Awake intradural spinal tumour resection.

Awake intradural spinal tumour resection.

World Neurosurg. 2018 Apr 05;:

Authors: Shtaya A, Luong CB, Pereira E

Abstract
BACKGROUND: Meningioma is a common slow growing spinal tumour 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 anaesthesia. However, there exist high anaesthetic risk patients unsuitable for general anaesthesia. Performing spinal surgeries under local anaesthesia 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 (COAD) who presented with ten months' history of worsening back pain and bilateral leg pains, ataxia, hyperreflexia in lower limbs as well as altered lower limb sensation. Magnetic resonance imaging (MRI) revealed a contrast enhancing intradural lesion at T6/7 with severe spinal cord compression. However, the patient was ASA class IV and her cardiac disease was not amenable to intervention. She underwent thoracic laminectomy and excision of the tumour under local anaesthesia and sedation with no significant complications and clinical improvement.
CONCLUSION: Our illustrative case and literature review suggest that utilising local anaesthesia and sedation to perform spinal surgeries including intradural tumours is possible even in high-risk patients with good outcome. Our ASA class IV patient tolerated the surgery well with gross total tumour resection and subsequent resolution of the symptoms.

PMID: 29627630 [PubMed - as supplied by publisher]

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