‘Micro endoscopic’ vs. ‘pure endoscopic’ surgery for spinal intra dural mass lesions: a comparative study and review

Publication date: Available online 13 February 2018
Source:The Spine Journal
Author(s): Sivashanmugam Dhandapani, Madhivanan Karthigeyan
BackgroundEndoscopy is increasingly being used for minimal invasiveness and panoramic visualization, with unclear efficacy and safety among spinal intradural lesions.ObjectiveTo compare micro-endoscopic and pure-endoscopic surgery for spinal intradural lesions.MethodsSpinal intradural lesions operated by us using endoscopic/access ports were categorized 'micro-endoscopic' (predominant microscope use), or 'pure-endoscopic' (standalone endoscopy) surgery, and studied with respect to clinico-radiological features, techniques, peri-operative course, histopathology, clinical and radiological outcome at minimum of 3 months.ResultsAmong 34 patients studied, the initial 15 had 'micro-endoscopic' surgery, 16 had 'pure-endoscopic' surgery, while 3 had 'mixed' use. There were 18 nerve sheath tumors, 6 meningiomas, 6 cysts, 2 ependymomas, 1 hemangioblastoma and 1 paraganglioma, from 1.5 to as large as 6.8cm (21%≥4cm). Intermuscular or paraspinous approach was utilized, followed by small bony fenestration/interlaminar corridor. Even larger schwannomas could be excised through smaller bony fenestration using 'sliding-delivery' technique. While visualization of sides and angles was better with endoscope, hemostasis and dural closure had steep learning curve, necessitating use of microscope in the initial cases. Clinical improvement and radiological resolution could be achieved in all. There was no significant difference between the groups. The change in Nurick grade had significant correlation with only the dimension of lesion (P=0.03) and pre-operative grade (P=0.05).ConclusionEndoscopy is effective and safe for even large intradural spinal tumors with better visualization of sides and angles, albeit with hemostasis and dural closure having initial learning curve. Wide heterogeneity of surgical terminologies in literature on these procedures warrants consensus for uniform reporting.



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