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  • Ten years experience with the unilateral approach for the removal of intradural spinal schwannomas and meningiomas,

    Final Number:

    Alfredo Pompili MD; Vincenzo Anelli; Fabrizio Caroli; Francesco Crispo; Maddalena Giovannetti MD; Laura Raus; Stefano Telera MD; Antonello Vidiri MD

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2012 Annual Meeting

    Introduction: Spinal intradural-extramedullary tumors are usually removed by uni- or multi-level laminectomy/laminotomy with midline dural incision. Patients’ pain, discomfort, delayed postoperative kyphosis, and spinal instability may be minimized by adopting an unilateral approach, which avoids bilateral muscles and ligamenta damage.

    Methods: Methods 60 patients with schwannomas (63 tumors) and 14 with meningiomas (15) tumors) were operated upon with the limited unilateral laminectomy approach (June 2000-December 2010). No patient with either NF1 or NF2 was included. The laminectomy was one level, having care to remove all the ligamentum flavum. When necessary, it was extended 1.5-2 cm cranio-caudally. Dura was opened paramedially and the tumor dissected and removed either “en bloc” or piecemeal. Closure was done with 5-0 or 6-0 stitches. Removal was total in 62/63 schwannomas ; Simpson’s grade 1 was performed in 5 meningiomas and grade 2 in 10.

    Results: The uncomplicated patients were mobilized on day 3 and discharged on day 5. Post-operative pain was minimal and therapy was discontinuated after 24 hours. Four patients had orthostatic headache; two had a pseudomeningocele requiring reoperation. The most impressive, immediate result was on pain as evaluated by the Dennis Pain Scale: measured with the Wilcoxon signed rank test pain decrement was significant either at discharge or at 6-10 months ( p<0.0001 for schwannomas and p<0.001 for meningiomas ) Neurological results were excellent/good: 27 cases had pre-operative moderate to severe neurological impairment: 12 recovered completely, 12 up to 80-90%, 3 up to 70%. One patient with cervical malignant melanocytic schwannoma( partial removal) died 12 months post-op, while still recovering.

    Conclusions: Hospital stay is shortened (no pain, early mobilization) and stability preserved with an appropriate microsurgical mininvasive technique. Neurological and oncological results are good. Patients’ post-operative pain and discomfort are greatly reduced. No external bracing is necessary, permitting early rehabilitation, and reduction of the overall costs.

    Patient Care: Post operative pain may be neglected as an important event in spinal tumor neurosurgery. By this approach the results on pain are impressive and this improves overall results. Spinal stability is preserved and no external bracing is required.

    Learning Objectives: By the conclusion of this session, partecipants should be able to select the correct approch to intradural extramedullary tumors and to have a proper view of the surgical anatomy and technical steps to remove them


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