1
|
Peng W, Zhuang Y, Cui W, Chen W, Chu R, Sun Z, Zhang S. Unilateral Biportal Endoscopy for the Resection of Thoracic Intradural Extramedullary Tumors: Technique Case Report and Literature Review. Int Med Case Rep J 2024; 17:301-309. [PMID: 38618188 PMCID: PMC11015842 DOI: 10.2147/imcrj.s444226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 03/28/2024] [Indexed: 04/16/2024] Open
Abstract
This study describes a patient with an intradural extramedullary (IDEM) tumor removed entirely using the unilateral biportal endoscopic technique (UBE), achieving satisfactory clinical outcomes. A 60-year-old woman had a diagnosis of meningioma with sensations and motor dysfunction in the lower extremities and perineum and gait disturbances for three years, which has worsened over the last month. Preoperative imaging data showed a sizeable IDEM tumor at the T10 level, significantly compressing the thoracic spinal cord to the right side, with 80% intraspinal encroachment. The IDEM tumor was removed entirely by UBE surgery. To the best of our knowledge, this study may be the first to report the application of UBE techniques for IDEM tumor treatment. In this case, UBE provides a magnified and clear surgical field, greater maneuverability, and a less invasive surgical procedure. The procedure objectives were pathological confirmation, spinal cord decompression, and complete tumor removal; all were met. The patient was satisfied with her dramatically improved clinical symptoms. UBE may be an alternative surgical treatment option for benign IDEM tumors presenting with symptomatic, especially the non-giant lateral and posterior tumors.
Collapse
Affiliation(s)
- Wei Peng
- Department of Spine Surgery, Wuxi Ninth People’s Hospital Affiliated to Soochow University, Wuxi, Jiangsu, People’s Republic of China
| | - Yin Zhuang
- Department of Spine Surgery, Wuxi Ninth People’s Hospital Affiliated to Soochow University, Wuxi, Jiangsu, People’s Republic of China
| | - Wei Cui
- Department of Spine Surgery, Wuxi Ninth People’s Hospital Affiliated to Soochow University, Wuxi, Jiangsu, People’s Republic of China
| | - Wenjin Chen
- Department of Spine Surgery, Wuxi Ninth People’s Hospital Affiliated to Soochow University, Wuxi, Jiangsu, People’s Republic of China
| | - Rupeng Chu
- Department of Spine Surgery, Wuxi Ninth People’s Hospital Affiliated to Soochow University, Wuxi, Jiangsu, People’s Republic of China
| | - Zhenzhong Sun
- Department of Spine Surgery, Wuxi Ninth People’s Hospital Affiliated to Soochow University, Wuxi, Jiangsu, People’s Republic of China
| | - Shujun Zhang
- Department of Spine Surgery, Wuxi Ninth People’s Hospital Affiliated to Soochow University, Wuxi, Jiangsu, People’s Republic of China
| |
Collapse
|
2
|
Şentürk S, Ünsal ÜÜ. Percutaneous endoscopic translaminar approach in a patient with pedicle screw malposition and cement leakage. Br J Neurosurg 2023; 37:1157-1159. [PMID: 33463378 DOI: 10.1080/02688697.2020.1861435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 12/04/2020] [Indexed: 10/22/2022]
Abstract
We present a 79-year-old female patient who had L2-5 dynamic stabilization with cement (Polymethylmethacrylate) injection 6 weeks prior. Due to post-operative right radicular pain, a lumbar CT was scheduled in which a malposition of the right L4 screw and cement leakage was observed. Via a percutaneous translaminar endoscopic approach the leaked cement was removed and the portion of the screw in contact with the nerve root was drilled. With this minimal-invasive procedure, the patient was relieved of her radicular pain.
