Unilateral Laminectomy Approach for the Removal of Spinal Meningiomas and Schwannomas: Impact on Pain, Spinal Stability, and Neurologic Results

• Published in: World neurosurgery 2016, Vol.85, p.282-291
• Main Authors: Pompili, Alfredo, Caroli, Fabrizio, Crispo, Francesco, Giovannetti, Maddalena, Raus, Laura, Vidiri, Antonello, Telera, Stefano
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Angiography; Diffusion Magnetic Resonance Imaging; Female; Follow-Up Studies; Hemilaminectomy; Humans; Image Interpretation, Computer-Assisted; Laminectomy - methods; Magnetic Resonance Imaging; Male; Meningeal Neoplasms - diagnosis; Meningeal Neoplasms - surgery; Meningioma - diagnosis; Meningioma - surgery; Minimally invasive neurosurgery; Neurilemmoma - diagnosis; Neurilemmoma - surgery; Neurologic Examination; Neurosurgery; Pain; Pain Measurement; Postoperative Complications - diagnosis; Spinal meningioma; Spinal Neoplasms - diagnosis; Spinal Neoplasms - surgery; Spinal schwannoma; Spinal surgery; Young Adult
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2015.09.099

Background Spinal intradural tumors are usually removed with laminectomy/laminotomy with a midline dural incision. Pain, discomfort, postoperative kyphosis, and instability may be minimized with unilateral microsurgery. Methods Seventy patients with schwannoma (73 tumors) and 27 patients with meningioma (29 tumors) were operated on with unilateral hemilaminectomy (June 2000 to March 2014). Surgery was generally kept to 1 or 2 levels, removing all the craniocaudal ligamentum flavum. Careful radioscopic identification is mandatory; in thoracolumbar schwannomas, the tumor may be mobile; in the prone position, it may move cranially than appears on magnetic resonance imaging. The dura was opened paramedially, and the tumor was dissected and removed either en bloc or piecemeal after ultrasonic debulking. Neurophysiologic monitoring was performed. The tumor was approached tangentially with no cord rotation or minimal manipulation. Average duration of surgery was 160 minutes (100–320 minutes). Removal was total in 72 of 73 schwannomas; Simpson grade was 1 in 10 meningiomas and 2 in 19. Results Patients with no complications were discharged on day 5–7. Ten patients had orthostatic headaches; 2 had pseudomeningocele that required reoperation. Pain improvement (Dennis Scale) was significant either at discharge or at follow-up ( P < 0.0001 schwannomas, P