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Keyhole approaches to intradural pathologies.

Klaus C Mende1, Theresa Krätzig1, Malte Mohme1

  • 1Department of Neurosurgery, University Medical Center Hamburg, Germany.

Neurosurgical Focus
|August 2, 2017
PubMed
Summary
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Minimally invasive mini-open approaches enable safe resection of intradural spinal tumors, reducing complications and preserving spinal stability. This technique is effective for meningiomas and neuromas, with selected use for intramedullary tumors.

Area of Science:

  • Neurosurgery
  • Spinal Surgery
  • Oncology

Background:

  • Spinal tumors are rare, comprising 2%-4% of central nervous system tumors.
  • Traditional wide surgical approaches carry risks of complications like skin incisions and spinal instability.
  • Minimally invasive techniques aim to reduce these surgical morbidities.

Purpose of the Study:

  • To evaluate the safety and efficacy of mini-open surgical approaches for intradural spinal tumors.
  • To compare outcomes between mini-open and traditional large exposure approaches.
  • To analyze complications and spinal stability following mini-open tumor resection.

Main Methods:

  • Retrospective review of 245 patients with intramedullary and intradural extramedullary tumors treated between 2009 and 2016.
Keywords:
intraduralkeyholeminimally invasivespine

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  • Detailed description of the mini-open keyhole/interlaminar surgical technique.
  • Analysis of tumor subgroups (meningioma, neuroma, intramedullary) and associated complications.

    • Main Results:

    • Mini-open approaches successfully resected all meningiomas (n=79) and neuromas (n=72).
    • Only 5.3% of intramedullary tumors were accessed via mini-open techniques, often requiring laminotomy or laminectomy.
    • Surgery-associated complications were significantly lower in the mini-open group (9.6%) compared to the large exposure group (19.1%).

    Conclusions:

    • Mini-open interlaminar approaches are safe and effective for resecting intradural extramedullary spinal tumors.
    • This technique preserves spinal stability and reduces comorbidities by avoiding extensive laminectomies.
    • Selected intramedullary pathologies can also be addressed with this minimally invasive method.