Minimally Invasive Intradural Tumor Resection

  • Hani Malone
  • John E. O’TooleEmail author


Minimally invasive surgical (MIS) approaches to intradural pathology, specifically intradural extramedullary tumors, have been shown to be safe and effective. In appropriately selected patients, MIS techniques may potentially reduce complications, morbidity, and cost, compared to traditional open surgery. In this chapter, we discuss the preoperative planning, technical details, and postoperative considerations related to the minimally invasive resection of intradural extramedullary tumors. Surgical steps are illustrated by a case presentation and accompanying video. Current evidence supporting the use of MIS techniques for intradural tumor surgery is also discussed.


Minimally invasive spine surgery Intradural Intradural extramedullary MIS Spinal tumor 

Supplementary material

Video 28.1

The accompanying surgical video illustrates the use of a minimally invasive surgical approach to intradural spinal tumor resection. The recorded operation was performed at Rush University Medical Center in Chicago, IL. (MP4 1299929 kb)


  1. 1.
    Kurland LT. The frequency of intracranial and intraspinal neoplasms in the resident population of Rochester, Minnesota. J Neurosurg. 1958;15(6):627–41.CrossRefGoogle Scholar
  2. 2.
    Sasaoka R, Nakamura H, Konishi S, Nagayama R, Suzuki E, Terai H, et al. Objective assessment of reduced invasiveness in MED. Compared with conventional one-level laminotomy. Eur Spine J. 2006;15(5):577–82.CrossRefGoogle Scholar
  3. 3.
    Snyder L, Clark J, Nakaji P, Tumialán L. Minimally invasive surgical techniques for intradural extramedullary lesions of the thoracic spine. Barrow Q. 2016;26(1):20–5.Google Scholar
  4. 4.
    Martin H, Pham K-EC, Liu JC, Hsieh PC. Minimally invasive surgery for intradural extramedullary spinal tumors: a comprehensive review with illustrative clinical cases. World Spinal Column J. 2016;7(2):84–96.Google Scholar
  5. 5.
    Fontes RB, Wewel JT, O’Toole JE. Perioperative cost analysis of minimally invasive vs open resection of intradural extramedullary spinal cord tumors. Neurosurgery. 2016;78(4):531–9.CrossRefGoogle Scholar
  6. 6.
    Wong AP, Lall RR, Dahdaleh NS, Lawton CD, Smith ZA, Wong RH, et al. Comparison of open and minimally invasive surgery for intradural-extramedullary spine tumors. Neurosurg Focus. 2015;39(2):E11.CrossRefGoogle Scholar
  7. 7.
    Raygor KP, Than KD, Chou D, Mummaneni PV. Comparison of minimally invasive transspinous and open approaches for thoracolumbar intradural-extramedullary spinal tumors. Neurosurg Focus. 2015;39(2):E12.CrossRefGoogle Scholar
  8. 8.
    Afathi M, Peltier E, Adetchessi T, Graillon T, Dufour H, Fuentes S. Minimally invasive transmuscular approach for the treatment of benign intradural extramedullary spinal cord tumours: Technical note and results. Neurochirurgie. 2015;61(5):333–8.CrossRefGoogle Scholar
  9. 9.
    Nzokou A, Weil AG, Shedid D. Minimally invasive removal of thoracic and lumbar spinal tumors using a nonexpandable tubular retractor. J Neurosurg Spine. 2013;19(6):708–15.CrossRefGoogle Scholar
  10. 10.
    Gandhi RH, German JW. Minimally invasive approach for the treatment of intradural spinal pathology. Neurosurg Focus. 2013;35(2):E5.CrossRefGoogle Scholar
  11. 11.
    Lee B, Hsieh PC. Minimally invasive lumbar intradural extramedullary tumor resection. Neurosurg Focus. 2012;33(Suppl 1):1.CrossRefGoogle Scholar
  12. 12.
    Dahlberg D, Halvorsen CM, Lied B, Helseth E. Minimally invasive microsurgical resection of primary, intradural spinal tumours using a tubular retraction system. Br J Neurosurg. 2012;26(4):472–5.CrossRefGoogle Scholar
  13. 13.
    Mannion RJ, Nowitzke AM, Efendy J, Wood MJ. Safety and efficacy of intradural extramedullary spinal tumor removal using a minimally invasive approach. Neurosurgery. 2011;68(1 Suppl Operative):208–16. discussion 16.PubMedGoogle Scholar
  14. 14.
    Dakwar E, Smith WD, Malone KT, Uribe JS. Minimally invasive lateral extracavitary resection of foraminal neurofibromas. J Clin Neurosci. 2011;18(11):1510–2.CrossRefGoogle Scholar
  15. 15.
    Tredway TL, Santiago P, Hrubes MR, Song JK, Christie SD, Fessler RG. Minimally invasive resection of intradural-extramedullary spinal neoplasms. Neurosurgery. 2006;58(1 Suppl):ONS52–8. discussion ONS-8.PubMedGoogle Scholar
  16. 16.
