Foreword
Preface
Acknowledgments
Contents
Contributors
Part I: Anterior Approaches
1: Anterior Cranio-Cervical Approach: Transnasal
Case Presentation
Introduction
Preoperative Planning
Measurement to Evaluate Accessibility to the Cranio-Cervical Junction
Patient Positioning
Surgical Approach
Transnasal Approach
Transclival Approach
Skull Base Reconstruction
Postoperative Management
Complications
Advantages and Limitations of the Approach
Advantages
Limitations
References
2: Contemporary Transoral Approach for Resection of Craniocervical Junction Tumors
Introduction
Surgical Technique
Case Presentation
Discussion
Conclusion
References
3: Transmandibular Approach to Craniocervical Spine
Background
Risks
Alternative Surgical Approaches
Standard Transoral Approach
Transmaxillary Approaches
Endoscopic Approaches
Preoperative Assessment
Imaging
Tracheostomy/PEG
Multidisciplinary Care
Surgical Technique
Positioning
Surgical Technique
Postoperative Care
Conclusion
References
4: Craniocervical Approach: Transcervical
Overview
Indications, Contraindications, and Advantages
Clinical Materials and Methods
Surgical Preparation and Positioning
Surgical Techniques
Surgical Anatomy
Access Granted by Procedure and Surgical Corridors
Understanding the Anatomy of the Craniocervical Junction
Arteries
C1 and C2
Ligaments
Other Anatomical Structures
Complications
Discussion
Conclusion
References
5: Anterior Subaxial Cervical Approach
Part I: General Considerations of the Anterior Cervical Approach
History of the Anterior Cervical Exposure
General Considerations of the Anterior Cervical Approach Versus Posterior Approach
Pertinent Neural Anatomy
Pathology
Anterior Cervical Exposure and Local Anatomy
Reconstruction and Stabilization: Options and Challenges
Complications and Avoidance
Part II: Oncologic Considerations of Anterior Cervical Surgery
Primary Versus Metastatic Lesions
Primary Spinal Tumors
Metastatic Lesions
Diagnostic and Therapeutic Adjuncts to Surgery
Goals of Surgery
Other Concerns
Part III: Case Illustrations
Hemangioma of C4
Ventral Meningioma at C4âC5
Cervical Chordoma
References
6: Cervicothoracic Approach: Manubriotomy and Sternotomy
Introduction
Approach Overview
Surgical Technique
Patient Positioning
Low Anterior Approach
Modified Anterior Approach
Sternal Splitting Approach
Alternative Vascular Corridors
Complications
Dangers
The Vagus and Recurrent Laryngeal Nerves
Thoracic Duct
Cervical Sympathetic Trunk
Case Report
History
Examination and Imaging
Procedure
Postoperative Course
References
7: Posterolateral Thoracotomy
Anatomy
Positioning
Procedure
Exposure
Localization
Corpectomy
Closure
Postoperative Care
Complications
References
8: Minimally Invasive Thoracoscopic Approach to the Anterior Thoracic Spine
Introduction
Equipment for Thoracoscopic Surgery
Video Imaging System
Endoscopic Tools
Endoscopic Spinal Reconstruction
Preoperative Considerations
Single-Lung Ventilation
Indications and Contraindications
Patient Education and Informed Consent
Operative Technique
Patient Positioning
Thoracoscopic Access and Exposure
Thoracolumbar Junction Access
Vertebral Body Exposure
Placement of Screws and Instrumentation
Corpectomy and Spinal Canal Decompression
Interbody Reconstruction and Endoscopic Stabilization
Placement of Chest Tube and Closure
Results
Conclusion
References
9: Thoracoabdominal Approach for Tumors of the Thoracolumbar Spine
Anatomic and Biomechanical Considerations
Operative Technique
Choosing Surgical Approach
Patient Positioning
Thoracoabdominal Exposure
Decompression
Reconstruction and Instrumentation
Closure
Case Presentation
Imaging
Pathologic Diagnosis
Tumor Staging and Surgical Planning
Preoperative Optimization
Operative Technique
Clinical Outcome
Conclusion
References
10: Retroperitoneal Approach to the Lumbar Spine: A Case-Based Approach for Primary Tumor