Collapse
Affiliation(s)
- Salim Şentürk
- Department of Neurosurgery, Koç University Hospital, Istanbul, Turkey
| | - Ülkün Ünlü Ünsal
- Department of Neurosurgery, Koç University Hospital, Istanbul, Turkey
| |
Collapse
|
3
|
Lokhande PV. Full endoscopic spine surgery. J Orthop 2023; 40:74-82. [PMID: 37197373 PMCID: PMC10183645 DOI: 10.1016/j.jor.2023.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 04/08/2023] [Accepted: 04/17/2023] [Indexed: 05/19/2023] Open
Abstract
Background With a dramatic increase in elderly population worldwide, the prevalence of degenerative spine disease is steadily rising. Even though the entire spinal column is affected the problem is more commonly seen in the lumbar, cervical spine and to some extent the thoracic spine. The treatment of symptomatic lumbar disc or stenosis is primarily conservative with analgesics, epidural steroids and physiotherapy. Surgery is advised only if conservative treatment is ineffective. Conventional open microscopic procedures even though are still a gold standard, have the disadvantages of excessive muscle damage and bone resection, epidural scarring along with prolonged hospital stay and increased need of postoperative analgesics. Minimal access spine surgeries minimize surgical access related injury by minimizing soft tissue and muscle damage and also bony resection thus preventing iatrogenic instability and unnecessary fusions. This leads to good functional preservation of the spine and enhances early postoperative recovery and early return to work. Full endoscopic spine surgeries are one of the more sophisticated and advanced form of MIS surgeries. Purpose Full endoscopy has definitive benefits over conventional microsurgical techniques. These include better and clear vision of the pathology due to presence of irrigation fluid channel, minimal soft tissue and bone trauma, better and relatively easy approach to deep seated pathologies like thoracic disc herniations and a possibility to avoid fusion surgeries. The purpose of this article is to describe these benefits, give an overview of the two main approaches - transforaminal and interlaminar, their indications, contraindications and their limitations. The article also describes about the challenges in overcoming the learning curve and its future prospectives. Conclusion Full endoscopic spine surgery is one of the fastest growing technique in the field of modern spine surgery. Better intraoperative visualization of the pathology, lesser incidence of complications, faster recovery time, less postoperative pain, better relief of symptoms and early return to activity are the main reasons behind this rapid growth. With better patient outcomes and reduced medical costs, the procedure is going to be more accepted, relevant and popular procedure in future.
Collapse
|
4
|
Hung WP, Kavishwar RA, Natalie THW, Tan G. Unilateral biportal endoscopic supralaminar, posterior spinous process sparing approach for en bloc cervical laminectomy in case of cervical osteochondroma causing myelopathy: A case report. NORTH AMERICAN SPINE SOCIETY JOURNAL 2023; 14:100225. [PMID: 37440987 PMCID: PMC10333713 DOI: 10.1016/j.xnsj.2023.100225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 04/22/2023] [Accepted: 04/22/2023] [Indexed: 07/15/2023]
Abstract
Background Context Cervical osteochondroma is a rare cause of myelopathy. Traditional treatment is open laminectomy with or without fusion. There is limited literature on unilateral bi-portal endoscopic en-bloc resection of cervical osteochondroma. Study Design We describe a case of a 39-year-old male diagnosed with cervical compressive myelopathy. The pathologic site is located on the ventral surface of C4 lamina. Herein we describe a step-by-step method of unilateral biportal endoscopy (UBE) en-bloc resection of extra-dural sublaminar osteochondroma for patient who had cervical myeloradiculopathy. Spinous process sparing osteotomy was performed to conserve the spinous process and supraspinous ligament.. Outcome Measures The patient was successfully treated via UBE and the operative time was 50 minutes with no intra-operative complications. Patient symptoms improved in the immediate postoperative period and by 3 months he regained fine motor functions of hand. Conclusions Unilateral biportal endoscopic en bloc cervical laminectomy can effectively decompress cervical spine and remove posterior benign cervical tumor. UBE preserves musculature and posterior ligamentous complex and thus reduces postoperative neck pain and postlaminectomy kyphosis.
Collapse
Affiliation(s)
- Wu Pang Hung
- Division Of Spine Sugery, Orthopaedic Surgery, Jurong Health Campus, National University Health System, 1 Jurong East St 21, 609606, Singapore
| | - Rohit Akshay Kavishwar
- Spine Division, Orthopaedic Surgery, Jurong Health Campus, National University Health System, 1 Jurong East St 21, 609606, Singapore
| | - Tan Hui Wen Natalie
- Orthopaedic Surgery, Jurong Health Campus, National University Health System, 1 Jurong East St 21, 609606, Singapore
| | - Gamaliel Tan
- Spine Division, Orthopaedic Surgery, Jurong Health Campus, National University Health System, 1 Jurong East St 21, 609606, Singapore
| |
Collapse
|
5
|
Chen KT, Kim JS, Huang APH, Lin MHC, Chen CM. Current Indications for Spinal Endoscopic Surgery and Potential for Future Expansion. Neurospine 2023; 20:33-42. [PMID: 37016852 PMCID: PMC10080449 DOI: 10.14245/ns.2346190.095] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 02/15/2023] [Indexed: 04/03/2023] Open
Abstract
Endoscopic spine surgery (ESS) has evolved as a safe, effective, and efficient alternative for minimally invasive spine surgery (MISS). The innovation of full-endoscopic systems makes definitive decompression surgery through different approaches feasible. The approach can be determined according to the location of the target lesion or the surgeon's preference. During the past 2 decades, ESS has expanded its indications from lumbar to cervical spines. Except for decompression, endoscopy-assisted fusion surgery is also developing. However, ESS is still evolving and has a steep learning curve. The revolution of technologies and ESS techniques will enable surgeons to treat various spinal diseases more practically. In recent years, the application of the computer-assisted navigation system and augmented reality have reformed imaging quality and interpretation. The endoscopic rhizotomy techniques have opened a new way for MISS of chronic low back pain. This review introduces the current indications of ESS and its potential future expansion.
