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[Application of microchannel technique in minimally invasive resection of cervical intraspinal tumors]
Guozhong Lin1, Changcheng Ma1, Chao Wu1
1Department of Neurosurgery, Peking University Third Hospital, Beijing 100191, China.
Objective:
To explore the application and key points of microchannel approaches in resection of cervical intraspinal tumors.
Methods:
A retrospective analysis was performed on 51 cases of cervical spinal canal tumors from February 2017 to March 2020. Among them, 5 cases were located epidural space, 6 cases were located epidural and subdural space, and 40 cases were located under the subdural extramedullary space(6 cases were located on the ventral side of the spinal cord). The maximum diameter ranged from 0.5 to 3.0 cm. The clinical manifestations included neck, shoulder or upper limb pain 43 cases, sensory disturbance (numbness) in 22 cases, and limb weakness in 8 cases. The microchannel keyhole technique was used to expose the tumor, and the tumor was resected microscopically.
Results:
In this study, 35 patients underwent hemilaminectomy, 12 patients underwent interlaminar fenestration, 2 patients underwent medial 1/4 facetectomy on the basis of hemilaminectomy or interlaminar fenestration. Two tumors were resected through anatomy space (no bone was resected). The degree of tumor resection included total resection in 50 cases and subtotal resection in 1 case. The type of the tumor included 36 schwannomas, 12 meningiomas, 2 enterogenic cysts and 1 dermoid cyst. There was no infection and cerebrospinal fluid leakage postoperatively. Limb numbness occurred in 7 patients. The average follow-up time was 15 months (3 to 36 months). No deformity such as cervical instability or kyphosis was found. The tumor had no recurrence.
Conclusion:
The cervical spinal canal is relatively wide, cervical tumors with no more than three segments can be fully exposed by means of microchannel technology. Besides intramedullary or malignant tumors, they can be microsurgically removed. Preservation of the skeletal muscle structure of cervical spine is beneficial to recover the anatomy and function of cervical spine. The electrophysiological monitoring helps to avoid spinal cord or nerve root injury.
Insights
Microchannel keyhole surgery offers a minimally invasive approach for resecting cervical intraspinal tumors. This technique allows for safe and effective tumor removal while preserving spinal structures and function.
Area of Science:
- Neurosurgery
- Spinal Surgery
- Minimally Invasive Techniques
Context:
- Cervical intraspinal tumors present a surgical challenge due to their location.
- Traditional approaches may involve significant bone resection and soft tissue disruption.
- Microchannel techniques offer a less invasive alternative.
Purpose:
- To evaluate the application and key aspects of microchannel approaches for cervical intraspinal tumor resection.
- To assess the safety and efficacy of this minimally invasive technique.
Summary:
- A retrospective analysis of 51 cervical intraspinal tumor cases (2017-2020) using microchannel keyhole technique.
- Tumors included schwannomas, meningiomas, and cysts; 50 out of 51 cases achieved total resection.
- Procedures involved variations of hemilaminectomy or interlaminar fenestration, with minimal bone removal in some cases.
- Postoperative outcomes were favorable, with no infection, cerebrospinal fluid leakage, or recurrence; minor numbness occurred in 7 patients.
- Follow-up showed no cervical instability or kyphosis, preserving skeletal muscle structure and spinal function.
Impact:
- Microchannel technology enables full exposure and microsurgical removal of cervical tumors within a limited spinal segment range.
- Preservation of cervical spine musculature aids in functional recovery.
- Electrophysiological monitoring is crucial for preventing neural damage.