Introduction
Planning Principles
Indications for Anterior Lumbar Retroperitoneal Approach
Surgical Anatomy of the Anterior Lumbar Retroperitoneal Approach
Specific Considerations by Level
Complications
Case Description: History, Examination, and Radiological Diagnosis
Case Description: Staging
Case Description: Surgical Planning
Case Description: Procedure
Case Description: Posterior Approach
Case Description: Anterior Retroperitoneal Approach
Case Description: Removal of the Diseased Vertebra
Case Description: Postoperative Course
References
11: Anterior Lumbar and Lumbosacral Approach: Transperitoneal
Case Presentation
Introduction
Staging and Surgical Planning
Adjuvant Therapy
Chemotherapy
Percutaneous Techniques
Radiation Therapy
Surgical Approaches
Vertebrectomy
Posterior Vertebrectomy
Anterior Vertebrectomy
Sagittal Resection
Resection of the Posterior Arch
Surgical Technique: Transperitoneal Vertebrectomy
Approach
En Bloc Corpectomy
Reconstruction
Complications
Conclusion
References
Part II: Posterior Approaches
12: Occipital-Cervical Approach and Stabilization
Anatomy
Diagnosis and Decision-Making
Operative Techniques
Approach
Positioning
Neuromonitoring
Exposure
Decompression
Instrumentation
Closure
Complications
Case Presentation 1
Case Presentation 2
References
13: Posterior Subaxial Cervical Approach and Stabilization
Introduction
Clinical Evaluation
Clinical Scenario
Positioning
Surgical Approach
Decompression and Tumor Resection
Fusion
Closure
Complications
Clinical Pearls
References
14: Anterior/Anterolateral Thoracic Access and Stabilization from Posterior Approach: Transpedicular, Costotransversectomy, Lateral Extracavitary Approaches: Standard Intralesional Resection
Introduction
Case Description
Procedure
Outline of Steps
Preoperative Image Review and Surgical Planning
Positioning
Neuromonitoring
Localization
Incision
Pedicle Screw Placement
Bone Removal
Rib Dissection
Rib Resection
Rib Disarticulation
Laminectomy
Pars and Facets
Temporary Rod
Transpedicular Resection
Corpectomy
Nerve Root
Boundary Localization
Boundary Dissection
Resection of Vertebral Body
Fusion and Cage Placement
Cage Placement
Posterior Instrumentation
Case Follow-Up
Discussion and Conclusion
References
15: Antero/Anterolateral Thoracic Access and Stabilization from a Posterior Approach, Costotransversectomy, and Lateral Extracavitary Approach, En Bloc Resection
Introduction
Anatomy
Case 1: Posterior-Only En Bloc Spondylectomy for Giant-Cell Tumor of Bone
Posterior Exposure
Passage of Saws
Osteotomies and Reconstruction
Case 2: En Bloc Spondylectomy with Chest Wall Excision for Ewingâs Sarcoma
Discussion
Conclusion
References
16: Anterior/Anterolateral Thoracic Access and Stabilization from Posterior Approach, Transpedicular, Costotransversectomy, Lateral Extracavitary Approaches via Minimally Invasive Approaches, Minimal Access and Tubular Access
Introduction
Preoperative Evaluation
Surgical Techniques
Mini-Open Transpedicular Approach
Indications
Patient Positioning
Surgical Details and Special Considerations
MISS Costotransversectomy Approach
Indications
Patient Positioning
Surgical Details and Special Considerations
MISS Lateral Extracavitary Approach
Patient Positioning
Surgical Details and Special Considerations
Lateral Approach
Patient Positioning
Surgical Details and Special Considerations
Postoperative Care
Conclusion
References
17: Posterolateral Approach to Thoraco-Lumbar Metastases - Separation Surgery
Introduction
Case Presentation
Diagnostic Workup
Surgery
Discussion
Conclusion
References
18: Minimally Invasive Stabilization Alone (Thoracic and Lumbar): Cement Augmentation
Introduction
Patient Selection
Minimally Invasive Methods and Case Studies
Cement Augmentation
Percutaneous Screws and Fixation Systems
Combination Techniques
