The Unilateral Hemilaminectomy Approach For The Removal Of The Spinal Cord Tumors

Background and objective:Intraspinal tumors account for 15%of the whole central nervous systemic tumors.About 60%-70%intraspinal tumor are located extramedullary, myoschwannoma,spinal meningioma and ependymocytoma of the filum terminale are most common extramedullary tumors.Most of the extramedullary are benign in histological representation,they can be cured by surgical intervention,laminectomy are the traditional means for the management of intraspinal tumor.Commonly the processus spinosus and bilateral vertebral plate are exsected,the stability of spinal will be influenced.Hemilaminectomy are the newly minimally invasived technique for the management of intraspinal tumors.Our study applying retrospective analytic process,analyze 26 cases since 2006 with intraspinal tumor tooking hemilaminectomy.Analyze the advantages and disadvantages of the hernilaminectomy,also analyze the surgical idication of the hemilaminectomy technique,summarized and analyzed the experience and skill of the hemilaminectomy.Method:Applying retrospective analytic process,analyze 57cases with intraspinal neurinoma with pathologically confirmation.26 cases took hemilaminectomy,32 cases with laminectomy.The comparability analysis was used between the two groups,analytical factor including age,sex,symptom,tumor location and tumor size.Compared the total resection rate,length of stay,blood loss,postoperative complications occurrence between the two groups by statistical analysis with SPSS.The surgery process:All patient took the x ray for location of the corresponding vertebral plate,some patient took c-arm x-ray in operation for location.Most of the patient took prone position,litle part of the patient took lateral decubitus position,the incision all from the midsection,cut off the skin and subcutaneous fat to the processus spinosus.Separating the muscle adhere to the vertebral plate,abrading or biting the vertebral plate by gouge forceps or high speed drill.The circumscription should exposure the inferior border and superiod border of the tumor.Cut off the cyst of the tumor and exised the tumor to minify it,then seperating the tumor's boundary,using silk toraisethe tumor,cut off the distal end and near end of the nerve root,took out of the tumor as a whole.The dura mate and fascia must be sutured rigorously.Result:The patients performed hemilaminectomy recovered faster than those with total laminectomy and shorter hospitalization time,smaller bleeding,more stable for spine stability,no neural dysfunction and spinal deformity or cervical and lumbar and back pain occurred in the hemilaminectomy gorup,the long-term outcome was better than total laminectomy.But the exposure for large tumor was not sufficient.Conclusions:Hemilaminectomy for the removal of intraspinal tumors is a mini-invasive procedure,especially in the case of tumor located in one side of the canalis spinalis,is beneficial to the stability of spine,and with the advantages of shorter hospitalization time and lower expense,smaller bleeding,good long-term outcome.But the localationg of the exposure for large tumor is obvious.