Microneurosurgical Removal of a Cervical Intramedullary Tumor Via Hemilaminoplasty: 3-Dimensional Operative Video.

Intramedullary tumors of the spinal cord are rare and account for 2% to 8.5% of all central nervous system tumors. In adults, ependymomas are the most common intramedullary tumors. The primary choice of treatment should be radical surgical removal, as this is curative for most tumors. Adequate tumor exposure is crucial and mostly achieved through standard laminectomy followed by midline myelotomy. However, extensive removal of posterior spinal elements may lead to worsening kyphotic deformities.  After obtaining patient consent, this 3-dimensional video publication was prepared to present microneurosurgical removal of a C3-C6 cervical intramedullary tumor using right-sided hemilaminoplasty. C3-C6 hemilaminae were lifted en bloc. After dural and arachnoid incision, midline myelotomy was performed. Using microneurosurgical technique, the tumor was removed totally. After the dural closure, C3-C6 hemilaminae were placed into the previous position and reconstructed with mini-plates and screws. Preserving contralateral paraspinal muscles, spinous processes, midline spinal ligaments and bilateral facet joints helped maintaining the alignment of the spinal column.  Comparing to laminectomy, hemilaminoplasty, decreases the postoperative pain and the total blood loss as only one side muscle dissection is enough.  In the presented case, postoperative MRI showed total removal of the tumor. The final histopathology report indicated an ependymoma (WHO-Grade 2). Successful bone healing was demonstrated by postoperative cervical radiographs and CT scans. The patient has no postoperative neurological deficit.  In conclusion, hemilaminoplasty is an effective and a less-invasive method in removal of intradural-intramedullary tumors with its advantages such as preventing the instability and reduction of blood loss and postoperative pain.
(Copyright © 2018 by the Congress of Neurological Surgeons.)