Diagnosis and Patient Evaluation
Ependymoma of the spine is diagnosed through imaging studies such as magnetic resonance imaging (MRI) or computed tomography (CT) scans. Patient evaluation includes assessing general health, neurological status, and other factors that may impact the surgical approach.
Review of imaging studies in detail to determine the location, size, and extent of the tumor. Optimal surgical approach is planned based on tumor characteristics, patient factors, and surgeon expertise.
Anesthesia and Patient Positioning
The patient is placed under general anesthesia, and positioned in the prone (face-down) position on the operating table to provide adequate exposure of the spine for the posterior approach.
Skin Incision and Exposure
A midline incision is made in the back over the affected spinal segment. Muscles and soft tissues are carefully dissected to expose the vertebral lamina, which may be removed to access the tumor.
Once the tumor is visualized, the surgeon carefully removes it while preserving the surrounding healthy spinal cord tissue. This requires meticulous dissection and careful monitoring of the spinal cord function during surgery to minimize the risk of damage to the nervous tissue.
Hemostasis and Closure
Bleeding is carefully controlled using surgical techniques, and the wound is closed using appropriate sutures or staples. Hemostasis is crucial to minimize the risk of postoperative bleeding.
The patient is closely monitored in the intensive care unit (ICU) or a specialized neurosurgical ward. Pain management, wound care, and early mobilization are important aspects of postoperative care. Physical and occupational therapy may also be initiated to help the patient regain strength and function.
Risks and Complications
Like any surgical procedure, surgery for ependymoma of the spine via the posterior approach carries risks and potential complications, including infection, bleeding, nerve injury, spinal cord damage, and complications related to anesthesia. The risk of complications can be minimized through careful patient selection, meticulous surgical technique, and postoperative monitoring.
The posterior approach is a common surgical technique for resecting ependymomas of the spine, with careful preoperative planning, precise surgical technique, and diligent postoperative care being crucial for successful outcomes.