Summary
A series of 256 consecutive patients suffering from spinal tumours was studied with respect to the value of bilateral or unilateral surgical approaches. The case material included 152 extradural, 87 intradural, extramedullary and 17 intramedullary tumours. The cervical spinal cord was involved in 43, the thoracic in 152 and the lumbosacral region in 61 cases. Hemilaminectomy was chosen mainly for juxtamedullary tumours, while laminectomy was used for intramedullary tumours. No remarkable difference regarding the choice of approaches was found in extradural tumours. More than 60% of cervical or lumbosacral tumours were managed using unilateral procedures. A higher rate of surgical radicality but fewer complications, shorter stay in hospital and better early results were achieved using hemilaminectomy especially in patients with juxtamedullary tumours. From the observations it may be concluded that the results do not depend on the type of surgical approach but are closely related to the histology and location of tumours. Under the prerequisite of exact pre-operative definition of tumour location, unilateral approaches are advantageous for all kinds of spinal tumours especially for juxtamedullary benign tumours.
Similar content being viewed by others
References
Alexander Jr E (1985) Postlaminectomy kyphosis. In: Wilkins RH, Rengachary SS (eds) Neurosurgery, Vol 3. McGraw-Hill, New York, pp 2293–2297
Bickham WS (1905) Technique of exposure of the spinal cord and canal; osteoplastic resection and laminectomy. Ann Surg 41: 372–398
Black P (1979) Spinal metastasis: Current status and recommended guidelines for management (Review). Neurosurgery 5(6): 726–746
Black P (1985) Spinal epidural tumors. In: Wilkins RH, Rengachary SS (eds) Neurosurgery, Vol 1. McGraw-Hill, New York, pp 1062–1069
Bradford DS (1980) Spinal instability: Orthopedic perspective and prevention (Review). Clin Neurosurg 27: 591–610
Connolly ES (1982) Spinal cord tumors in adults. In: Youmans JR (eds) Neurological surgery, Vol 5. Saunders WB, Philadelphia London, pp 3196–3214
Eggert HR (1982) Zur Seitenlokalisation juxtamedullÄrer Tumoren. Neurochirurgia 25: 116–118
Eggert HR, Scheremet R, Seeger W, Gaitzsch J (1983) Unilateral microsurgical approaches to extramedullary spinal tumours: Operative technique and results. Acta Neurochir (Wien) 67: 245–253
Gilsbach J, Kaiser D, Eggert HR, Reif J (1985) Partielle Costotransversektomie und Thorakotomie in der Neurochirurgie. In: Hohmann D, Kügelgen B, Liebig K (eds) NeuroorthopÄdie 3. Springer, Berlin Heidelberg New York Tokyo, pp 219–225
Guidetti B (1974) Removal of extramedullary benign spinal cord tumours. In: Krayenbühl H, Brihaye J, Loew F (eds) Advances and technical standards in neurosurgery, Vol 1. Springer, Wien New York, pp 173–197
Hendrick EB (1982) Spinal cord tumors in children. In: Youmans JR (ed) Neurological surgery, Vol 5. Saunders WB, Philadelphia London, pp 3215–3221
Hofmann C (1910) Eine einfache Art der temporÄren Laminektomie. Zbl Chir 37: 706–707
Nittner K (1976) Spinal meningiomas, neurinomas and neurofibromas and hourglass tumors. In: Vinkin PJ, Bruyn GW (eds) Handbook of clinical neurology, Vol 20. Amsterdam, North-Holland, pp 177–322
Panjabi MM, White III AA (1980) Basic biomechanics of the spine. Neurosurgery 7 (1): 76–93
Parkinson D (1977) Replacement laminotomy. Surg Neurol 8: 277–279
Patterson Jr RH (1980) Metastatic disease of the spine: Surgical risk versus radiation therapy. Clin Neurosurg 27: 641–644
Raimondi AJ, Gutierrez FA, Rocco CD (1976) Laminotomy and total reconstruction of the posterior spinal arch for spinal canal surgery in childhood. J Neurosurg 45: 555–560
Reimer R, Onofrio BM (1985) Astrocytomas of the spinal cord in children and adolescents. J Neurosurg 63: 669–675
Seeger W (1982) Microsurgery of the spinal cord and surrounding structures: Anatomical and technical principles. Springer, Wien New York
Siegal TZ, Siegeal TA (1985) Surgical decompression of anterior and posterior malignant epidural tumors compressing the spinal cord: A prospective study. Neurosurgery 17 (3): 424–432
Stein BM (1985) Spinal intradural tumors. In: Wilkins RH, Rengachary SS (eds) Neurosurgery, Vol 1. McGraw-Hill, New York, pp 1048–1061
Wenker H, Reuter F (1986) Spinal tumors: A multi-center study of the Deutsche Gesellschaft für Neurochirurgie. In: Wenker H, Klinger M, Brock Met al (eds) Advances in neurosurgery, Vol 14. Spinal cord tumors. Springer, Berlin Heidelberg New York, pp 81–97
Yasuoka S, Peterson HA, Laws ER, MacCarty CS (1981) Pathogenesis and prophylaxis of postlaminectomy deformity of the spine after multiple level laminectomy: Difference between children and adults. Neurosurgery 9 (2): 145–152
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Chiou, S.M., Eggert, H.R., Laborde, G. et al. Microsurgical unilateral approaches for spinal tumour surgery: Eight years' experience in 256 primary operated patients. Acta neurochir 100, 127–133 (1989). https://doi.org/10.1007/BF01403599
Issue Date:
DOI: https://doi.org/10.1007/BF01403599