J Korean Neurosurg Soc.  2012 Oct;52(4):427-431. 10.3340/jkns.2012.52.4.427.

Minimally Invasive Removal of an Intradural Cervical Tumor : Assessment of a Combined Split-Spinous Laminectomy and Quadrant Tube Retractor System Technique

• Kwak YS
• Kim KT
• Cho DC
• Kim YB

• KMID: 2190667
• DOI: http://doi.org/10.3340/jkns.2012.52.4.427

Abstract

Conventional laminectomy is the most popular technique for the complete removal of intradural spinal tumors. In particular, the central portion intramedullary tumor and large intradural extramedullary tumor often require a total laminectomy for the midline myelotomy, sufficient decompression, and adequate visualization. However, this technique has the disadvantages of a wide incision, extensive periosteal muscle dissection, and bony structural injury. Recently, split-spinous laminectomy and tubular retractor systems were found to decrease postoperative muscle injuries, skin incision size and discomfort. The combined technique of split-spinous laminectomy, using a quadrant tube retractor system allows for an excellent exposure of the tumor with minimal trauma of the surrounding tissue. We propose that this technique offers possible advantages over the traditional open tumor removal of the intradural spinal cord tumors, which covers one or two cervical levels and requires a total laminectomy.

Keyword

Cervical cord tumor; Split-spinous laminectomy; Quadrant tube retractor

MeSH Terms

Decompression
Laminectomy
Muscles
Skin
Spinal Cord Neoplasms

Figure

• 

  Fig. 1 Schematic drawing of the combined split-spinous laminectomy and quadrant tube retractor system technique. A : Split-spinous process and spinous process divided at its base, preserving the paraspinalis muscles attachments. B : Quadrant tube retractors are placed on the exposed lamina with a slight opening. C : Quadrant tube retractors are wide enough for total laminectomy. The black region is required for a total laminectomy. D : Operator's view of C. E : Each half of the split-spinous process is re-approximated after successful tumor removal.

• 

  Fig. 2 Preoperative and two-year postoperative T2-weighted axial MR images. The dotted lines outline the deep extensor muscles margins. A : Combined split-spinous laminectomy and quadrant tube retractor system technique, with a muscle atrophy rate of 13% (A1 : preoperative MRI, A2 : postoperative MRI). B : Conventional total laminectomy technique, with a muscle atrophy rate of 54% (B1 : preoperative MRI, B2 : postoperative MRI).

• 

  Fig. 3 Central cavernous hemangioma. A : Preoperative T2-weighted sagittal MRI showing a centrally located intramedullary tumor. B : Intraoperative image showing meticulous dural closure in quadrant tube retractors. C : This figure showing a skin closure after removing of retractors. D : Two-year postoperative T2-weighted sagittal MRI showing no evidence of tumor recurrence. E : Postoperative one-month CT showing focal fluid collection (black arrow) and deviatory split spinous process (white arrow). F : Two-year postoperative CT showing resolved fluid collection and proper location of the spinous process with complete bony fusion.

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