Minimally invasive surgical treatment of extramedullary tumors at the level of craniovertebral junction: experience of the Burdenko Neurosurgical Center

Close metadata

OBJECTIVE

To describe own experience of treating patients with extramedullary tumors at the level of craniovertebral junction using minimally invasive surgical approaches.

MATERIAL AND METHODS

The study included 29 patients who underwent minimally invasive microsurgical resection of extramedullary tumors at the level of craniovertebral junction. We analyzed the main clinical and surgical parameters.

RESULTS

Gross total resection was achieved in most patients with high degree of safety. Two patients required redo surgery due to CSF leakage and soft tissue cyst. Mean length of hospital-stay was 7 days. VAS score of pain syndrome at discharge was 2 points and 0 points after 3 months. No significant differences in neurophysiological monitoring indicators were observed (p=0.76).

CONCLUSION

Minimally invasive posterior approaches to extramedullary tumors at the level of craniovertebral junction can significantly reduce surgical trauma with equal extent of resection.

Keywords:

intradural extramedullary tumors

craniovertebral junction

surgical treatment

minimally invasive surgical approaches

Authors:

Kaprovoy S.V.

Burdenko Neurosurgical Center

ORCID: 0000-0001-8813-2793

Konovalov N.A.

Burdenko Neurosurgical Center

ORCID: 0000-0002-9976-948X

Onoprienko R.A.

Burdenko Neurosurgical Center

ORCID: 0000-0002-8637-9079

Strunina Yu.V.

Burdenko Neurosurgical Center

ORCID: 0000-0003-1696-4050

Shmelev N.D.

Burdenko Neurosurgical Center

ORCID: 0009-0005-7058-902X

Received:

09.01.2024

Accepted:

12.01.2024

List of references:

