Resection of a large spinal intradural ependymoma using a limited unilateral laminectomy approach in the lumbosacral region

Abstract

Ependymomas are the most common gliomas of the lower spinal cord, conus medullaris and filum terminale. Although there are several surgical modalities indicated in the removal of spinal tumors, total laminectomy is the conventional method used. However, surgical complications, such as spinal deformities and instability are more common with this approach compared to limited unilateral hemilaminectomy. To present the clinical and radiologic results of patient with a large spinal intradural ependymoma via a limited posterior unilateral laminectomy approach in the lumbosacral region. The aim of this study was to present a modified duramater incisions and surgical positions setup, and discussed the major controversies in treatment in the literature. This article reports the surgical resection of a lumbosacrally localized ependymoma in a 25-year-old male patient using unilateral laminectomy at the L4 to S3 levels. The tumor was removed with any difficulty in reaching to contralateral side. A follow-up lumbar magnetic resonance imaging scan with and without contrast performed 18 months postoperatively showed no residual or recurrent tumor lesions. This procedure may be more difficult than the conventional total laminectomy as suturing of the duramater. However, modified duramater incisions and setup of microscope-operating table provides best facilitates to surgery manipulation. Besides, unilateral limited laminectomy protected the posterior supporting elements. In order to reduce the postoperative complications and minimize the destruction of tissue, unilateral limited hemilaminectomy is recommended for the removal of intradural tumors. This technique facilitates the return of the patient to ordinary life.