Associated Procedures
Case Presentations
Case 1: Vertebroplasty for Compression Fractures in the Setting of Multiple Myeloma
Case 2: Fenestrated Screw Placement with Cement Augmentation for Osteopenic Bone in the Setting of Spine Metastasis
Case 3: Cement Augmentation with Pedicle Screws to Correct Kyphotic Deformity in the Setting of Spine Cancer
Case 4: Vertebrectomy and Reconstruction of the Vertebral Column with Cement Augmentation
Discussion and Conclusion
References
19: Percutaneous Stabilization
Introduction
Case Presentation
Diagnostic Workup
Treatment Approach
Surgery
Discussion
Conclusion
References
20: Posterior Lumbar and Sacral Approach and Stabilization: Intralesional Lumbar Resection
Introduction
Goals of Surgery: Strategy and Approach Considerations
An Integrated Approach with Radiation Planning
Clinical Presentation: Spine Tumor Pain
Radiological Evaluation
Case Illustration: Lumbar
Surgical Technique: Pearls and Planning
Case Illustration: Lumbosacral
Conclusion
References
21: Lumbar En Bloc Resection
Introduction
Indications and Margins
Surgical Planning
Type 1
Type 2
Type 2a
Type 2b
Type 2c
Type 3a
Type 3b
Type 3c
Type 4
Type 5
Type 6
Type 7
Complications
Case-Based Planning of Lumbar En Bloc Resection
Discussion and Conclusion
Conclusion
References
22: Intralesional Sacrectomy
Anatomic Considerations
Patient Evaluation
Operative Techniques
Positioning and Monitoring
Surgical Exposure
Intralesional Sacrectomy for Sacral Metastasis
Posterior Nerve-Sparing Sacrectomy
Closure
Case Presentation 1
Case Presentation 2
References
23: Technique of Oncologic Sacrectomy
Introduction
Patient Presentation
Patient Evaluation
Pre-operative Planning
General Pre-operative Preparation
Anterior Approach
Posterior Approach
Spinopelvic Reconstruction
Post-operative Care
Complications
Outcomes
Case Presentation 1
Conclusion
References
Part III: Intradural Approaches
24: Intradural Extramedullary Tumor: Cervical
Introduction
Patient Selection
Operative Planning and Approach
Modifications, Pearls, Pitfalls, and Specific Considerations
Intradural Exposure/Dissection
Nerve Sheath Tumors
Modifications, Pearls, Pitfalls, and Specific Considerations
Dumbbell Tumors
Modifications, Pearls, Pitfalls, and Specific Considerations
Meningiomas
Modifications, Pearls, Pitfalls, and Specific Considerations
Wound Closure and Postoperative Management
Modifications, Pearls, Pitfalls, and Specific Considerations
Conclusion
References
25: Intradural Extramedullary Tumor: Thoracic
Schwannomas
Meningiomas
Surgical Technique
Posterior/Laminectomy (Fig. 25.1)
Other Approaches (Figs. 25.2, 25.3, 25.4 and 25.5)
Case Presentation 1
References
26: Intradural Extramedullary Tumor in the Lumbar Spine
Introduction
Anatomical Basis
Preoperative Considerations
Surgical Technique
Operating Room Setup
Localization and Positioning
Planning the Incision
Incision and Exposure
Exposure and Laminectomy
Dural Opening
Resection of the Lesion
Closure of the Dura
Case Presentation
Clinical History and Neurological Examination
Radiographic Studies
Preoperative Considerations
Surgical Technique
Postoperative Course
Complications and Strategies for Complication Avoidance
Cerebrospinal Fluid Leak
Localization of the Lesion
Conclusion
References
27: Intradural, Intramedullary Tumor
Introduction
Operative Treatment
Surgical Anatomy
Operative Technique
Intraoperative Neuromonitoring
Operative Complications
Early Complications
Delayed Complications
Conclusion
References
28: Minimally Invasive Intradural Tumor Resection
Introduction
Patient Selection: Indications, Advantages, and Disadvantages
Preoperative Assessment and Planning
Surgical Technique
Positioning and Anesthesia
Exposure
Tumor Resection
Dural Closure
Postoperative Care and Concerns
Case Presentation (Video 28.1)
Discussion
Conclusion
References
Index