Awake Intradural Spinal Tumor Resection; Case Report and Literature Review.

Autor: Shtaya A; Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St. George's University of London, London, United Kingdom; Department of Neurosurgery, Atkinson Morley Wing, St. George's University Hospital, London, United Kingdom. Electronic address: ashtaya@sgul.ac.uk., Luong CB; Department of Neuroanesthesia, Atkinson Morley Wing, St. George's University Hospital, London, United Kingdom., Pereira E; Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St. George's University of London, London, United Kingdom; Department of Neurosurgery, Atkinson Morley Wing, St. George's University Hospital, London, United Kingdom.
Jazyk: angličtina
Zdroj: World neurosurgery [World Neurosurg] 2018 Jun; Vol. 114, pp. 344-347. Date of Electronic Publication: 2018 Apr 05.
DOI: 10.1016/j.wneu.2018.03.200
Abstrakt: Background: Meningioma is a common slow-growing spinal tumor with a predilection for intradural occurrence. Patients usually present with pain followed by ataxia and sensory and sphincter problems. The gold standard treatment in these cases is gross total microsurgical resection under general anesthesia. However, there exist high-anesthetic-risk patients unsuitable for general anesthesia. Performing spinal surgeries under local anesthesia and sedation has been reported, albeit rarely for mostly minimally invasive procedures but not for open intradural pathologies.
Case Description: We report a 63-year-old woman with critical aortic stenosis, coronary artery disease, and severe chronic obstructive airways disease who presented with 10 months' history of worsening back pain and bilateral leg pain, ataxia, hyperreflexia in lower limbs, as well as altered lower limb sensation. Magnetic resonance imaging revealed a contrast-enhancing intradural lesion at T6/7 with severe spinal cord compression. However, the patient was American Society of Anesthesiologists class IV and her cardiac disease was not amenable to intervention. She underwent thoracic laminectomy and excision of the tumor under local anesthesia and sedation with no significant complications and clinical improvement.
Conclusion: Our illustrative case and literature review suggest that using local anesthesia and sedation to perform spinal surgeries including intradural tumors is possible even in high-risk patients with good outcome. Our American Society of Anesthesiologists class IV patient tolerated the surgery well with gross total tumor resection and subsequent resolution of the symptoms.
(Copyright © 2018 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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