Spinal Disorders: Fundamentals of Diagnosis and Treatment Part 102. Spinal disorders are among the most common medical conditions with significant impact on health related quality of life, use of health care resources and socio-economic costs. Spinal surgery is still one of the fastest growing areas in clinical medicine. | 1012 Section Tumors and Inflammation a Figure 4. Surgical treatment of a neurinoma Intraoperative views of a neurinoma at the thoracic region see Case Study 1 . a After the dural opening in the midline dissection of the rostral pole of the tumor is shown. b After intracapsular gutting of the tumor the spinal cord the roots and the ligamentum dentatum become visible. c View just at the time of opening of the arachnoidea at the rostral pole of the tumor. One recognizes a dorsal root crossing the tumor on its dorsal surface. d View at the end of the tumor removal. The neurinoma was carefully dissected and removed from the spinal cord preserving the posterior spinal veins. A part of the dorsal root with tumor attachment was removed together with the tumor. around 7 -15 . There is no clear correlation between the results and the extent of resection of the dural attachment. The surgical approach is usually via a laminectomy for midline dorsal tumors. A hemilaminectomy can sometimes be performed in small tumors more laterally located. For tumors in a lateroventral location a lateral approach has to be performed 7 9 23-25 33 35 . Intrinsic Spinal Cord Tumor Resection The surgical approach is mostly via a laminectomy with the patient in the prone position or sitting position. The opening should be large enough to expose the Intradural Tumors Chapter 35 1013 cranial and caudal poles of solid tumor. Intraoperative ultrasound echography can therefore be helpful for this purpose. After the laminectomy the dura and the arachnoidea are opened in the midline and the opened dural edge is secured by traction sutures. Most intramedullary spinal cord tumors are approached through an incision between the posterior column . spreading the sulcus medianus which can be difficult but is mostly possible by searching out small emerging veins in the sulcus Case Study 3 . Occasionally for hemangioblastomas or astrocytomas the access might be through the dorsal root entry zone. Once the tumor
