Spinal Tumor Surgery

Description

Foreword Preface Acknowledgments Contents Contributors Part I: Anterior Approaches 1: Anterior Cranio-Cervical Approach: Transnasal Case Presentation Introduction Preoperative Planning Measurement to Evaluate Accessibility to the Cranio-Cervical Junction Patient Positioning Surgical Approach Transnasal Approach Transclival Approach Skull Base Reconstruction Postoperative Management Complications Advantages and Limitations of the Approach Advantages Limitations References 2: Contemporary Transoral Approach for Resection of Craniocervical Junction Tumors Introduction Surgical Technique Case Presentation Discussion Conclusion References 3: Transmandibular Approach to Craniocervical Spine Background Risks Alternative Surgical Approaches Standard Transoral Approach Transmaxillary Approaches Endoscopic Approaches Preoperative Assessment Imaging Tracheostomy/PEG Multidisciplinary Care Surgical Technique Positioning Surgical Technique Postoperative Care Conclusion References 4: Craniocervical Approach: Transcervical Overview Indications, Contraindications, and Advantages Clinical Materials and Methods Surgical Preparation and Positioning Surgical Techniques Surgical Anatomy Access Granted by Procedure and Surgical Corridors Understanding the Anatomy of the Craniocervical Junction Arteries C1 and C2 Ligaments Other Anatomical Structures Complications Discussion Conclusion References 5: Anterior Subaxial Cervical Approach Part I: General Considerations of the Anterior Cervical Approach History of the Anterior Cervical Exposure General Considerations of the Anterior Cervical Approach Versus Posterior Approach Pertinent Neural Anatomy Pathology Anterior Cervical Exposure and Local Anatomy Reconstruction and Stabilization: Options and Challenges Complications and Avoidance Part II: Oncologic Considerations of Anterior Cervical Surgery Primary Versus Metastatic Lesions Primary Spinal Tumors Metastatic Lesions Diagnostic and Therapeutic Adjuncts to Surgery Goals of Surgery Other Concerns Part III: Case Illustrations Hemangioma of C4 Ventral Meningioma at C4–C5 Cervical Chordoma References 6: Cervicothoracic Approach: Manubriotomy and Sternotomy Introduction Approach Overview Surgical Technique Patient Positioning Low Anterior Approach Modified Anterior Approach Sternal Splitting Approach Alternative Vascular Corridors Complications Dangers The Vagus and Recurrent Laryngeal Nerves Thoracic Duct Cervical Sympathetic Trunk Case Report History Examination and Imaging Procedure Postoperative Course References 7: Posterolateral Thoracotomy Anatomy Positioning Procedure Exposure Localization Corpectomy Closure Postoperative Care Complications References 8: Minimally Invasive Thoracoscopic Approach to the Anterior Thoracic Spine Introduction Equipment for Thoracoscopic Surgery Video Imaging System Endoscopic Tools Endoscopic Spinal Reconstruction Preoperative Considerations Single-Lung Ventilation Indications and Contraindications Patient Education and Informed Consent Operative Technique Patient Positioning Thoracoscopic Access and Exposure Thoracolumbar Junction Access Vertebral Body Exposure Placement of Screws and Instrumentation Corpectomy and Spinal Canal Decompression Interbody Reconstruction and Endoscopic Stabilization Placement of Chest Tube and Closure Results Conclusion References 9: Thoracoabdominal Approach for Tumors of the Thoracolumbar Spine Anatomic and Biomechanical Considerations Operative Technique Choosing Surgical Approach Patient Positioning Thoracoabdominal Exposure Decompression Reconstruction and Instrumentation Closure Case Presentation Imaging Pathologic Diagnosis Tumor Staging and Surgical Planning Preoperative Optimization Operative Technique Clinical Outcome Conclusion References 10: Retroperitoneal Approach to the Lumbar Spine: A Case-Based Approach for Primary Tumor Introduction Planning Principles Indications for Anterior Lumbar Retroperitoneal Approach Surgical Anatomy of the Anterior Lumbar Retroperitoneal Approach Specific Considerations by Level Complications Case Description: History, Examination, and Radiological Diagnosis Case Description: Staging Case Description: Surgical Planning Case Description: Procedure Case Description: Posterior Approach Case Description: Anterior Retroperitoneal Approach Case Description: Removal of the Diseased Vertebra Case Description: Postoperative Course References 11: Anterior Lumbar and Lumbosacral Approach: Transperitoneal Case Presentation Introduction Staging and Surgical Planning Adjuvant Therapy Chemotherapy Percutaneous Techniques Radiation Therapy Surgical Approaches Vertebrectomy Posterior Vertebrectomy Anterior Vertebrectomy Sagittal Resection Resection of the Posterior Arch Surgical Technique: Transperitoneal Vertebrectomy Approach En Bloc Corpectomy Reconstruction Complications Conclusion References Part II: Posterior Approaches 12: Occipital-Cervical Approach and Stabilization Anatomy Diagnosis and Decision-Making Operative Techniques Approach Positioning Neuromonitoring Exposure Decompression Instrumentation Closure Complications Case Presentation 1 Case Presentation 2 References 13: Posterior Subaxial Cervical Approach and Stabilization Introduction Clinical Evaluation Clinical Scenario Positioning Surgical Approach Decompression and Tumor Resection Fusion Closure Complications Clinical Pearls References 14: Anterior/Anterolateral Thoracic Access and Stabilization from Posterior Approach: Transpedicular, Costotransversectomy, Lateral Extracavitary Approaches: Standard Intralesional Resection Introduction Case Description Procedure Outline of Steps Preoperative Image Review and Surgical Planning Positioning Neuromonitoring Localization Incision Pedicle