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En-bloc resection of thoracic calcified meningioma with inner dural layer in recapping T-saw laminoplasty: a case report.

Miyakoshi N, Hongo M, Kasukawa Y, Shimada Y - BMC Surg (2015)

Bottom Line: Postoperatively, the patient achieved complete recovery of neurological functions.Bone union after laminoplasty was obtained within 6 months.Recapping T-saw laminoplasty provides extensive exposure for tumor removal.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan. miyakosh@doc.med.akita-u.ac.jp.

ABSTRACT

Background: In the treatment of spinal cord tumors, complete tumor resection with complete reconstruction of the spine represents the ideal goal. However, for the treatment of heavily calcified spinal meningioma, en-bloc resection of the tumor together with the involved dura at the tumor base through laminectomy is quite difficult. Conventional laminectomy is not wide enough to allow full exposure of such tumors, and postoperative dural defects can cause serious complications.

Case presentation: A 58-year-old Japanese woman presented with a 3-month history of progressive muscle weakness and numbness of the lower extremities. Magnetic resonance imaging (MRI) and computed tomography showed a calcified spinal cord tumor with dural tail sign at the T10-T11 level, severely compressing the spinal cord anterolaterally. The patient underwent en-bloc resection of the tumor with the inner layer of the dura and preservation of the outer layer of the dura through recapping T-saw laminoplasty of T10-T11, including bilateral facet joints. The tumor was histologically diagnosed as meningioma. Postoperatively, the patient achieved complete recovery of neurological functions. Bone union after laminoplasty was obtained within 6 months. Follow-up MRI at 5 years postoperatively demonstrated no recurrence of the tumor.

Conclusion: Resection of spinal meningioma with only the inner layer of dura can minimize postoperative complications, including spinal fluid leakage. Recapping T-saw laminoplasty provides extensive exposure for tumor removal. The combination of these techniques may offer an ideal surgical option for complete resection of spinal meningioma with complete preservation of the posterior spinal elements.

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Related in: MedlinePlus

Intraoperative photographs. a Dura was widely exposed after en-bloc excision of the posterior elements of T10-T11, including bilateral T10-T11 facet joints, by cutting the pars interarticularis of the lamina of T10 and pedicles to the transverse processes of T11 using a T-saw. b After opening the outer layer of dura, the inner layer of dura (asterisk) surrounding the tumor was cut and the tumor was lifted up. c The tumor was resected en bloc with the inner layer of dura. d The outer layer of dura was closed with titanium clips. e Following complete resection of the tumor and repair of the outer layer of dura, the excised posterior elements were recapped exactly to their anatomical sites and sutured
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Fig2: Intraoperative photographs. a Dura was widely exposed after en-bloc excision of the posterior elements of T10-T11, including bilateral T10-T11 facet joints, by cutting the pars interarticularis of the lamina of T10 and pedicles to the transverse processes of T11 using a T-saw. b After opening the outer layer of dura, the inner layer of dura (asterisk) surrounding the tumor was cut and the tumor was lifted up. c The tumor was resected en bloc with the inner layer of dura. d The outer layer of dura was closed with titanium clips. e Following complete resection of the tumor and repair of the outer layer of dura, the excised posterior elements were recapped exactly to their anatomical sites and sutured

Mentions: Surgery was performed under transcranial electrical stimulation of motor evoked potentials for spinal cord monitoring. The spinous process of the above vertebra (T9) was split longitudinally and divided at its base from the lamina with bilateral paravertebral muscles attached to the split spinous process. The T10-T11 posterior arches lateral to bilateral transverse processes were then exposed. Bilateral pars interarticularis of the lamina of T10 and bilateral pedicles to the transverse processes of T11 were cut using a T-saw (Koshiya, Kanazawa, Japan). Posterior elements of T10-T11, including bilateral T10-T11 facet joints, were excised en bloc and the posterior and lateral surfaces of the dura were widely exposed (Fig. 2a). After exposing the dura, an incision was made only within the outer layer of the dura under microscopy, and the outer layer was then stripped away from the inner layer [1]. After retracting the outer layers bilaterally, an incision was made in the inner layer and continued around the tumor base [1]. The hard calcified tumor was then resected en bloc with the inner layer of dura (Fig. 2b, c). The outer layer of dura was closed with titanium clips (Fig. 2d). The excised T10-T11 laminae were then recapped exactly to the anatomical sites and the corresponding cut surfaces were bound by sutures (Fig. 2e). The split T9 spinous process was reapproximated and the paravertebral muscles were closed. Histopathological study of the tumor was consistent with calcified meningioma. This surgery was conducted in accordance with the Declaration of Helsinki.Fig. 2


En-bloc resection of thoracic calcified meningioma with inner dural layer in recapping T-saw laminoplasty: a case report.