Collapse
Affiliation(s)
- Kuo-Tai Chen
- Department of Neurosurgery, Chang Gung Memorial Hospital Chiayi, Chiayi, Taiwan
| | - Jin-Sung Kim
- Department of Neurosurgery, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - Abel Po-Hao Huang
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Martin Hsiu-Chu Lin
- Department of Neurosurgery, Chang Gung Memorial Hospital Chiayi, Chiayi, Taiwan
| | - Chien-Min Chen
- Department of Leisure Industry Management, National Chin-Yi University of Technology, Taichung, Taiwan
- Division of Neurosurgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan
- Corresponding Author Chien-Min Chen Division of Neurosurgery, Department of Surgery, Changhua Christian Hospital, No. 135 Nanxiao St., Changhua City, Changhua County 500, Taiwan
| |
Collapse
|
6
|
Dolas I, Yorukoglu AG, Sencer A, Unal TC, Gulsever CI, Aydoseli A, Aras Y, Sabanci PA, Ruetten S. Full-endoscopic technique for posterior fossa decompression in Chiari malformation type I: An anatomical feasibility study in human cadavers. Clin Anat 2023; 36:660-668. [PMID: 36786563 DOI: 10.1002/ca.24024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 01/30/2023] [Accepted: 02/10/2023] [Indexed: 02/15/2023]
Abstract
Although endoscope-assisted techniques have been described, a full-endoscopic approach is yet to be performed for posterior fossa decompression (PFD) in Chiari malformation type I (CM-I). This study aims to describe the full-endoscopic PFD technique and evaluate its feasibility. Five fresh-frozen anonymized adult human cadavers were operated on using an endoscope with an oval shaft cross-section with a diameter of 9.3 mm, a working length of 177 mm, and a viewing angle of 20°. It also had an eccentric working channel with a diameter of 5.6 mm, a light guide, a sheath for continuous irrigation, and a rod lens system. The instruments were introduced from the working channel. Posterior craniocervical structures were dissected, and PFD was achieved. The planned steps were performed in all five cadavers. The endoscope was introduced to the posterior craniocervical region, dissecting the structures to easily expose the suboccipital bone and C1 posterior arch. Important structures, such as the C1 posterior tubercle, rectus capitis posterior minor muscles, and posterior atlantooccipital membrane, were used as landmarks. PFD was feasible even with the dural opening. Using the full-endoscopic approach, posterior craniocervical structures can be reached, and PFD can be performed successfully. The instruments used are well-defined for spinal usage; thus, this full-endoscopic technique can be widely used in the surgical treatment of patients with CM-I.
