Modified Hemilaminectomy for Bilateral Exposure in Intramedullary Spinal Cord Tumor Resection

Area of Science:

• Neurosurgery
• Spinal Surgery
• Minimally Invasive Techniques

Background:

• Traditional posterior approaches for spinal cord tumors require bilateral laminotomy/laminoplasty for adequate exposure.
• Unilateral approaches are limited by visualization and working angle concerns across the midline.

Purpose of the Study:

• To present a modified hemilaminectomy technique for unilateral access to intramedullary spinal cord tumors.
• To enable safe midline myelotomy and bilateral tumor dissection via a single corridor.

Main Methods:

• Retrospective analysis of 14 patients with intramedullary spinal cord tumors undergoing resection.
• Utilized a refined hemilaminectomy with spinous process thinning and dural suspension.
• Assessed neurological status using the modified McCormick scale pre- and post-operatively.

Main Results:

• Achieved gross total resection in 92.9% (13/14) of patients with no new permanent neurological deficits.
• Demonstrated significant functional recovery (p=0.013) with 50% showing early improvement.
• No postoperative cord tethering observed on MRI; approach is reproducible with a shallow learning curve.

Conclusions:

• The modified hemilaminectomy provides effective bilateral exposure and safe midline myelotomy through a unilateral approach.
• This technique achieves high resection rates with minimal morbidity, offering a feasible alternative to bilateral procedures.
• Further prospective validation is warranted for this reproducible surgical method.