Miyakoshi N, Hongo M, Kasukawa Y, Shimada Y - BMC Surg (2015)

Intraoperative photographs. a Dura was widely exposed after en-bloc excision of the posterior elements of T10-T11, including bilateral T10-T11 facet joints, by cutting the pars interarticularis of the lamina of T10 and pedicles to the transverse processes of T11 using a T-saw. b After opening the outer layer of dura, the inner layer of dura (asterisk) surrounding the tumor was cut and the tumor was lifted up. c The tumor was resected en bloc with the inner layer of dura. d The outer layer of dura was closed with titanium clips. e Following complete resection of the tumor and repair of the outer layer of dura, the excised posterior elements were recapped exactly to their anatomical sites and sutured
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4491201&req=5

Fig2: Intraoperative photographs. a Dura was widely exposed after en-bloc excision of the posterior elements of T10-T11, including bilateral T10-T11 facet joints, by cutting the pars interarticularis of the lamina of T10 and pedicles to the transverse processes of T11 using a T-saw. b After opening the outer layer of dura, the inner layer of dura (asterisk) surrounding the tumor was cut and the tumor was lifted up. c The tumor was resected en bloc with the inner layer of dura. d The outer layer of dura was closed with titanium clips. e Following complete resection of the tumor and repair of the outer layer of dura, the excised posterior elements were recapped exactly to their anatomical sites and sutured
Mentions: Surgery was performed under transcranial electrical stimulation of motor evoked potentials for spinal cord monitoring. The spinous process of the above vertebra (T9) was split longitudinally and divided at its base from the lamina with bilateral paravertebral muscles attached to the split spinous process. The T10-T11 posterior arches lateral to bilateral transverse processes were then exposed. Bilateral pars interarticularis of the lamina of T10 and bilateral pedicles to the transverse processes of T11 were cut using a T-saw (Koshiya, Kanazawa, Japan). Posterior elements of T10-T11, including bilateral T10-T11 facet joints, were excised en bloc and the posterior and lateral surfaces of the dura were widely exposed (Fig. 2a). After exposing the dura, an incision was made only within the outer layer of the dura under microscopy, and the outer layer was then stripped away from the inner layer [1]. After retracting the outer layers bilaterally, an incision was made in the inner layer and continued around the tumor base [1]. The hard calcified tumor was then resected en bloc with the inner layer of dura (Fig. 2b, c). The outer layer of dura was closed with titanium clips (Fig. 2d). The excised T10-T11 laminae were then recapped exactly to the anatomical sites and the corresponding cut surfaces were bound by sutures (Fig. 2e). The split T9 spinous process was reapproximated and the paravertebral muscles were closed. Histopathological study of the tumor was consistent with calcified meningioma. This surgery was conducted in accordance with the Declaration of Helsinki.Fig. 2

Bottom Line: Postoperatively, the patient achieved complete recovery of neurological functions.Bone union after laminoplasty was obtained within 6 months.Recapping T-saw laminoplasty provides extensive exposure for tumor removal.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan. miyakosh@doc.med.akita-u.ac.jp.

ABSTRACT

Background: In the treatment of spinal cord tumors, complete tumor resection with complete reconstruction of the spine represents the ideal goal. However, for the treatment of heavily calcified spinal meningioma, en-bloc resection of the tumor together with the involved dura at the tumor base through laminectomy is quite difficult. Conventional laminectomy is not wide enough to allow full exposure of such tumors, and postoperative dural defects can cause serious complications.

Case presentation: A 58-year-old Japanese woman presented with a 3-month history of progressive muscle weakness and numbness of the lower extremities. Magnetic resonance imaging (MRI) and computed tomography showed a calcified spinal cord tumor with dural tail sign at the T10-T11 level, severely compressing the spinal cord anterolaterally. The patient underwent en-bloc resection of the tumor with the inner layer of the dura and preservation of the outer layer of the dura through recapping T-saw laminoplasty of T10-T11, including bilateral facet joints. The tumor was histologically diagnosed as meningioma. Postoperatively, the patient achieved complete recovery of neurological functions. Bone union after laminoplasty was obtained within 6 months. Follow-up MRI at 5 years postoperatively demonstrated no recurrence of the tumor.

Conclusion: Resection of spinal meningioma with only the inner layer of dura can minimize postoperative complications, including spinal fluid leakage. Recapping T-saw laminoplasty provides extensive exposure for tumor removal. The combination of these techniques may offer an ideal surgical option for complete resection of spinal meningioma with complete preservation of the posterior spinal elements.

Show MeSH
Related in: MedlinePlus