Microscopic Minimal Invasive Resection of Spinal Tumor with Tubular Retractor System: Case Studies of 70 Patients with Literature Review

Abstract

Objective: Minimal invasive spine surgery with tubular retractor system avoids contralateral laminectomy, minimizes manipulation of midline supportive structures, and reduces surgical morbidity. The objective of this study was to evaluate the safety and efficacy of microscopic minimal invasive tubular retractor system for intradural spinal tumor resection.

Materials and methods: A retrospective study was performed in 70 patients who were admitted between January 2017 and January 2024 with intradural spinal tumors and underwent excision with microscopic minimal invasive tubular retractor system. Patient's data including age, sex, clinical symptoms, and magnetic resonance imaging were collected. The extent of resection, surgical complications, estimated blood loss, estimated surgical time, and neurological outcomes were recorded. The neurological assessment was done by the modified McCormick grading scale pre- and postoperatively.

Results: Out of 70 patients, there were 38 (54.28%) males and 32 (45.71%) females, with a mean age of 45.16 (range: 8-79) years. The histology of these cases was meningioma (34.28%), schwannoma (51.42%), astrocytoma (2.85%), ependymoma (2.85%), and neurofibroma (8.57%). The average volume of tumors was 1.98 cm ³ , and gross total resection was achieved in 64 (91.53%) cases and subtotal resection was achieved in 6 (8.57%) cases. One patient had neurological deterioration, which was improved on follow-up after 6 months, and cerebrospinal fluid (CSF) leakage was noted in one case, which recovered after keeping lumbar drain for 5 days. No permanent neurological deficits were observed compared with their preoperative status, with improvement noted in visual analog scale and modified McCormick grade in all cases in the long-term follow-up evaluation (6-24 months).

Conclusion: Microscopic minimal invasive resection of intradural spinal tumor by the tubular retractor system is safe and effective with excellent neurological improvement as well as better resection rate, short hospital stay, and less surgical complication.

Keywords: excision; intradural spinal tumor; minimal invasive; outcome; tubular retractor.

Fig. 1

( A ) A 2-cm skin incision 1.5 cm lateral to midline. ( B ) Serial insertion of dilators. ( C, D ) Insertion of nonexpandable tubular retractor and fixed table mounted arm. ( E, F ) Anteroposterior and lateral views of fluoroscopy after insertion of tubule. ( G ) Removing of remaining tissue from the lamina by electrocautery and drilling lamina. ( H ) Removing of the remaining the lamina and ligamentum flavum. ( I ) Dura incision with a no. 15 blade with a long-handled scalpel. ( J ) Removing of tumor. ( K ) Closure of the dura with fat overlay and fibrin sealant.

Fig. 2

( A, B ) Sagittal and axial views of preoperative magnetic resonance imaging with large schwannoma compressing the spinal cord toward the left side. ( C, D ) Sagittal and axial views of postoperative magnetic resonance imaging with right side hemilaminectomy with gross total resection of schwannoma.