Koeller KK, Shih RY. Intradural Extramedullary Spinal Neoplasms: Radiologic-Pathologic Correlation. Radiographics. 2019;39(2):468-490. https://doi.org/10.1148/rg.2019180200
Schellinger KA, Propp JM, Villano JL, McCarthy BJ. Descriptive epidemiology of primary spinal cord tumors. Journal of Neuro-Oncology. 2008;87(2):173-179. https://doi.org/10.1007/s11060-007-9507-z
Lador R, Bandiera S, Gasbarrini A, Ghermandi R, Boriani S. Treatment of Spinal Tumors in a High Volume Center has Direct Impact on Local Recurrence, Morbidity, and Mortality. Journal of Neuro-Oncology. 2017;30(8):E1074-E1081. https://doi.org/10.1097/BSD.0000000000000482
Tessitore E, Dehdashti AR, Schonauer C, Thomé C. Surgery of the Cranio-Vertebral Junction. Cham: Springer; 2020. https://doi.org/10.1007/978-3-030-18700-2
Wu Z, Hao S, Zhang J, Zhang L, Jia G, Tang J, Xiao X, Wang L, Wang Z. Foramen magnum meningiomas: experiences in 114 patients at a single institute over 15 years. Surgical Neurology. 2009;72(4):376-382; discussion 382. https://doi.org/10.1016/j.surneu.2009.05.006
Carlos-Escalante JA, Paz-López ÁA, Cacho-Díaz B, Pacheco-Cuellar G, Reyes-Soto G, Wegman-Ostrosky T. Primary Benign Tumors of the Spinal Canal. World Neurosurgery. 2022;164:178-198. https://doi.org/10.1016/j.wneu.2022.04.135
Kelly R, Fayed I, Conte A, Rock M, Nair N, Voyadzis JM, Sandhu F, Anaizi A. Minimally invasive surgery for intradural extramedullary spinal cord pathologies: A case series and technical note. Journal of Clinical Neuroscience. 2022;97:108-114. https://doi.org/10.1016/j.jocn.2022.01.012
Duhrsen L, Emami P, Matschke J, Abboud T, Westphal M, Regelsberger J. Meninigiomas of the Craniocervical Junction--A Distinctive Subgroup of Meningiomas. PLoS One. 2016;11(4):e0153405. https://doi.org/10.1371/journal.pone.0153405
Amelot A, Terrier LM, Lot G. Craniovertebral Junction Transoral Approach: Predictive Factors of Complications. World Neurosurgery. 2018;110:568-574.
Raygor KP, Than KD, Chou D, Mummaneni PV. Comparison of minimally invasive transspinous and open approaches for thoracolumbar intradural-extramedullary spinal tumors. Neurosurgical Focus. 2015;39(2):E12. https://doi.org/10.3171/2015.5.FOCUS15187
Wong AP, Lall RR, Dahdaleh NS, Lawton CD, Smith ZA, Wong RH, Harvey MJ, Lam S, Koski TR, Fessler RG. Comparison of open and minimally invasive surgery for intradural-extramedullary spine tumors. Neurosurgical Focus. 2015;39(2):E11. https://doi.org/10.3171/2015.5.FOCUS15129
Lu DC, Chou D, Mummaneni PV. A comparison of mini-open and open approaches for resection of thoracolumbar intradural spinal tumors. Journal of Neurosurgery: Spine. 2011;14(6):758-764. https://doi.org/10.3171/2011.1.SPINE09860
Xie T, Qian J, Lu Y, Chen B, Jiang Y, Luo C. Biomechanical comparison of laminectomy, hemilaminectomy and a new minimally invasive approach in the surgical treatment of multilevel cervical intradural tumour: a finite element analysis. European Spine Journal. 2013;22(12):2719-2730. https://doi.org/10.1007/s00586-013-2992-1
Kaya RA. Surgical Excition of Spinal Intradural Meningiomas through a Single-Sided Minimally Invasive Approach: Key-Hole Laminotomy. Asian Spine Journal. 2015;9(2):225-231. https://doi.org/10.4184/asj.2015.9.2.225
Helal A, Yolcu YU, Kamath A, Wahood W, Bydon M. Minimally invasive versus open surgery for patients undergoing intradural extramedullary spinal cord tumor resection: A systematic review and meta-analysis. Clinical Neurology and Neurosurgery. 2022;214:107176. https://doi.org/10.1016/j.clineuro.2022.107176
Nzokou A, Weil AG, Shedid D. Minimally invasive removal of thoracic and lumbar spinal tumors using a nonexpandable tubular retractor. Journal of Neurosurgery: Spine. 2013;19(6):708-715. https://doi.org/10.3171/2013.9.SPINE121061
Eicker SO, Mende KC, Dührsen L, Schmidt NO. Minimally invasive approach for small ventrally located intradural lesions of the craniovertebral junction. Neurosurgical Focus. 2015;38(4):E10. https://doi.org/10.3171/2015.2.FOCUS14799
