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A novel lateral myelotomy approach for the treatment of lateral or ventrolateral spinal gliomas

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Abstract

Objective

To describe a novel surgical approach in which myelotomy was performed lateral to the dorsal root entry zone (LDREZ), for the treatment of lateral or ventrolateral spinal intramedullary glioma.

Methods

This study reviewed six patients with lateral or ventrolateral spinal intramedullary glioma who received surgical treatments by using myelotomy technique of LDREZ approach. The patient’s clinical characteristics, magnetic resonance imaging (MRI) results, and follow-up outcomes were analyzed. The neurological function of patients before and after operation was assessed based on the Frankel scale system. The anatomical feasibility, surgical techniques, advantages and disadvantages of LDREZ approach were analyzed.

Results

Myelotomy technique of LDREZ approach was employed in all 6 patients. Gross total resections were achieved in 4 patients, and 2 patients with astrocytoma (case 2, 6) underwent partial removal. The perioperative recovery was all smooth and all the patients were discharged on schedule. All the patients who suffered from neuropathic pain were relieved. After surgery, neurological function remained unchanged in 3 patients. 2 patients improved from Frankel grade B to C, and 1 patient deteriorated from Frankel grade D to C immediately after surgery and returned to Frankel grade D at 3 months follow-up. Regarding to the poor prognosis of high-grade glioma, the two cases with WHO IV glioma didn’t achieve long survival.

Conclusion

LDREZ approach is feasible and safe for the surgical removal of lateral or ventrolateral spinal gliomas. This approach can provide a direct pathway to lateral or ventrolateral spinal gliomas with minimal damage to normal spinal cord.

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Data availability

The clinical information and surgical video are approved by the patient.

Code availability

Not applicable.

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Funding

No funds were received in support of this study.

Author information

Authors and Affiliations

  1. School of Medicine, Wuhan University of Science and Technology, Wuhan, China

    Gai Hang, Yukang Gong & Hang **e

  2. Department of Neurosurgery, Central Theater General Hospital of Chinese PLA, Wuhan, China

    Tianhao **e

Authors
  1. Gai Hang
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  2. Yukang Gong
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  3. Hang **e
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  4. Tianhao **e
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Contributions

Conceptualization: Tianhao **e. Formal Analysis: Gai Hang. Investigation: Hang **e, Tianhao **e. Methodology: Tiabhao **e, Gai Hang. Project Administration: Yukang Gong. Writing – Original Draft: Gai Hang. Writing – Review & Editing: Tianhao **e, Gai Hang.

Corresponding author

Correspondence to Tianhao **e.

Ethics declarations

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by The General Hospital of Chinese PLA Central Theater Command Institutional Review Board, Wuhan, China.

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Informed consent was obtained from all individual participants included in the study.

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Informed consent was obtained from the patient for publication of this case report and any accompanying images.

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All the authors declare that they have no conflict of interest.

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Hang, G., Gong, Y., **e, H. et al. A novel lateral myelotomy approach for the treatment of lateral or ventrolateral spinal gliomas. Acta Neurochir 166, 237 (2024). https://doi.org/10.1007/s00701-024-06139-2

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