NS04 INTRADURAL EXTRAMEDULLARY TUMOUR REMOVAL USING MINIMALLY INVASIVE TECHNIQUES – INDICATIONS, ADVANTAGES AND DIFFICULTIES

Purpose:   While minimally invasive surgery offers the potential benefit of less post‐operative pain, a quicker recovery and the avoidance of long‐term instability from multilevel laminectomy, there are concerns over whether one can safely and effectively remove intradural extramedullary tumours in a fashion comparable to open techniques, and whether the theoretical advantages of minimally invasive surgery are clinically significant. Here we review our early experience with minimally invasive techniques for intradural tumours in the thoracolumbar spine. Methodology:   Eleven intradural thoracic or lumbar tumours in 9 patients were operated upon using a muscle splitting, tube‐assisted para‐median approach with hemilaminectomy to access the spinal canal. Fluoroscopy and navigation were used to determine the surgical level in all cases. Results:   Satisfactory tumour resection using standard microsurgical techniques was achieved in all but one case through a minimally invasive approach. Surgical time and intra‐operative blood loss were favourable compared to open techniques. There was no post‐operative morbidity in any of these cases although there were 2 cases in the high thoracic spine in which the surgical site was inaccurately placed by 1 level. In one case, the approach was converted to open when the tumour could not be found. In this case there was a post‐operative CSF leak which required re‐admission. Conclusions:   Intradural tumours can be safely and effectively removed using minimally invasive techniques. The pros and cons of minimally invasive versus open surgery are discussed.