Neurooncology and Neurosurgery

Complete resection of intradural extra medullary spinal tumor is the gold-standard treatment, particularly for tumors with less aggressive potential, such as meningiomas, neuromas or ependymoma. Accordingly, sufficient exposure for visibility and maneuvering space are crucial to this type of surgery. Therefore, extensive approaches were preferred in the past, with full laminectomies of 2 or more segments. These approaches led to problems in terms of large wounds with high infection rates and blood loss and may pre-disposed patients to spinal instability and deformities, like the swan neck that was observed especially in young patients who underwent multilevel laminectomy. This led to an increase the use of additional spinal instrumentation to solve this expected long-term complication. With technology advancing, several reports have elucidated that possibility to achieve a comparable quality of resection with minimally invasive approaches, thus dropping exposure-related comorbidities to a minimum. Our work objective is to share our experience with intradural extra medullary spinal tumor resection and show the feasibility and safety of tumor excision using a Minimally Invasive (MIS) approach. Our results showed that one and two level intradural extra medullary spinal tumors could be resected through a minimally invasive surgical corridor without an increased risk for adverse neurologic complications. The use of the tubular retractor system allows for adequate visualization while minimizing local tissue damage. MIS approach resulted in less post-operative pain, intra-operative blood loss, surgical time and length of hospital stay. In conclusion, MIS can be an appropriate alternative to an open approach for one or two level intradural extra medullary lesions. Although our initial experience is promising, these results will require validation through methodologically sound randomized, prospective trials before routine recommendation of MIS approaches for spinal tumor resection.