MINIMALLY INVASIVE UNILATERAL HEMILAMINECTOMY APPROACH FOR THE REMOVAL OF SPINAL SCHWANNOMAS IMPACT ON PAIN AND NEUROLOGICAL RESULTS
Journal of Turkish Spinal Surgery, cilt.35, sa.1, ss.6-12, 2024 (Scopus, TRDizin)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 35 Sayı: 1
- Basım Tarihi: 2024
- Doi Numarası: 10.4274/jtss.galenos.2023.27247
- Dergi Adı: Journal of Turkish Spinal Surgery
- Derginin Tarandığı İndeksler: Scopus, TR DİZİN (ULAKBİM)
- Sayfa Sayıları: ss.6-12
- Anahtar Kelimeler: hemilaminectomy, minimally invasive neurosurgery, pain, spinal schwannoma, Spinal surgery
- Gazi Üniversitesi Adresli: Hayır
Özet
Objective: Spinal intradural tumors are commonly removed using laminectomy or laminotomy; however, these approaches can lead to postoperative pain, discomfort, kyphosis, and instability. Unilateral hemilaminectomy (UHL) is a minimally invasive alternative that may minimize these issues by using a smaller incision and less disruption to spinal structures. Materials and Methods: From 2010 to 2021, 79 patients with schwannoma underwent UHL surgery. Surgery was generally limited to three levels, and the tumor was removed en bloc or piecemeal after ultrasonic debulking. Paramedial opening of the dura was performed, and neurophysiological monitoring was performed. Baseline medical data on demographic and clinical variables were analyzed, including patients’ sex, age, tumor location and volume, overall operative time, length of postoperative immobilization, duration of hospitalization, preoperative (1-month/3-month postoperative Denis Pain Scale value), comorbidities, and modified McCormick Scale. Results: Of these patients, 35 were female and 44 were male, with ages ranging from 19 to 72 years (mean 48.9±14.6). Pain and radiculopathy were the first symptoms in 56 (70.8%) and 36 (45.5%) patients, respectively. No spinal instability was observed postoperatively, and the mean estimated blood loss was 285 mL, ranging from 245-420 mL. The maximal sagittal diameter of the tumor was measured on contrast-enhanced T1-weighted images, with a mean of 26.0±12.4 mm (range, 8.2-36.2 mm). Conclusion: Unilateral microsurgery for spinal intradural tumor removal has resulted in good neurologic and oncologic outcomes and reduced postoperative pain and discomfort. In addition, this approach has preserved spinal stability, eliminating the need for bracing, and enabling earlier rehabilitation.