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  4. Resection of cervical extra-intraspinal neuromas through the enlarged intervertebral foramen: Results in 34 case series patients

Resection of cervical extra-intraspinal neuromas through the enlarged intervertebral foramen: Results in 34 case series patients

Frontiers in Surgery, 2023 · DOI: 10.3389/fsurg.2022.945857 · Published: April 20, 2023

Surgery

Simple Explanation

This study focuses on a surgical technique to remove cervical dumbbell neuromas, which are tumors extending both inside and outside the spinal canal, through an enlarged intervertebral foramen (the opening between vertebrae). The approach involves exposing the tumor and removing it through the enlarged foramen without cutting any bone structures, aiming to preserve spinal stability and avoid damage to critical structures like the spinal cord and vertebral artery. The study reviews the outcomes of 34 patients who underwent this procedure, assessing the effectiveness of tumor removal, preservation of neurological function, and maintenance of spinal stability.

Study Duration
April 2008 and May 2020
Participants
34 consecutive patients (19 male, 15 female) with cervical dumbbell neuromas
Evidence Level
Not specified

Key Findings

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    All 34 tumors were completely exposed using the described incising approach.
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    31 tumors were completely removed in one stage, while 3 underwent subtotal resection due to brachial plexus nerve adhesion.
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    No spinal instability, spinal cord injury, or vertebral artery damage occurred in any of the cases.

Research Summary

This study demonstrates the effectiveness of resecting cervical extra-intraspinal neuromas through the enlarged intervertebral foramen, highlighting the ability to completely expose and remove the tumors while preserving spinal stability and avoiding injury to critical structures. The key to this approach lies in the careful selection of the incision site based on tumor location, meticulous intermuscular dissection, and preservation of neural structures during tumor removal. The study also introduces a classification of dumbbell tumors (Type A, B, and C) to guide surgical planning and technique, considering the tumor's relationship to the spinal cord, vertebral artery, and surrounding tissues.

Practical Implications

Minimally Invasive Approach

The enlarged intervertebral foramen approach offers a less invasive alternative to traditional methods, potentially reducing morbidity and preserving spinal stability.

Improved Surgical Planning

The tumor classification system aids in preoperative planning, allowing surgeons to tailor their approach based on the tumor's specific characteristics and location.

Enhanced Neurological Outcomes

Careful dissection and preservation of neural structures, guided by electrophysiological monitoring, can minimize the risk of neurological deficits and improve patient outcomes.

Study Limitations

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