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Updated: Aug 6, 2026
Electromagnetic Navigation Transthoracic Nodule Localization for Minimally Invasive Thoracic Surgery
Published on: May 4, 2022
Minimally invasive extracavitary approach for selected ventral intradural extramedullary thoracic lesions:
Filippo Gagliardi1, Lina Raffaella Barzaghi1, Pierfrancesco De Domenico2,3
1Department of Neurosurgery and Gamma Knife Radiosurgery, IRCCS Ospedale San Raffaele, Milan, Italy.
Purpose:
To describe and evaluate the application of the minimally invasive extracavitary approach (miECA) for selected ventral intradural extramedullary thoracic lesions through a combined quantitative anatomical study and proof-of-concept clinical application.
Background:
Surgical treatment of ventral intradural extramedullary lesions of the thoracic spine remains technically demanding because the spinal cord lies directly within the operative corridor. Although conventional posterior approaches are effective in most cases, selected lesions may require substantial spinal cord mobilization to achieve adequate exposure, potentially increasing the risk of neurological morbidity.
Methods:
A quantitative anthropometric neuroimaging study was performed on a reference population to characterize the geometry of the miECA corridor to the ventral intradural (premedullary) space. Working distance (WD), maneuverability arc (MAC), and surgical angle of incidence (SAI) were measured using a previously validated operability score methodology. These data were integrated with a proof-of-concept clinical application to assess technical feasibility and safety. An illustrative case is presented.
Results:
The miECA provided a muscle-sparing, stability-preserving surgical corridor with favorable geometry, characterized by a median SAI of 55.0° (interquartile range [IQR] 50.0-60.0), a median MAC of 45° (IQR 40-65) and a median WD of 8.0 cm (IQR 6.0-9.0). This configuration enabled direct access to the ventral intradural premedullary space while minimizing the need for spinal cord mobilization. Endoscopic assistance further enhanced the visualization of the ventral intradural compartment. In the illustrative case, complete tumor resection was achieved without procedure-related neurological deterioration.
Conclusions:
The miECA may represent a useful adjunct for carefully selected ventral intradural extramedullary thoracic lesions in which conventional posterior routes are expected to require substantial spinal cord manipulation. The present study establishes anatomical feasibility and provides preliminary technical guidance for future clinical applications.