Collapse
Affiliation(s)
- I Dolas
- Department of Neurosurgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - A G Yorukoglu
- Department of Neurosurgery, Istanbul Scoliosis and Spine Center, Florence Nightingale Hospital, Istanbul, Turkey
| | - A Sencer
- Department of Neurosurgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Tugrul Cem Unal
- Department of Neurosurgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - C I Gulsever
- Department of Neurosurgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - A Aydoseli
- Department of Neurosurgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Y Aras
- Department of Neurosurgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - P A Sabanci
- Department of Neurosurgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - S Ruetten
- Center for Spine Surgery and Pain Therapy, Center for Orthopedics and Traumatology of the St. Elisabeth Group-Catholic Hospitals Rhein-Ruhr, St. Anna Hospital Herne/Marien Hospital Herne University Hospital/Marien Hospital Witten, Herne, Germany
| |
Collapse
|
7
|
Hu XB, Gu C, Chen AQ, Ying GY, Shen F, Zhu YJ. Percutaneous Full Endoscopic Management of Spinal Foraminal Schwannomas: Case Series. Oper Neurosurg (Hagerstown) 2023; 24:483-491. [PMID: 36735518 DOI: 10.1227/ons.0000000000000570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 10/06/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Schwannoma, a benign peripheral nerve sheath tumor, is perhaps only secondary to degenerative pathology as the most common lesion at neural foramen. The surgical dilemma here is either risking nerve injury because of inadequate exposure or the need for internal fixation because of facet joint sacrifice. OBJECTIVE To evaluate the feasibility and safety of management of foraminal schwannomas by percutaneous full-endoscopic technique. METHODS A single-center retrospective review was conducted on patients who underwent full-endoscopic resection of neural foraminal schwannomas. Tumors were grouped into either medial type or lateral type based on relevant location to the neural foramen, and respective surgical approaches were adopted. Data including preoperative neurological status, tumor size, surgery time, the extension of resection, and clinical outcomes were collected. The learning curve was plotted as surgical time/tumor size against case number. RESULTS A total of 25 patients were treated between May 2015 and March 2022. Gross total resection was achieved in 24 patients, and near-total resection in 1 case, with 1 patient experienced transient voiding difficulty. No tumor recurrence or spinal instability was detected in the short-term follow-up (median follow-up 22 months, range 3 months-6 years). Surgical efficiency improved with the number of cases operated on and remained stable after the initial 10 cases. CONCLUSION Percutaneous full-endoscopic technique is a safe and minimally invasive technique for the resection of foraminal schwannomas.
Collapse
Affiliation(s)
- Xin-Ben Hu
- Department of Neurosurgery, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Chi Gu
- Department of Neurosurgery, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Ai-Qin Chen
- Department of Neurosurgery, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Guang-Yu Ying
- Department of Neurosurgery, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Fang Shen
- Department of Surgery, Box Hill Hospital, Eastern Health, Box Hill, Australia
| | - Yong-Jian Zhu
- Department of Neurosurgery, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| |
Collapse
|
8
|
Kravtsov MN, Manukovsky VA, Mirzametov SD, Malysheva OV, Averyanov DA, Svistov DV. Percutaneous Transforaminal Full-Endoscopic Removal of Neurinoma of the Fifth Lumbar Nerve Root With Intraoperative Neuromonitoring: A Case Report. Front Surg 2022; 9:877974. [PMID: 35574561 PMCID: PMC9098990 DOI: 10.3389/fsurg.2022.877974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 03/29/2022] [Indexed: 11/29/2022] Open
Abstract
Background Technical achievements and surgical techniques improvement contribute to the expansion of the endoscopic spine surgery possibilities. However, today there are few reports about the use of percutaneous endoscopy in spinal tumor surgery. A case of percutaneous transforaminal endoscopic removal of the lumbar spinal nerve tumor with intraoperative neuromonitoring is presented. Case Description A 59-year-old female was complaining of a left shin and foot pain, weakness, and paresthesia. Preoperative magnetic resonance imaging (MRI) revealed a tumor (neurinoma) at the left L5-S1 intervertebral foramen. Transforaminal endoscopic removal of an extramedullary tumor from an 8-mm skin incision with intraoperative neuromonitoring was performed. Postoperative MRI revealed the signs of total resection of the tumor. Conclusion The presented case confirms that percutaneous endoscopic removal of lumbar spine intraforaminal neurinomas can be safe and effective.
