Name of the Procedure:

Laminectomy for biopsy/excision of intraspinal neoplasm; intradural, intramedullary, cervical

• Common Names: Cervical Spinal Tumor Removal, Cervical Intradural Tumor Surgery

Summary:

A laminectomy for biopsy or excision of an intradural, intramedullary cervical neoplasm involves surgically removing a portion of the vertebrae to access the spinal cord and remove or biopsy a tumor located within the spinal cord covering (dura) and spinal cord itself in the cervical (neck) region.

Purpose:

This procedure addresses spinal tumors located inside the dura and within the spinal cord. The goals are to relieve symptoms caused by the tumor, obtain a tissue sample for diagnosis, or completely remove the tumor to prevent further complications.

Indications:

• Persistent or worsening neck pain.
• Neurological deficits such as weakness, numbness, or difficulty walking.
• Diagnostic imaging showing an intradural, intramedullary tumor.
• Biopsy to diagnose the type of neoplasm.
• Tumor resection to alleviate symptoms or prevent progression.

Preparation:

• Fasting: Patients may need to abstain from eating or drinking 6-8 hours before surgery.
• Medication Adjustments: Certain medications, especially blood thinners, might need to be paused. Specific instructions will be given by the healthcare provider.
• Diagnostic Tests: MRI, CT scans, and possibly preoperative blood tests.

Procedure Description:

1. Anesthesia: General anesthesia is administered to ensure the patient is unconscious and pain-free during the surgery.
2. Incision: A midline incision is made over the cervical spine.
3. Exposure: Muscles and soft tissues are retracted to expose the vertebrae.
4. Laminectomy: The lamina (a part of the vertebral bone) is removed to access the spinal canal.
5. Tumor Biopsy/Excision: The dura is carefully opened, and the tumor is located and biopsied or removed entirely. Delicate instruments and microscopic technology are used.
6. Closure: The dura is closed, followed by the surrounding tissues and skin.

Duration:

Approximately 3-6 hours, depending on the complexity and extent of the surgery.

Setting:

Performed in a hospital's operating room.

Personnel:

• Neurosurgeon or spine surgeon.
• Anesthesiologist.
• Surgical nurses and technicians.
• Possibly a neurophysiologist for intraoperative monitoring.

Risks and Complications:

• Infection.
• Bleeding.
• Spinal cord injury or nerve damage.
• Cerebrospinal fluid leak.
• Postoperative pain.
• Anesthesia-related risks.

Benefits:

• Alleviation of symptoms such as pain, weakness, and neurological deficits.
• Diagnosis through biopsy to guide future treatment.
• Potential removal of the tumor to improve prognosis and prevent further complications.
• Recovery timelines vary, often within weeks to a few months.

Recovery:

• Post-procedure Care: Hospital stay for monitoring, pain management, and possible physical therapy.
• Instructions: Wound care, medication management, activity restrictions (e.g., no heavy lifting), and follow-up appointments.
• Recovery Time: Initial recovery may take several weeks, with full recovery potentially taking a few months.

Alternatives:

• Radiotherapy: Non-surgical option, but not appropriate for all tumor types or locations.
• Chemotherapy: Used for certain types of spinal tumors, often in conjunction with other treatments.
• Observation: Monitoring smaller, asymptomatic tumors with regular imaging.

Patient Experience:

• During Procedure: The patient will be under general anesthesia and will not feel any pain or be aware.
• After Procedure: Expect some pain and discomfort at the incision site, managed with pain medication. Neurological status will be closely monitored. Return to normal activities will be gradual, following medical advice and physical therapy.