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Mini-invasive unilateral approach for removal of lumbar ependymomas
EANS Academy. Telera S. 09/26/19; 275989; EP04140
Dr. Stefano Telera
Dr. Stefano Telera

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Abstract
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Background: Spinal intradural tumors are usually removed by uni-multi-levels laminectomy/laminotomy with midline dural incision. Patients' pain, discomfort, delayed post-operative kyphosis, and spinal instability (6%) may be minimized by a more conservative unilateral microsurgery, avoiding bilateral damage to muscles and to interspinous ligaments.
Methods: 17 patients with lumbar ependymomas (16 myxopapillary, one metastatic) were operated with unilateral laminectomy: 8 males and 9 females, mean age 42 years (17-74). The extent of the laminectomy was usually kept to one-two levels, removing the cranial and caudal ligamentum flavum. Careful radioscopic indentification is mandatory. The dura was opened paramedially, the tumor dissected and removed either 'en bloc', when smaller than 2 cm, or piecemeal, after CUSA debulking. Neurophysiologic monitoring was performed routinely. Dural closure was done with 6-0 Prolene stitches. KPS, Dennis Pain Scale (DPS), and Mc Cormick Scale were evaluated pre-post operatively and at follow-up.
Results: Mean operative time was 160 minutes. No mortality or major neurological complications were observed. 5 patients had orthostatic headaches; one of them presented a CSF leak which resolved with lumbar drainage. Median KPS preoperative was 71. The most common symptom was pain 15 cases out of 17 (median 5 DPS).
4 patients presented a preoperative neurological deficit.
No neurological worsening post-operatively, recurrent tumors or spinal instabilities after a mean follow up of 6 yrs were observed. After one year, only two patients complained about pain (Grade 2 DPS) (p< 0.001). Median KPS was 95 (p< 0.001).
Conclusion: Hospital stay is shortened and stability preserved with this mini-invasive technique. Neurological and oncological results are good. Patient's post-operative pain and discomfort are reduced. No external bracing is necessary, permitting early rehabilitation, and possibly a reduction of the overall costs. Based on our experience on schwannomas and meningiomas, such technique could be also proposed for ependymomas.
Background: Spinal intradural tumors are usually removed by uni-multi-levels laminectomy/laminotomy with midline dural incision. Patients' pain, discomfort, delayed post-operative kyphosis, and spinal instability (6%) may be minimized by a more conservative unilateral microsurgery, avoiding bilateral damage to muscles and to interspinous ligaments.
Methods: 17 patients with lumbar ependymomas (16 myxopapillary, one metastatic) were operated with unilateral laminectomy: 8 males and 9 females, mean age 42 years (17-74). The extent of the laminectomy was usually kept to one-two levels, removing the cranial and caudal ligamentum flavum. Careful radioscopic indentification is mandatory. The dura was opened paramedially, the tumor dissected and removed either 'en bloc', when smaller than 2 cm, or piecemeal, after CUSA debulking. Neurophysiologic monitoring was performed routinely. Dural closure was done with 6-0 Prolene stitches. KPS, Dennis Pain Scale (DPS), and Mc Cormick Scale were evaluated pre-post operatively and at follow-up.
Results: Mean operative time was 160 minutes. No mortality or major neurological complications were observed. 5 patients had orthostatic headaches; one of them presented a CSF leak which resolved with lumbar drainage. Median KPS preoperative was 71. The most common symptom was pain 15 cases out of 17 (median 5 DPS).
4 patients presented a preoperative neurological deficit.
No neurological worsening post-operatively, recurrent tumors or spinal instabilities after a mean follow up of 6 yrs were observed. After one year, only two patients complained about pain (Grade 2 DPS) (p< 0.001). Median KPS was 95 (p< 0.001).
Conclusion: Hospital stay is shortened and stability preserved with this mini-invasive technique. Neurological and oncological results are good. Patient's post-operative pain and discomfort are reduced. No external bracing is necessary, permitting early rehabilitation, and possibly a reduction of the overall costs. Based on our experience on schwannomas and meningiomas, such technique could be also proposed for ependymomas.
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