Collapse
Affiliation(s)
- Maxim N. Kravtsov
- Kirov Military Medical Academy, St. Petersburg, Russia
- Saint-Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine, St. Petersburg, Russia
- North-Western State Medical University Named After I.I. Mechnikov, St. Petersburg, Russia
- *Correspondence: Maxim N. Kravtsov
| | - Vadim A. Manukovsky
- Saint-Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine, St. Petersburg, Russia
- North-Western State Medical University Named After I.I. Mechnikov, St. Petersburg, Russia
| | | | | | | | | |
Collapse
|
9
|
Sofoluke N, Barber SM, Telfeian AE, Hofstetter CP, Konakondla S. The role of the endoscope in spinal oncology: a systematic review of applications and systematic analysis of patient outcomes. World Neurosurg 2022; 164:33-40. [DOI: 10.1016/j.wneu.2022.04.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 04/17/2022] [Accepted: 04/18/2022] [Indexed: 11/30/2022]
|
10
|
Zeng W, Jiang H, He S, Zhang Y, Yu B, Wang H, Wang C. Comparison of Neuroendoscopic and Microscopic Surgery for Unilateral Hemilaminectomy: Experience of a Single Institution. Front Surg 2022; 9:823770. [PMID: 35425804 PMCID: PMC9002179 DOI: 10.3389/fsurg.2022.823770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 03/04/2022] [Indexed: 12/12/2022] Open
Abstract
Objective This study was designed to compare the safety and efficacy of unilateral hemilaminectomy conducted under complete neuroendoscopic visualization (UHNV) relative to unilateral hemilaminectomy under total microscopic visualization (UHMV) for the treatment of patients diagnosed with intraspinal tumors. Methods In total, 41 patients undergoing intraspinal tumor resection at Northern Jiangsu People's Hospital were included in this study, including 20 and 21 patients in the UHNV and UHMV groups, respectively. Intraoperative parameters including incision length, operative duration, number of vertebral laminae removed and intraoperative blood loss, as well as indicators of curative efficacy such as total tumor resection rates and postoperative symptom improvement rates, and safety indicators including complication rates, recurrence rates, spinal deformity rates, spinal instability incidence, and length of stay (LOS), were compared between the two groups. Results In contrast to the UHMV group, patients in the UHNV group had a significantly shorter incision length and decreased intraoperative blood loss (P < 0.05), while the operative duration (P > 0.05) showed no statistical difference. Although the postoperative improvement and total tumor resection rates were enhanced, the difference was not statistically significant (P > 0.05). In comparison, the bedridden time and length of stay (LOS) were significantly shortened (P < 0.05) in the UHNV group. However, there were no significant differences in recurrence, incidence of complications, spinal deformity, and spinal instability (P > 0.05). Conclusion Collectively, our findings indicate that UHNV is not inferior to the UHMV approach. Moreover, due to its safe and minimally invasive nature, UHNV represents a promising alternative to UHMV as a treatment for patients with intradural extramedullary tumors.
Collapse
Affiliation(s)
- Wei Zeng
- Department of Clinical Medicine, School of Medicine, Yangzhou University, Yangzhou, China
| | - Haixiao Jiang
- Department of Clinical Medicine, School of Medicine, Yangzhou University, Yangzhou, China
| | - Shiwei He
- Department of Clinical Medicine, Dalian Medical University, Dalian, China
| | - Yukun Zhang
- Department of Clinical Medicine, Dalian Medical University, Dalian, China
| | - Bo Yu
- Department of Neurosurgery, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Hui Wang
- Department of Neurosurgery, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Cunzu Wang
- Department of Neurosurgery, Clinical Medical College of Yangzhou University, Yangzhou, China
- *Correspondence: Cunzu Wang
| |
Collapse
|
11
|
Kravtsov MN, Manukovsky VA, Bulyshchenko GG, Mirzametov SD, Byvaltsev VA. Case Report: Full-Endoscopic Surgery for Bullet Wounds of the Spine: A Report of Three Cases. Front Surg 2022; 9:873365. [PMID: 35402482 PMCID: PMC8990913 DOI: 10.3389/fsurg.2022.873365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 02/28/2022] [Indexed: 11/17/2022] Open
Abstract
Objectives To determine the feasibility and evaluate effectiveness of full-endoscopic surgery in gunshot wound of the spine. Methods Three clinical cases of lumbar and thoracic spine bullet wounds made by firearms and traumatic weapons are described. Percutaneous endoscopic surgery was performed to extract bullet from the spinal canal. The results are compared to the data from literature. Results Percutaneous endoscopic approach to spinal canal with a possibility to extract a bullet, decompression of nerve roots, defect closure of the dura mater is demonstrated. Conclusion Good clinical outcomes allows to recommend percutaneous endoscopic surgery to manage similar lumbar and thoracic spine bullet wounds at the tertiary care level.
