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Posterolateral trans dentate approach to anterior extensive extramedullary tumor of the cervical spine in a pediatric case: how I do it

  • How I Do it - Pediatric Spine
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Abstract

Background

Extramedullary anterior cervical canal tumors can be challenging lesions to reach. The posterolateral trans dentate approach offers an alternative route.

Method

Classic posterior laminoplasty is done to expose the medulla; the dentate ligament is identified as a fibrous structure running from the lateral pial surface of the medulla to the lateral dura between nerve roots spaces. Once the ligament is cut, the medulla can be gently rotated to access the anterior cervical canal. Intraoperative neurophysiological stimulation is mandatory.

Conclusion

This approach allows a safe route, without the need for corpectomies. It should be considered especially in children where multilevel corpectomies could be challenging.

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Author information

Authors and Affiliations

  1. Hospital Universitario Marques de Valdecilla, Santander, Spain

    Carlos Santos

  2. Hospital Universitario Virgen del Rocio, Sevilla, Spain

    Monica Rivero-Garvía & Javier Marquez-Rivas

  3. Center for Advanced Neurology, Seville, Spain

    Javier Marquez-Rivas

Authors
  1. Carlos Santos
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  2. Monica Rivero-Garvía
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  3. Javier Marquez-Rivas
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Corresponding author

Correspondence to Carlos Santos.

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Key points

1. Anterior and anterolateral cervical canal extramedullary lesions can be tackled through a posterior trans dentate approach.

2. Intramedullary lesions or tumors invading the anterior medullar pia mater should not be managed throughout this approach.

3. Laminoplasty, one level above and one level below must be done for adequate control and visualization.

4. Midline durotomy needs to be complemented with lateral cuts at its edges.

5. Dentate ligament is easily identified along the side of the medulla as a white cord structure with triangular dural attachments.

6. After the dentate ligament is cut, medullary rotation can be done safely with dentate or pial sutures gently traction.

7. Intraoperative electrophysiological monitoring is mandatory.

8. Meticulous microsurgical technique is needed for inter nerve root dissection.

9. If multilevel laminoplasty is needed, posterior lateral mass screw fixation should be considered to avoid postoperative kyphosis.

10. Close wound follow-up is needed to spot CSF leak or pseudomeningocele.

This article is part of the Topical Collection on Pediatric Spine

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Santos, C., Rivero-Garvía, M. & Marquez-Rivas, J. Posterolateral trans dentate approach to anterior extensive extramedullary tumor of the cervical spine in a pediatric case: how I do it. Acta Neurochir 164, 1153–1156 (2022). https://doi.org/10.1007/s00701-021-04988-9

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  • DOI: https://doi.org/10.1007/s00701-021-04988-9

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