Microscopic Minimally Invasive Keyhole Technique for Surgical Resection of Spinal Dumbbell Tumors.

Abstract

Multiple surgical modalities have been developedl and applied for surgical excision of spinal dumbbell tumors. The microscopic minimally invasive keyhole technique has not yet been well characterized for this purpose. We report our experience with 1-stage surgical resection of both intraforaminal and extraforaminal/paraspinal components of spinal dumbbell tumors using the microsurgical keyhole technique. We retrospectively reviewed 12 cases of spinal dumbbell tumors treated via 1-stage surgical resection by the same senior spinal surgeon from January 2013 to April 2017. All patients were treated surgically using the microsurgical keyhole technique through a tubular retractor. Demographic data, perioperative variables, and associated complications were recorded. The clinical outcomes were evaluated at the last follow-up using a visual analog scale and the American Spinal Injury Association scale. Mean duration of surgical resection was 184.58 minutes, and mean estimated total blood loss was 208.33 mL. The mean hospitalization time was 9.17 days. Postoperatively, 11 patients (91.67%) who originally presented with pain had a significantly lower visual analog scale score, indicating a reduction in their pain intensity. All patients demonstrated neurologic stability or improvement by 1-3 grades: 16.67% remained stable, 41.67% improved by 1 grade, 33.33% improved by 2 grades, and 8.33% improved by 3 grades. The microscopic minimally invasive keyhole technique can be used successfully for resection of spinal dumbbell tumors. Further comparative studies are warranted to demonstrate the benefits of the microsurgical keyhole technique compared with traditional open procedures for surgical resection of spinal dumbbell tumors.