The precise midline myelotomy through anatomical posterior median septum by dissecting dorsal column in microsurgical resection of ependymoma (2-dimensional operative video)

This video demonstrates a surgical technique for removing ependymomas, which are tumors located within the spinal cord. The technique involves a precise midline myelotomy, which is a surgical incision along the midline of the spinal cord, through the anatomical posterior median septum. The approach involves dissecting the dorsal column, a specific area of the spinal cord, to access the tumor. The posterior median septum is not always linear, which necessitates careful dissection of the dorsal column to minimize neural tissue damage. The technique aims to achieve gross-total resection of the tumor, which is associated with better outcomes, while minimizing damage to surrounding neural tissue. The video presents the principles and application of this surgical technique.

• 1
  The posterior median septum is not linear or vertical, and its orientation can be deformed by tumor growth, making direct dissection of the dorsal column a safer approach for midline myelotomy.
• 2
  Dissecting the dorsal column during midline myelotomy allows for safe access to centrally located intramedullary lesions with minimal neural tissue damage.
• 3
  Gross-total resection of spinal cord ependymoma can promote better progression-free survival and overall survival.