Lumbar Laminoplasty for Resection of Myxopapillary Ependymoma of the Conus Medullaris: 2-Dimensional Operative Video
Document Type
Article
Abstract
Myxopapillary ependymomas are slow-growing tumors that are located almost exclusively in the region of the conus medullaris, cauda equina, and filum terminale of the spinal cord. Surgical intervention achieving a gross total resection is the main treatment modality. If, however, a gross total resection cannot be achieved, surgery is augmented with radiation therapy. In this video, we present the case of a 27-yr-old male with persistent back pain and radiculopathy who was found to have a myxopapillary ependymoma that was adherent to the conus. Preoperative imaging demonstrated that the tumor was displacing the conus and nerve roots ventrally. A laminoplasty at L1-L2 was performed with near-total resection because of the intimate involvement of neural tissue. The key features of the video include performing laminoplasty and rationale, and performing maximum safe tumor resection with a combination of bipolar cautery, suction, and ultrasonic aspiration augmented with frequent stimulation, gel foam pledgets intradurally, and achieving a watertight closure of the dura and fascia. The patient tolerated the surgery well without any complications. Given his gross residual disease along the conus and young age, he was at a high risk for continued tumor growth without adjuvant therapy, with a recurrence rate of roughly 33% to 45% in patients who underwent subtotal resection. With the addition of adjuvant radiation therapy, the recurrence rate is 20% to 29%.1,2 He was discharged to home with a plan for conventional fractionated external beam radiation. At the most recent follow-up, he reported decreased back pain and radiculopathy. Appropriate patient consent was obtained.
Medical Subject Headings
Ependymoma (diagnostic imaging, radiotherapy, surgery); Humans; Laminoplasty; Magnetic Resonance Imaging; Male; Neoplasm Recurrence, Local (surgery); Spinal Cord Neoplasms (diagnostic imaging, radiotherapy, surgery)
Publication Date
4-15-2021
Publication Title
Operative neurosurgery (Hagerstown, Md.)
E-ISSN
2332-4260
Volume
20
Issue
5
First Page
E352
PubMed ID
33647943
Digital Object Identifier (DOI)
10.1093/ons/opab038
Recommended Citation
Strong, Michael J.; Yee, Timothy J.; Khalsa, Siri Sahib; Saadeh, Yamaan S.; North, Robert; and Oppenlander, Mark E., "Lumbar Laminoplasty for Resection of Myxopapillary Ependymoma of the Conus Medullaris: 2-Dimensional Operative Video" (2021). Neurosurgery. 1631.
https://scholar.barrowneuro.org/neurosurgery/1631