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Minimally Invasive Resection of a High-Thoracic Intradural Extramedullary Tumor


Surgical treatment of thoracic spinal cord tumors can be challenging due to the risk of neurologic compromise as well as the potential for approach-related morbidity. Anterior approaches may require a thoracotomy, and are associated with significant post-operative pain and potential injury to the pleura or thoracic vasculature. Posterior approaches are limited by the midline thoracic spinal cord, which is intolerant of manipulation for resection of ventral tumors. In addition, the traditional “open” posterolateral approaches may require extensive soft-tissue and bony exposure for surgical access, leading to significant post-operative pain and potential spinal instability. Recently, the modernization of minimally invasive spine (MIS) techniques has enabled spine surgeons to treat a vast array of spinal disorders through minimal access approaches. MIS approaches may lead to decreased blood loss, improved post-operative pain scores, shorter hospital stays, and preservation of normal anatomic supporting structures.

We present 3-D operative video from a case that demonstrates the benefits of MIS approaches in spinal tumor resection: A healthy 56-year-old female who presented with several months of mid-thoracic radicular pain, progressive gait difficulty, and clinical signs of myelopathy. She was diagnosed with a large, T4 intradural-extramedullary ventral mass with spinal cord compression, most consistent with a meningioma. She underwent elective resection of this mass through an MIS approach. The procedure was uncomplicated, and the post-operative MRI demonstrated gross-total resection of the lesion. The patient did well post-operatively and was discharged home on post-operative day 2.

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“The AANS/CNS Spine Section brings together neurosurgeons, orthopedic spine surgeons, spine surgery fellows, as well as residents and advanced practice providers focused on spinal surgery. The Spine Section advances our interests, represents us in national advocacy, and disseminates science. Becoming a member means joining this exceptional community and helping it grow.” ...Read More >