each lesion was measured in the rostrocaudal, lateral, and anteroposterior dimensions and then averaged and compared with reported dimensions of the thoracic spinal canal. Results The mean (range) dimensions of the surgically resected thoracic lesions were 18.6 mm (10–25 mm) for rostrocaudal, 13.0 mm (7–18 mm) for lateral, and 13.6 mm (9–17 mm) for anteroposterior. No patient had any evidence of thoracic canal remodeling. Conclusions Thoracic intradural extramedullary lesions become symptomatic as they approach the limits of the thoracic canal, resulting in an inherent dimensional limitation in the rostrocaudal, lateral, and anteroposterior dimensions. Displacement of the spinal cord by the lesion to one side further favors a minimally invasive unilateral approach. A paraspinal unilateral hemilaminectomy approach with a 35 × 20 mm exposure centered over the lesion offers a safe surgical corridor for resection while preserving the posterior tension band, facet complexes, and paraspinal musculature.

AB - Objective Since the first resections of intradural extramedullary neoplasms, neurosurgeons have tended to preserve as much of the integrity of the spine as possible while ensuring a safe corridor to resect these lesions. A dimensional analysis of intradural lesions superimposed on a dimensional analysis of the thoracic canal would provide the anatomic basis for a minimal access approach. The authors report the results of such an analysis on a series of patients with intradural extramedullary lesions. Methods A retrospective analysis was undertaken of 26 thoracic intradural extramedullary lesions managed with open or minimally invasive resection. The size of each lesion was measured in the rostrocaudal, lateral, and anteroposterior dimensions and then averaged and compared with reported dimensions of the thoracic spinal canal. Results The mean (range) dimensions of the surgically resected thoracic lesions were 18.6 mm (10–25 mm) for rostrocaudal, 13.0 mm (7–18 mm) for lateral, and 13.6 mm (9–17 mm) for anteroposterior. No patient had any evidence of thoracic canal remodeling. Conclusions Thoracic intradural extramedullary lesions become symptomatic as they approach the limits of the thoracic canal, resulting in an inherent dimensional limitation in the rostrocaudal, lateral, and anteroposterior dimensions. Displacement of the spinal cord by the lesion to one side further favors a minimally invasive unilateral approach. A paraspinal unilateral hemilaminectomy approach with a 35 × 20 mm exposure centered over the lesion offers a safe surgical corridor for resection while preserving the posterior tension band, facet complexes, and paraspinal musculature.

KW - Anatomy

KW - Intradural extramedullary neoplasm

KW - Minimally invasive surgery

KW - Resection

KW - Spinal cord

KW - Thoracic spine

UR - http://www.scopus.com/inward/record.url?scp=85034604634&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85034604634&partnerID=8YFLogxK

U2 - 10.1016/j.wneu.2017.10.078

DO - 10.1016/j.wneu.2017.10.078

M3 - Article

VL - 109

SP - e770-e777

JO - World Neurosurgery

T2 - World Neurosurgery

JF - World Neurosurgery

SN - 1878-8750

ER -