Klingler JH, Volz F, Lützen N, Staszewski O, Beck J. Minimally invasive posterior paramedullary approach to the anterior craniocervical junction for intradural lesions using a non-expandable tubular retractor. Clinical Neurology and Neurosurgery. 2020;197:106189. https://doi.org/10.1016/j.clineuro.2020.106189
Vandenbroucke JP, von Elm E, Altman DG, Gøtzsche PC, Mulrow CD, Pocock SJ, Poole C, Schlesselman JJ, Egger M; STROBE Initiative. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration. PLOS Medicine. 2007;4(10):e297.
World Medical Association. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA. 2013;310(20):2191-2194.
Patel PD, Canseco JA, Houlihan N, Gabay A, Grasso G, Vaccaro AR. Overview of Minimally Invasive Spine Surgery. World Neurosurgery. 2020;142:43-56. https://doi.org/10.1016/j.wneu.2020.06.043
Bruneau M, George B. Foramen magnum meningiomas: detailed surgical approaches and technical aspects at Lariboisiere Hospital and review of the literature. Neurosurgical Review. 2008;31(1):19-32; discussion 32-33. https://doi.org/10.1007/s10143-007-0097-1
Cohadon F, Symon L, Calliauw L, Cohadon F, Lobo Antunes J, Loew F, Nornes H, Pásztor E, Pickard JD, Strong AJ, Yaşargil MG. Advances and technical standards in Neurosurgery. Vol. 26. Berlin: Springer Science & Business Media; 2012.
Benzel EC, Steinmetz MP. Benzel’s spine surgery techniques, complication avoidance, and management. Elsevier Health Sciences, 2017.
Ravindra VM, Schmidt MH. Management of Spinal Meningiomas. Neurosurgery Clinics of North America. 2016;27(2):195-205. https://doi.org/10.1016/j.nec.2015.11.010
Kandenwein JA, Richter HP, Antoniadis G. Foramen magnum meningiomas-experience with the posterior suboccipital approach. British Journal of Neurosurgery. 2009;23(1):33-39. https://doi.org/10.1080/02688690802545932
Wolinsky JP, Sciubba DM, Suk I, Gokaslan ZL. Endoscopic image-guided odontoidectomy for decompression of basilar invagination via a standard anterior cervical approach. Technical note. Journal of Neurosurgery: Spine. 2007;6(2):184-191. https://doi.org/10.3171/spi.2007.6.2.184
Passacantilli E, Santoro A, Pichierri A, Delfini R, Cantore G. Anterolateral approach to the craniocervical junction. Journal of Neurosurgery: Spine. 2005;3(2):123-128. https://doi.org/10.3171/spi.2005.3.2.0123
de Divitiis O, Conti A, Angileri FF, Cardali S, La Torre D, Tschabitscher M. Endoscopic transoral-transclival approach to the brainstem and surrounding cisternal space: anatomic study. Neurosurgery. 2004;54(1):125-30; discussion 130. https://doi.org/10.1227/01.neu.0000097271.55741.60
Choi D, Gleeson M. Surgery for chordomas of the craniocervical junction: lessons learned. Skull Base. 2010;20(1):41-45. https://doi.org/10.1055/s-0029-1242984
El Ahmadieh TY, Haider AS, Cohen-Gadol A. The Far-Lateral Suboccipital Approach to the Lesions of the Craniovertebral Junction. World Neurosurgery. 2021;155:218-228. https://doi.org/10.1016/j.wneu.2021.08.018
Refai D, Shin JH, Iannotti C, Benzel EC. Dorsal approaches to intradural extramedullary tumors of the craniovertebral junction. Journal of Craniovertebral Junction and Spine. 2010;1(1):49-54. https://doi.org/10.4103/0974-8237.65482
Alshafai NS, Klepinowski T. The Far Lateral Approach to the Craniovertebral Junction: An Update. Acta Neurochirurgica Supplement. 2019;125:159-164. https://doi.org/10.1007/978-3-319-62515-7_23
Canalis RF, Martin N, Black K, Ammirati M, Cheatham M, Bloch J, Becker DP. Lateral approach to tumors of the craniovertebral junction. Laryngoscope. 1993;103(3):343-349. https://doi.org/10.1288/00005537-199303000-00019
Shkarubo AN, Chernov IV, Andreev DN. Transoral Removal of Ventrally Located Meningiomas of the Craniovertebral Junction. World Neurosurgery. 2018:S1878-8750(18)32926-7.
Zozulya YP, Slynko YI, Al-Qashqish II. Surgical treatment of ventral and ventrolateral intradural extramedullary tumors of craniovertebral and upper cervical localization. Asian Journal of Neurosurgery. 2011;6(1):18-25.
Amelot A, Terrier LM, Lot G. Craniovertebral Junction Transoral Approach: Predictive Factors of Complications. World Neurosurgery. 2018;110:568-574.

Close metadata