OBJECTIVE: To explore the feasibility and key technology of microscopic resection of lumbar intraspinal tumor through microchannel keyhole approach. METHODS: The clinical features, imaging characteristics and surgical methods of 54 cases of lumbar intraspinal tumor which were microscopically operated by microchannel from February 2017 to September 2019 were reviewed and analyzed. There were 8 cases of extradural tumor, 3 cases of extra-and intradural tumor and 43 cases of subdural extramedullary tumor (including 3 cases of ventral spinal tumor). The tumors were 0.5-3.0 cm in diameter. The clinical symptoms included 49 cases of pain in the corresponding innervation area, 5 cases of sensory disturbance (numbness) at or below the tumor segment, 7 cases of limb weakness and 2 cases of urination and defecation dysfunction. RESULTS: In the study, 37 tumors were resected through hemilaminectomy, 14 tumors were resected through interlaminar fenestration, 3 tumors were resected through hemilaminectomy or interlaminar fenestration combined with facetectomy of medial 1/4 facet. All of the 54 tumors were totally resected. The operation time was 75-135 min, with an average of 93.3 min. The postoperative hospital stay was 4-7 days, with an average of 5.7 days. Postoperative pathology included 34 cases of schwannoma, 4 cases of meningioma, 9 cases of ependymoma, 1 case of enterogenous cyst, 5 cases of teratoma/epidermoid/dermoid cyst, and 1 case of paraganglioma. No infection or cerebrospinal fluid leakage was found after operation. No neurological dysfunction occurred except 1 case of urination dysfunction and 4 cases of limb numbness. The follow-up period ranged from 3 to 33 months with an average of 14.4 months. Five patients with new onset symptoms returned to normal. The pain symptoms of 49 patients were completely relieved; 4 of 5 patients with hypoesthesia recovered completely, the other 1 patient had residual mild hypoesthesia; 7 patients with limb weakness, and 2 patients with urination and defecation dysfunction recovered to normal. No spinal instability or deformity was found, and no recurrence or residual tumors were found. According to McCormick classification, they were of all grade Ⅰ. CONCLUSION The lumbar intraspinal extramedullary tumors within two segments (including the ventral spinal tumors) can be totally resected at stage Ⅰ through microchannel keyhole approach with appropriate selection of the cases. Microchannel technique is beneficial to preserve the normal structure and muscle attachment of lumbar spine, and to maintain the integrity and stability of lumbar spine.
Humans ; Hypesthesia ; Lumbar Vertebrae/surgery* ; Meningeal Neoplasms ; Pain ; Retrospective Studies ; Spinal Cord Neoplasms/surgery* ; Spinal Neoplasms/surgery* ; Treatment Outcome

Child ; Germinoma ; chemistry ; pathology ; surgery ; Humans ; Immunohistochemistry ; Male ; Spinal Cord Neoplasms ; chemistry ; pathology ; surgery

OBJECTIVETo evaluate the clinical outcomes of total en-bloc spondylectomy (TES) in recurrence spinal tumor.

METHODSThe study was a retrospective study of recurrence spinal tumor from January 2010 to October 2013. A total of 6 patients with recurrent spinal tumor underwent TES procedures, with 5 cases located in thoracic spine and 1 case located in L1. There were 3 male and 3 female patients, with a mean age of 33.2 years. Pathological diagnosis included giant cell tumor of bone in 3 cases, breast cancer, lung cancer and nasopharyngeal carcinoma with 1 case in each. The operation time, bleeding loss, resected segments, cutting edge, spinal cord function and complications was evaluated.

RESULTSSingle segment resected in 1 case, 2 segments resected in 2 cases and 3 segments resected in 3 cases. The average operation time was 8.9 hours (7.5 to 12.0 hours). The average blood loss was 3 116 ml (2 500 to 4 500 ml). The average follow-up period was 23.2 months (12 to 47 months) without recurrence. There was no spinal cord injury during operation. The neurologic function was significantly improved in 2 cases (American Spinal Injury Association (ASIA) grade C to grade D), unchanged in 1 cases (ASIA grade B) and no deteriorated case in 3 cases (ASIA grade E). There was no perioperative deaths case. Complications included 2 cases pleural rupture, 1 case dural tear and 1 case massive haemothorax. No peri-operation death case.