Screw Placement Bone Removal Rib Dissection Rib Resection Rib Disarticulation Laminectomy Pars and Facets Temporary Rod Transpedicular Resection Corpectomy Nerve Root Boundary Localization Boundary Dissection Resection of Vertebral Body Fusion and Cage Placement Cage Placement Posterior Instrumentation Case Follow-Up Discussion and Conclusion References 15: Antero/Anterolateral Thoracic Access and Stabilization from a Posterior Approach, Costotransversectomy, and Lateral Extracavitary Approach, En Bloc Resection Introduction Anatomy Case 1: Posterior-Only En Bloc Spondylectomy for Giant-Cell Tumor of Bone Posterior Exposure Passage of Saws Osteotomies and Reconstruction Case 2: En Bloc Spondylectomy with Chest Wall Excision for Ewing’s Sarcoma Discussion Conclusion References 16: Anterior/Anterolateral Thoracic Access and Stabilization from Posterior Approach, Transpedicular, Costotransversectomy, Lateral Extracavitary Approaches via Minimally Invasive Approaches, Minimal Access and Tubular Access Introduction Preoperative Evaluation Surgical Techniques Mini-Open Transpedicular Approach Indications Patient Positioning Surgical Details and Special Considerations MISS Costotransversectomy Approach Indications Patient Positioning Surgical Details and Special Considerations MISS Lateral Extracavitary Approach Patient Positioning Surgical Details and Special Considerations Lateral Approach Patient Positioning Surgical Details and Special Considerations Postoperative Care Conclusion References 17: Posterolateral Approach to Thoraco-Lumbar Metastases - Separation Surgery Introduction Case Presentation Diagnostic Workup Surgery Discussion Conclusion References 18: Minimally Invasive Stabilization Alone (Thoracic and Lumbar): Cement Augmentation Introduction Patient Selection Minimally Invasive Methods and Case Studies Cement Augmentation Percutaneous Screws and Fixation Systems Combination Techniques Associated Procedures Case Presentations Case 1: Vertebroplasty for Compression Fractures in the Setting of Multiple Myeloma Case 2: Fenestrated Screw Placement with Cement Augmentation for Osteopenic Bone in the Setting of Spine Metastasis Case 3: Cement Augmentation with Pedicle Screws to Correct Kyphotic Deformity in the Setting of Spine Cancer Case 4: Vertebrectomy and Reconstruction of the Vertebral Column with Cement Augmentation Discussion and Conclusion References 19: Percutaneous Stabilization Introduction Case Presentation Diagnostic Workup Treatment Approach Surgery Discussion Conclusion References 20: Posterior Lumbar and Sacral Approach and Stabilization: Intralesional Lumbar Resection Introduction Goals of Surgery: Strategy and Approach Considerations An Integrated Approach with Radiation Planning Clinical Presentation: Spine Tumor Pain Radiological Evaluation Case Illustration: Lumbar Surgical Technique: Pearls and Planning Case Illustration: Lumbosacral Conclusion References 21: Lumbar En Bloc Resection Introduction Indications and Margins Surgical Planning Type 1 Type 2 Type 2a Type 2b Type 2c Type 3a Type 3b Type 3c Type 4 Type 5 Type 6 Type 7 Complications Case-Based Planning of Lumbar En Bloc Resection Discussion and Conclusion Conclusion References 22: Intralesional Sacrectomy Anatomic Considerations Patient Evaluation Operative Techniques Positioning and Monitoring Surgical Exposure Intralesional Sacrectomy for Sacral Metastasis Posterior Nerve-Sparing Sacrectomy Closure Case Presentation 1 Case Presentation 2 References 23: Technique of Oncologic Sacrectomy Introduction Patient Presentation Patient Evaluation Pre-operative Planning General Pre-operative Preparation Anterior Approach Posterior Approach Spinopelvic Reconstruction Post-operative Care Complications Outcomes Case Presentation 1 Conclusion References Part III: Intradural Approaches 24: Intradural Extramedullary Tumor: Cervical Introduction Patient Selection Operative Planning and Approach Modifications, Pearls, Pitfalls, and Specific Considerations Intradural Exposure/Dissection Nerve Sheath Tumors Modifications, Pearls, Pitfalls, and Specific Considerations Dumbbell Tumors Modifications, Pearls, Pitfalls, and Specific Considerations Meningiomas Modifications, Pearls, Pitfalls, and Specific Considerations Wound Closure and Postoperative Management Modifications, Pearls, Pitfalls, and Specific Considerations Conclusion References 25: Intradural Extramedullary Tumor: Thoracic Schwannomas Meningiomas Surgical Technique Posterior/Laminectomy (Fig. 25.1) Other Approaches (Figs. 25.2, 25.3, 25.4 and 25.5) Case Presentation 1 References 26: Intradural Extramedullary Tumor in the Lumbar Spine Introduction Anatomical Basis Preoperative Considerations Surgical Technique Operating Room Setup Localization and Positioning Planning the Incision Incision and Exposure Exposure and Laminectomy Dural Opening Resection of the Lesion Closure of the Dura Case Presentation Clinical History and Neurological Examination Radiographic Studies Preoperative Considerations Surgical Technique Postoperative Course Complications and Strategies for Complication Avoidance Cerebrospinal Fluid Leak Localization of the Lesion Conclusion References 27: Intradural, Intramedullary Tumor Introduction Operative Treatment Surgical Anatomy Operative Technique Intraoperative Neuromonitoring Operative Complications Early Complications Delayed Complications Conclusion References 28: Minimally Invasive Intradural Tumor Resection Introduction Patient Selection: Indications, Advantages, and Disadvantages Preoperative Assessment and Planning Surgical Technique Positioning and Anesthesia Exposure Tumor Resection Dural Closure Postoperative Care and Concerns Case Presentation (Video 28.1) Discussion Conclusion References Index