Name: 10.3171/2024.1.FOCVID23214
Uploaded: 2024-03-04T00:00:00.0000000
Duration: T00H04M46S
Description: 10.3171/2024.1.FOCVID23214

Name: 10.3171/2024.1.FOCVID23214

Description: 10.3171/2024.1.FOCVID23214

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Upload Date: 2024-03-04T00:00:00.0000000

Transcript: Language: EN.
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SPEAKER: Endoscopy for T10 nerve sheath tumor. Minimally invasive surgery is increasingly being adopted for spinal intradural tumors. Large IDEMs may impede the visualization of posterior attachments, and diligence is needed for the total excision of multilobulated tumors without causing neural deficits. A 28-year-old male patient presented with right-sided flank pain for 8 months and mild right-sided spasticity for a month.
SPEAKER: MRI thoracolumbar spine revealed a T10 intradural extramedullary tumor, suggestive of a nerve sheath tumor, towards the right. The minimally invasive endoscopic approach was chosen because of the minimal disruption of spine and soft tissues and the panoramic view and angled optics provided by the endoscope. In the prone position, the T10 level was identified using X-ray localization, and the right paramedian incision of 3 centimeters was given.
SPEAKER: The paraspinal muscles were retracted laterally to expose the T10 lamina, and a minimally invasive spine retractor was placed. Using endoscopes of 4-mm diameter and 18-cm length for illumination and view, right-sided fenestration was carried out with a high-speed drill and rongeurs. As the tumor did not have a foraminal extension, medial facetectomy was not necessary.
SPEAKER: A lateral longitudinal durotomy was done. Delineation of the extra arachnoidal tumor plane was accomplished with the help of a dissector using the sliding delivery technique. The tumor was gently rolled outside. Under neuromonitoring, the non-motor nerve root entering the tumor was coagulated and disconnected.
SPEAKER: By rotating the angle of the endoscope, the cord can be appreciated with no evidence of residual tumor. The angled optics can be especially helpful in case of multi-lobulated tumors if a piece gets disconnected and becomes inconspicuous. Using micro scissors, the tumor was dissected off the rootlets and was delivered en masse.
SPEAKER: The operative area was irrigated with lukewarm isotonic fluid. The dura was closed with small titanium clips, applied in an oblique manner using an angled applicator to lessen the chances of dural stricture. It was supplemented with multilayered soft tissue closure. The surgery was around 110 minutes' duration, and the blood loss was minimal. The key surgical steps were a minimally invasive paraspinous approach, fenestration of the right lamina, lateral longitudinal durotomy, extracapsular delivery of tumor, sharp dissection of rootlets, and dural closure with oblique clips.
SPEAKER: The patient recovered fully with no deficit or CSF leak. The histopathology was schwannoma grade 1. Postoperative CT scan shows the extent of bony removal. Contrast MRI shows no evidence of residual tumor. This minimally invasive endoscopic approach with fenestration of lamina and sliding delivery technique seems safe and effective for a T10 nerve sheath tumor.
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