Transtubular image-guided surgery for spinal intradural lesions: techniques, results, and complications in a consecutive series of 60 patients

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  • 1 Avaton Surgical Group, Genolier Spine Care Center, Clinique de Genolier, Genolier, Switzerland;
  • | 2 Department of Radiodiagnostic and Interventional Radiology, Lausanne University Hospital, Lausanne, Switzerland;
  • | 3 Department of Orthopedics, University Hospital, Umëa, Sweden;
  • | 4 Neurosurgical Service, Department of Clinical Neurosciences, Lausanne University Hospital, Lausanne, Switzerland; and
  • | 5 Centre Leenaards de la Memoire, Lausanne University Hospital, Lausanne, Switzerland
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OBJECTIVE

The authors previously described the image merge tailored access resection (IMTAR) technique for resection of spinal intradural lesions (SIDLs). The authors reported their updated experience with the IMTAR technique and compared surgical results between patients who underwent operations with 2D or 3D fluoroscopic guidance.

METHODS

The authors reviewed 60 patients who underwent SIDL resection with transtubular techniques over a 14-year period. The earlier patients in the series underwent operations with 2D fluoroscopic image guidance. The latter patients underwent operations with the IMTAR technique based on 3D image guidance. The results of both techniques were analyzed.

RESULTS

Sixty patients were included: 27 females (45%) and 33 males (55%). The median (range) age was 50.5 (19–92) years. Gross-total resection (GTR) was achieved in 52 patients (86.7%). Subtotal resection was accomplished in 5 patients (8.3%). Neurological complications occurred in 3 patients (5%), and tumor recurrence occurred in 1 patient (1.7%). The non-IMTAR and IMTAR cohorts showed similar postoperative Nurick scale scores and rates of neurological complications and GTR. The median (interquartile range) bone resection surface area at the index level was 89.5 (51–147) mm2 in the non-IMTAR cohort and 35.5 (11–71) mm2 in the IMTAR cohort, with a statistically significant difference (p = 0.0112).

CONCLUSIONS

Surgery for SIDLs may be challenging, and meticulous surgical planning is crucial to optimize tumor access, maximize resection, and minimize risk of complications. Image-guided transtubular resection is an additional surgical technique for SIDLs and facilitates microsurgical tumor removal of ventrally located lesions with a posterolateral approach, without requiring potentially destabilizing bone resection.

ABBREVIATIONS

GTR = gross-total resection; IMTAR = image merge tailored access resection; IQR = interquartile range; MIS = minimally invasive surgery; OSAT = optimal surgical access trajectory; SIDL = spinal intradural lesion; STR = subtotal resection.

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