Microsurgical Resection Of Multi-segmental Intraspinal Tumor Through Paruspinal Approach Using Percutaneous Multichannel

Objective:To evaluate the clinical outcomes of multi-segmental intraspinaltumor through paruspinal approach using percutaneous multichannel.Methods: A retrospective study was conducted to analyze 23 patients with multi-segmental intraspinaltumor who were admitted to Neurosurgery Department of Union Hospital affiliated with Fujian Medical University from November 2013 to June 2016,including schwannoma(n=12),dermoid cyst(n=4),meningioma(n=4),neurofibroma(n=2),lymphoma(n=1).Under the electrophysiological monitoring,with the help of high-speed air drills,interlaminar fenestrations were made and the tumor in spinal canal was resection through the percutaneous multichannel paruspinal approach after general anesthesia.The operation time,bleeding volume,and hospital stay were analyzed.Creatine phosphokinase(CPK-MM)level was recorded at 1 day preoperatively,l day,3 days and 5 days postoperativel.The clinical functional classification of McCormick and scores of visual analogscale(VAS)were analyzed preoperatively and postoperatively to evaluate the function status of spinal cord.CT three-dimensional reconstruction of spine was performed at l week after surgery.Magnetic resonance imaging(MRI)scan and X-ray of spine were performed preoperatively,1 week and 6 months postoperatively.Results: All patients with multi-segmental intraspinaltumor were totally removed without cerebrospinal fluid(CSF),postoperative infection.The operation lasted(166.65±22.73)min,the blood loss volume was(45.87±15.45)ml and the hospital stay was(8.09±1.31)d.Level of CPK-MM increased 1 day postoperatively with a statistically significant difference compared with preoperatively(P<0.05).and declined gradually,approach to preoperative level at 5 days postoperatively(P>0.05).At the 6 month follow up,The McCormick scores and VAS scores were improved compared with before procedure.MRI scan plus enhanced examination did not recommend no tumor residual and recurrence,The CT three-dimensional reconstruction showed that the minimally invasive incision did not affect the facet joints and stability of the spine,no instability and deformity of the spine occurred during the follow-up period.Conclusions: Through paruspinal approach using percutaneous multichannel not only can achieve the purpose of fully exposing and removing the tumorintralspinal canal,but also avoid damage to the spinous process,facet joints,reduce the muscle and ligament and other soft tissue damage.This technique offers the advantages of less trauma,less complications and less damage to spinal stability.