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Neurosurgery
Surgical Management of Spinal Metastatic Tumors The Anteri
Built from Feldman — Neurosurgical Operative Atlas: Neuro-Oncology
What’s inside
8 sections · 55 slides
Overview
- What this deck will teach you
Why This Problem Is Different
The goals of surgery are not what you might expect
- What a spinal metastasis is, and why it is hard
- So many factors feed the decision to operate
- Different disease, different goal of surgery
- The honest truth about surgery and survival
Choosing the Patient
Who is likely to benefit, and who is not
- How these patients present
- Timing is everything for neurological recovery
- Where the tumour sits picks the way in
Planning the Approach
Matching corridor to spinal level, and preparing safely
- The anterior lumbar approach: for the low lumbar spine
- The great vessels: the reason the front is dangerous
- Anterolateral retroperitoneal route: for T12-L4
- Quick reference: spinal level picks the corridor
- Why imaging before surgery is non-negotiable
Transperitoneal Lumbar Approach
Through the abdominal cavity to L4 and below
- Positioning and the skin incision
- Skin incision options for the anterior lumbar approach
- Incising the linea alba in the midline
- Getting down to the spine through the abdomen
- Dividing the peritoneum
- Opening the posterior peritoneum
- A nerve plexus you must respect
- Controlling the great vessels before you work
- Exposure of the promontory and great vessels
- Removing the tumour-filled vertebral body
- Rebuilding the gap and closing
Anterior Retroperitoneal Approach
Reaching the lumbosacral spine without entering the abdomen
- Why the retroperitoneal route has become preferred
- Incision choices and the University of Iowa practice
- Plane of dissection for the retroperitoneal route
- Developing the retroperitoneal plane
- Steps of the anterior retroperitoneal exposure
- Finding the vessels, the ureter, and the target discs
- Closing the retroperitoneal exposure
Anterolateral Retroperitoneal
From the side, for corpectomy between T12 and L4
- Why the surgeon comes in from the LEFT
- Positioning in the lateral decubitus, with a caution
- Cutting through the flank to the retroperitoneum
- Meeting the psoas muscle and the ureter
- Lumbar spine exposed from the side, showing the psoas
- Protecting the lumbar plexus during retraction
- Reconstructing after the corpectomy
- After corpectomy: mesh cage reconstruction
After Surgery and Pitfalls
Recovery, the risks to warn about, and the take-home message
- Postoperative management
- The complications to anticipate
- Two specific pitfalls worth naming
- Three ideas to carry away
- Viva: An L5 body metastasis - which anterior corridor, and why not the anterolateral retroperitoneal route?
- Conclusion
- References
- Neurosurgical Operative Atlas: Neuro-Oncology