Introduction: Meningiomas has been described in at least 46% of intraspinal tumors, whose predilection has been showed in the thoracic spine and postero-lateral position. When anterior positioned, the neurosurgeon can approach it by several surgical techniques. The authors presents a case report of an anterior meningioma associated to posterior medullary compression that was approached by left unilateral laminectomy.
Methods: This study was based on the documental research of data obtained in the medical records of the patient associated to the bibliographic research using the indexed databases
Results: A female patient, 36-year-old, who presented a paraparesis of crural predominance associated to paresis, bladder sphincter dysfunction and hypoesthesia affecting the T4 sensitive level. During complementary investigation, a intradural-extramedullary thoracic lesion was showed, measuring 2.2x1.2x1.5cm, associated to T1-T3 myelopathy. The surgical approach was performed under neurological monitoring and intraoperative radiology, microscopy and evoked potential stimulation. The patient was positioned in horizontal ventral decubitus under general anesthesia, resting head on Mayfield skull fixator and the surgical table lateralized 15 degrees to the right. After marking C7 and T3 levels, the incision and left side musculature divulsion and hemilaminectomy approach were performed. We showed no evidence of changes in somatosensory evoked potential during the lesion resection. In the postoperative, we showed no complications associated to total muscular strength and sensitive recovery.
Conclusions: Hemilaminectomy avoids postoperative instability and other complications associated with the deconstruction of the posterior elements of the spine. This approach can be used safely in intradural and extramedullary tumors, even in tumors such as meningiomas, where there is a greater probability of bleeding.
Patient Care: Although there are many surgical techniques aiming to perform the surgical approach of anterior tumors of spinal cord, this study showed that the adequate management of it can be result in decrease of patients’ loss of function, improvement of quality of life, as well as the reduction of governmental or particular health costs associated to the complications in the postoperative.
Learning Objectives: The goal of this study is discuss the risks, complications, advantages, patient outcome and technical pitfalls of the use of hemilamnectomy technique in the surgical management of anterior tumors of spinal cord.
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