Minimally Invasive Surgery for Intradural Tumors

The traditional approach for resection of intradural spinal tumors is an open laminectomy. This approach provides a wide, bilateral exposure to the spinal column. However, in order to achieve this exposure, the bilateral musculature must be stripped away from the bony anatomy and the posterior ligamentous complex disrupted. Minimally invasive spine surgery (MISS) has garnered increasing popularity over the past two decades and the use of tubular retractors to access the spinal column has been applied to all levels of the spine for multiple pathologies and surgical procedures. The potential benefits of MISS approaches are less postoperative pain, less blood loss, shorter hospital stays, faster recovery and return to work, and fewer complications. In this chapter, we will describe our method for the resection of intradural spinal tumors utilizing an MISS technique. We discuss the indications and preoperative considerations when considering an MISS approach. Our technique utilizing a non-expandable tubular retractor is then described. Finally, we examine the existing body of literature of intradural extramedullary and intramedullary spinal tumors. We aim to provide readers with a comprehensive overview of how to approach patients with intradural spinal tumors from an MISS perspective and safely and effectively perform resection through a tubular retractor.