CONCLUSIONSome of the recurrent spinal tumors are still suitable for en-bloc resection and TES procedure with the extent of its applicability under strict control.

Adult ; Female ; Humans ; Lung Neoplasms ; Male ; Neoplasm Recurrence, Local ; Retrospective Studies ; Spinal Cord Neoplasms ; Spinal Neoplasms ; surgery ; Spine

The spine is the most common site of bone metastases from malignant tumors, with metastatic epidural spinal cord compression occurring in about 10% of patients with spinal metastases. Palliative radiotherapy and simple laminectomy and decompression have been the main treatments for metastatic spinal cord compression. The former is ineffective and delayed for radiation-insensitive tumors, and the latter often impairs spinal stability. With the continuous improvement of surgical techniques and instrumentation in recent years, the treatment model of spinal metastases has changed a lot. Decompression surgery underwent open decompression, separation surgery, minimally invasive surgery and laser interintermal thermal ablation decompression. However, no matter what kind of surgical plan is adopted, it should be assessed precisely according to the specific situation of the patient to minimize the risk of surgery as far as possible to ensure the smooth follow-up radiotherapy. This paper reviews the research progress of decompression for spinal metastases.
Humans ; Spinal Cord Compression/surgery* ; Spinal Neoplasms/secondary* ; Decompression, Surgical/methods* ; Spine/surgery* ; Retrospective Studies ; Treatment Outcome

A 12-year-old boy was admitted for complaint of progressive urination disorder for over 2 years. Physical examination found dysesthesia in the perineal region and disappearance of anal reflex with anal relaxation and a spinal cleft in the sacrococcygeal region. Lumbosacral magnetic resonance imaging MRI showed a low-set of the spinal cord, tethered cord, spina bifida of sacral vertebrae, and meningocele combined with lipoma inside and outside of the spinal canal. Ultrasonography displayed a significantly increased residual urine volume. The diagnosis of tethered-cord syndrome resulting from mixed lipoma was thus established. During the microsurgery, the adhesions between the spinal cord, coccygeal nerve and lipoma were released with a laser scalpel, and the lipoma inside and outside of the spinal canal was excised, after which the dural defect was repaired. The patient recovered smoothly, and the urinary function was normal at the follow-up 6 months after the surgery. Spinal cord lipoma can be classified into 2 types based on the integrity of the dura mater, and in this case, a combined dural defect was found. A definite diagnosis can be derived from the clinical manifestations and MRI findings. Microsurgery remains the currently only effective treatment, and a favorable prognosis can be expected after an early surgical intervention, especially before the functional lesion of the spinal cord. The integrity of the local dura mater considerably affects the outcome of the treatment, and dural defect often leads to surgical difficulty and poor results. The key to a successful operation lies in a full release of the adhesion and avoidance of injury to the conus medullaris and cauda equina. A reoperation in case of recurrence should be carefully evaluated for its benefits.
Child ; Humans ; Lipoma ; complications ; surgery ; Male ; Microsurgery ; Neural Tube Defects ; etiology ; surgery ; Spinal Cord Neoplasms ; complications ; surgery ; Treatment Outcome

Cervical Vertebrae ; Dura Mater ; Epidural Space ; Humans ; Spinal Cord Neoplasms ; surgery

OBJECTIVE: To evaluate the therapeutical effect of surgical treatment for thoracic angioma with extraosseous extension which causes spinal cord compression and neurological dysfunction. METHODS: We retrospectively analyzed 5 cases of thoracic vertebral body angioma with extraosseous extension and spinal cord compression. The operation were performed through anterior approach to resect the involved vertebral body and intracanal angioma in 5 patients. Bone graft and internal fixation were also completed in the meantime. Two patients accepted radiotherapy for 2 periods of treatment postoperatively, and the other 3 patients didn't accept the other supportive therapy. RESULTS: The blood loss during the operation was 1000 mL to 1500 mL. All the patients recovered their neurological function rapidly after the operation. The patients were followed up for 1 to 4 years, and no patient recurred. The bone graft was solidly fused in all patients. No hardware failure occurred. CONCLUSION The surgical treatment for thoracic vertebral body and extraosseous angioma with spinal cord compression is effective, reliable, and workable. Good long-term result can be obtained.
Adult ; Follow-Up Studies ; Hemangioma ; complications ; surgery ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Spinal Cord Compression ; etiology ; Spinal Neoplasms ; complications ; surgery ; Thoracic Vertebrae ; surgery

OBJECTIVETo investigate the diagnosis and surgical techniques of intramedullary hemangioblastoma of the cervical spinal cord.