    O’Toole JE, Eichholz KM, Fessler RG. Minimally invasive approaches to vertebral column and spinal cord tumors. Neurosurg Clin N Am. 2006;17(4):491–506.CrossRefGoogle Scholar
  17. 17.
    Klimo P Jr, Kestle JR, Schmidt MH. Treatment of metastatic spinal epidural disease: a review of the literature. Neurosurg Focus. 2003;15(5):E1.PubMedGoogle Scholar
  18. 18.
    Weigel B, Maghsudi M, Neumann C, Kretschmer R, Muller FJ, Nerlich M. Surgical management of symptomatic spinal metastases. Postoperative outcome and quality of life. Spine (Phila Pa 1976). 1999;24(21):2240–6.CrossRefGoogle Scholar
  19. 19.
    Ghogawala Z, Mansfield FL, Borges LF. Spinal radiation before surgical decompression adversely affects outcomes of surgery for symptomatic metastatic spinal cord compression. Spine (Phila Pa 1976). 2001;26(7):818–24.CrossRefGoogle Scholar
  20. 20.
    Haji FA, Cenic A, Crevier L, Murty N, Reddy K. Minimally invasive approach for the resection of spinal neoplasm. Spine (Phila Pa 1976). 2011;36(15):E1018–26.CrossRefGoogle Scholar
  21. 21.
    Ogden AT, Fessler RG. Minimally invasive resection of intramedullary ependymoma: case report. Neurosurgery. 2009;65(6):E1203–4. discussion E4.CrossRefGoogle Scholar
  22. 22.
    On Tsang AC, Hang Tse PY, Ting Ng GH, Kit Leung GK. Minimal access microsurgical ligation of spinal dural arteriovenous fistula with tubular retractor. Surg Neurol Int. 2015;6:99.CrossRefGoogle Scholar
  23. 23.
    Patel NP, Birch BD, Lyons MK, DeMent SE, Elbert GA. Minimally invasive intradural spinal dural arteriovenous fistula ligation. World Neurosurg. 2013;80(6):e267–70.CrossRefGoogle Scholar
  24. 24.
    Fassett DR, Clark R, Brockmeyer DL, Schmidt MH. Cervical spine deformity associated with resection of spinal cord tumors. Neurosurg Focus. 2006;20(2):E2.PubMedGoogle Scholar
  25. 25.
    McGirt MJ, Chaichana KL, Atiba A, Bydon A, Witham TF, Yao KC, et al. Incidence of spinal deformity after resection of intramedullary spinal cord tumors in children who underwent laminectomy compared with laminoplasty. J Neurosurg Pediatr. 2008;1(1):57–62.CrossRefGoogle Scholar
  26. 26.
    Tan LA, Takagi I, Straus D, O’Toole JE. Management of intended durotomy in minimally invasive intradural spine surgery: clinical article. J Neurosurg Spine. 2014;21(2):279–85.CrossRefGoogle Scholar
  27. 27.
    Tan LA, Kasliwal MK, Wewel J, Fontes RB, O’Toole JE. Minimally invasive surgery for synchronous, same-level lumbar intradural-extramedullary neoplasm and acute disc herniation. Neurosurg Focus. 2014;37(Suppl 2). Video 16.Google Scholar
  28. 28.
    Tan LA, O’Toole JE. Tubular retractor selection in minimally invasive spinal tumor resection. J Neurosurg Spine. 2014;20(5):596–7. author reply 7-8.CrossRefGoogle Scholar
  29. 29.
    Park P, Leveque JC, La Marca F, Sullivan SE. Dural closure using the U-clip in minimally invasive spinal tumor resection. J Spinal Disord Tech. 2010;23(7):486–9.CrossRefGoogle Scholar
  30. 30.
    Hoover JM, Clarke MJ, Wetjen NM, Mandrekar J, Puffer RC, Krauss WE. Complications necessitating a return to the operating room following intradural spine surgery. World Neurosurg. 2012;78(3–4):344–7.CrossRefGoogle Scholar
  31. 31.
    Lu DC, Chou D, Mummaneni PV. A comparison of mini-open and open approaches for resection of thoracolumbar intradural spinal tumors. J Neurosurg Spine. 2011;14(6):758–64.CrossRefGoogle Scholar
  32. 32.
    O’Toole JE, Eichholz KM, Fessler RG. Surgical site infection rates after minimally invasive spinal surgery. J Neurosurg Spine. 2009;11(4):471–6.CrossRefGoogle Scholar
  33. 33.
    Omeis IA, Dhir M, Sciubba DM, Gottfried ON, McGirt MJ, Attenello FJ, et al. Postoperative surgical site infections in patients undergoing spinal tumor surgery: incidence and risk factors. Spine (Phila Pa 1976). 2011;36(17):1410–9.CrossRefGoogle Scholar
  34. 34.
    Wang MY, Lerner J, Lesko J, McGirt MJ. Acute hospital costs after minimally invasive versus open lumbar interbody fusion: data from a US national database with 6106 patients. J Spinal Disord Tech. 2012;25(6):324–8.CrossRefGoogle Scholar
  35. 35.
    Mende KC, Krätzig T, Mohme M, Westphal M, Eicker SO. Keyhole approaches to intradural pathologies. Neurosurg Focus. 2017;43:E5.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Scripps ClinicDivision of NeurosurgerySan DiegoUSA
  2. 2.Rush University Medical CenterDepartment of NeurosurgeryChicagoUSA

Personalised recommendations