Collapse
Affiliation(s)
- Maxim N. Kravtsov
- Department of Neurosurgery, S.M. Kirov Military Medical Academy, St. Petersburg, Russia
- Saint-Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine, St. Petersburg, Russia
- Department of Neurosurgery, North-Western State University n.a. I.I. Mechnikov, St. Petersburg, Russia
- *Correspondence: Maxim N. Kravtsov
| | - Vadim A. Manukovsky
- Saint-Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine, St. Petersburg, Russia
- Department of Neurosurgery, North-Western State University n.a. I.I. Mechnikov, St. Petersburg, Russia
| | | | | | - Vadim A. Byvaltsev
- Department of Neurosurgery, Irkutsk State Medical University, Irkutsk, Russia
- Department of Neurosurgery, Railway Clinical Hospital, Irkutsk, Russia
| |
Collapse
|
12
|
Khandge AV, Kim JS. Modified Interlaminar Endoscopic Lumbar Discectomy for Highly Upmigrated Disc Herniation: A Proctorship Description of the Technique via Translaminar Route. Neurospine 2020; 17:S66-S73. [PMID: 32746519 PMCID: PMC7410377 DOI: 10.14245/ns.2040264.132] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 06/09/2020] [Indexed: 12/12/2022] Open
Abstract
Lumbar disc herniation (LDH) comprises one of the most common causes of low back pain. 35%–72% of LDH is associated with disc fragment migration. The migration of the disc fragments can be high-grade up, low-grade up, high-grade down, and low-grade down. Spine surgeons deal with unique challenges during surgical management of migrated discs. Operational challenges with open surgery include extensive lamina excision, pars excision, and potential for iatrogenic instability without fixation. In contrast, rigid instruments and poor visualization are the challenges with transforaminal endoscopic spine surgery (ESS). Hence interlaminar approach with ESS is an excellent choice with these migrated LDH. The creation of a translaminar crater in the cranial lamina without dealing with the interlaminar window or ligamentum flavum could be an excellent option to deal with these herniations face front. The lamina is the only anatomical barrier between the endoscope and the migrated disc fragment. Hence with a translaminar approach, unnecessary flavectomy can be avoided. In this technical report and video, we demonstrate the surgical technique of performing the translaminar ESS for highly upmigrated LDH with the preservation of optimal natural anatomy.
Collapse
Affiliation(s)
| | - Jin-Sung Kim
- Department of Neurosurgery, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Korea
| |
Collapse
|
13
|
Konakondla S, Sofoluke N, Xia J, Grant R, Telfeian AE, Hofstetter CP, Slotkin JR. Transforaminal Endoscopic Approach for Large-Sample Tumor Biopsy using Beveled Working Channel for Core Technique: A Technical Note. World Neurosurg 2020; 141:346-351. [PMID: 32442734 DOI: 10.1016/j.wneu.2020.05.096] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 05/11/2020] [Indexed: 01/02/2023]
Abstract
BACKGROUND Identifying the histopathological diagnosis of a spinal tumor is the necessary step prior to pursuing subsequent treatment. Both minimally invasive and open spinal procedures have been described as useful methods of obtaining tumor tissue for diagnosis but differ by their limitations. Minimally invasive techniques, such as computed tomography-guided biopsies, can expose the patient to radiation, and the tissue obtained may be nondiagnostic. Tubular and open procedures require collateral soft-tissue damage and may require bony removal leading to iatrogenic injury. Endoscopic approaches to the spine can be employed to avoid treatment delay in diagnosis, decrease length of stay, and provide adequate tissue for diagnosis. METHODS We describe the surgical planning, tumor localization, and transforaminal endoscopic approach for tissue diagnosis of a lumbar spinal mass in a patient with a known history of Hodgkin lymphoma and non-Hodgkin lymphoma after a nondiagnostic computed tomography- guided biopsy. Final histopathological diagnosis of the lumbar spinal mass was consistent with large B-cell non-Hodgkin lymphoma. CONCLUSIONS We demonstrate the application of an endoscopic transforaminal approach in spine oncology. We also describe our technique on how we use a beveled working channel to obtain a large tissue core sample for definitive diagnosis.
Collapse
Affiliation(s)
- Sanjay Konakondla
- Department of Neurosurgery, Geisinger Neuroscience Institute, Geisinger Health System, Danville, Pennsylvania, USA.
| | - Nelson Sofoluke
- Department of Neurosurgery, Geisinger Neuroscience Institute, Geisinger Health System, Danville, Pennsylvania, USA
| | - Jimmy Xia
- Weill Cornell Medical College, New York, New York, USA
| | - Ryan Grant
- Department of Neurosurgery, Geisinger Neuroscience Institute, Geisinger Health System, Danville, Pennsylvania, USA
| | - Albert E Telfeian
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Christoph P Hofstetter
- Department of Neurological Surgery, The University of Washington, Seattle, Washington, USA
| | - Jonathan R Slotkin
- Department of Neurosurgery, Geisinger Neuroscience Institute, Geisinger Health System, Danville, Pennsylvania, USA
| |
Collapse
|