METHODSMR imaging and the methods and results of surgery were analyzed in 21 patients.

RESULTSThe tumors were divided into three types on MR imaging. Syringeal type, where the tumor varied in size and was accompanied by syringobulbia and syringomyelia; Cystic type, where the tumor presented as a cyst with a small mural node; and Solid type, where the tumor was revealed as a huge solid mass. All tumors were totally removed and diagnosis was confirmed by histological study. Post-operative neurological status was improved in 20 patients and aggravated in 1.

CONCLUSIONSThe localization and the nature diagnosis of the tumor can be made by cervical MR imaging. Operative methods vary with tumor types. It is the most important that the tumor is dissected along the right interface and removed after devascularization.

Adolescent ; Adult ; Cervical Vertebrae ; Female ; Hemangioblastoma ; diagnosis ; surgery ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Spinal Cord Neoplasms ; diagnosis ; surgery

OBJECTIVE: To evaluate the long-term clinical therapeutic effect of polyaxial screw-rod system for posterior cervical arthrodesis on patients with upper cervical spinal cord tumors.
 METHODS: From March 2007 to May 2013, 22 patients with upper cervical spinal cord tumors underwent tumor resection and posterior cervical arthrodesis in our institution. The medical records of these patients were reviewed respectively. There were 10 males and 12 females with ages ranging from 16 to 60 years old. Posterior cervical arthrodesis by polyaxial screw-rod was performed at the upper cervical spine (C1-3). All patients were followed-up clinically and radiographically.
 RESULTS: The average follow-up was 65.5 months. Twenty-two patients were enrolled and a total of 114 screws were placed in this study. Histopathology revealed neurinoma, meningioma, ganglioneuroma and ganglioglioma in 16, 3, 1 and 1 case (s), respectively. The mixed tumor with component of ganglioneuroma and neurinoma was observed in 1 case. All patients received tumor resection and posterior athrodesis by polyaxial screw-rod system. Cervical kyphosis was encountered in one patient and this patient suffered the recurrence of tumor. Solid fusion was achieved in all patients. The average postoperative Japanese Orthopaedic Association (JOA) score was 13.9 and the average recovery rate was 51.4%. Neurologic deterioration was found in 2 patients. No complications, such as spinal cord or vertebral artery injury, postoperative radiculopathy or instrumentation failure, were observed.
 CONCLUSION The long-term clinical therapeutic effects of posterior cervical arthrodesis using polyaxial screw-rod system on upper cervical spinal cord tumors are satisfactory, with no severe complication.
Adolescent ; Adult ; Bone Screws ; Cervical Cord ; pathology ; surgery ; Cervical Vertebrae ; Female ; Humans ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Spinal Fusion ; Spinal Neoplasms ; surgery ; Young Adult

Although lumbosacral lipoma is reported to occur in 4-8 of 100,000 patients, and 66% of lipomyelomeningoceles in young patients are accompanied by hypertrophic filum terminale, it is very rare to find two isolated spinal lipomas simultaneously. A 3 month-old baby girl was admitted to the hospital for a protruding, non-tender, soft, subcutaneous 2.5 cm mass of the lumbosacral area that had been present since birth. Simple radiography showed a spinal posterior arch defect from L3 to L5, and magnetic resonance imaging (MRI) demonstrated two isolated spinal lipomas, a transitional type from L3 to L5, and a terminal type below S1 without dural defect. The cornus medullaris was severely tethered descending to the S1, but there was no cerebellar or brain stem herniation on the MRI. We suggest that the presence of a combined spinal lipoma should be a point for careful differentiation in an infant with spinal lipoma.
Treatment Outcome ; Spinal Cord Neoplasms/*diagnosis/*surgery ; Neural Tube Defects/*diagnosis/*surgery ; Lumbosacral Region/*surgery ; Lipoma/*diagnosis/*surgery ; Infant ; Humans ; Female