Awake intradural spinal tumour resection.
World Neurosurg. 2018 Apr 05;:
Authors: Shtaya A, Luong CB, Pereira E
BACKGROUND: Meningioma is a standard sluggish rising spinal tumour with a predilection for intradural prevalence. Sufferers often current with ache adopted by ataxia and sensory and sphincter issues. The gold normal therapy in these circumstances is gross complete microsurgical resection underneath basic anaesthesia. Nonetheless, there exist excessive anaesthetic threat sufferers unsuitable for basic anaesthesia. Performing spinal surgical procedures underneath native anaesthesia and sedation has been reported albeit hardly ever for principally minimally invasive procedures however not for open intradural pathologies.
CASE DESCRIPTION: We report a 63-year-old lady with essential aortic stenosis, coronary artery illness and extreme continual obstructive airways illness (COAD) who offered with ten months’ historical past of worsening again ache and bilateral leg pains, ataxia, hyperreflexia in decrease limbs in addition to altered decrease limb sensation. Magnetic resonance imaging (MRI) revealed a distinction enhancing intradural lesion at T6/7 with extreme spinal wire compression. Nonetheless, the affected person was ASA class IV and her cardiac illness was not amenable to intervention. She underwent thoracic laminectomy and excision of the tumour underneath native anaesthesia and sedation with no important problems and scientific enchancment.
CONCLUSION: Our illustrative case and literature evaluate recommend that utilising native anaesthesia and sedation to carry out spinal surgical procedures together with intradural tumours is feasible even in high-risk sufferers with good end result. Our ASA class IV affected person tolerated the surgical procedure properly with gross complete tumour resection and subsequent decision of the signs.
PMID: 29627630 [PubMed – as supplied by publisher]