Unilateral Biportal Endoscopic Tumor Removal and Percutaneous Stabilization for Extradural Tumors: Technical Case Report and Literature Review

UBE单侧双通道内镜下肿瘤切除及经皮固定治疗硬膜外肿瘤：病例报告及文献复习

Background:

Extradural spinal tumors arise from soft or bony tissues in the spine and account for majority of spinal tumors. Interest in the unilateral biportal endoscopic (UBE) technique is rising, because it can easily decompress the bony spinal canal and accommodate all open surgical instruments under endoscopic guidance. However, reports of this technique have been limited to certain diseases. This study first demonstrates the UBE technique for extradural tumor biopsy and removal, and percutaneous stabilization in a 72-year-old female patient with dramatic symptom improvement. 

背景：

脊髓硬膜外肿瘤起源于脊柱的软组织或骨性组织，占脊髓肿瘤的大部分。人们对单侧双通道脊柱内镜(UBE)技术越来越感兴趣，因为它可以轻松地对骨椎管减压，并在内镜引导下容纳所有开放的手术器械。然而，关于这种技术的报道仅限于某些疾病。本研究证实UBE技术用于硬膜外肿瘤活检和切除，并对一位72岁的女性患者进行经皮稳定治疗，患者症状明显改善。

Methods: 

We used the UBE technique for decompression and the percutaneous screw fixation technique for stabilization in a patient with an extradural mass compressing the thecal sac and destroying the posterior element. Under endoscopic guidance, a unilateral approach was used, and decompression and flavectomy were performed bilaterally. After decompression, tumor removal and biopsy were performed using various forceps and biopsy needles. After confirming sufficient spinal canal decompression, the screw was placed percutaneously. We evaluated the technical process of the procedure, the patient’s pre- and postoperative pain (using the visual analog scale), and operative radiology and pathologic results. 

方法：

在内镜引导下，采用单侧入路，双侧行减压和黄体切除术。减压后，使用各种钳和活检针进行肿瘤切除和活检。确认椎管减压充分后，经皮置入螺钉。我们评估了手术的技术过程，患者的术前和术后疼痛(使用视觉模拟量表)，以及手术放射学和病理结果。

Results:

Postoperative pain and disability improved clinically, and spinal alignment stabilized radiologically. As the pathology findings confirmed an aneurysmal bone cyst, the treatment was completed without adjuvant therapy. 

结果：
由于病理结果证实为动脉瘤样骨囊肿，治疗结束，没有辅助治疗。

Conclusions: 

We treated an unstable spine due to an extradural tumor with the UBE and percutaneous screw techniques.

结论：

我们采用UBE和经皮螺钉技术治疗硬膜外肿瘤引起的脊柱不稳定。