Case ReportAwake Intradural Spinal Tumor Resection; Case Report and Literature Review
Introduction
Spinal tumors represent 2%–4% of central nervous system tumors and can be intramedullary, intradural extramedullary, or extradural.1 Approximately 40%–50% of spinal tumors are intradural lesions, and the vast majority are extramedullary.2 About 25%–46% of the intradural spinal tumors are meningiomas.3, 4 The peak incidence is in the fifth and sixth decade age group with female predominance.5, 6 Patients most commonly present with pain followed by gait disturbances, sensory changes, and sphincter problems.5 Meningiomas are slowly growing benign lesions, and therefore the gold-standard treatment is complete resection. To achieve this goal, surgical approach has been addressed thoroughly in literature ranging from more than 1-level laminectomies to minimally invasive endoscopic procedures.7 However, all these procedures are carried out under general anesthesia. Although minimally invasive spinal surgeries have been reported under local anesthesia and sedation,8, 9, 10 the literature is scarce regarding resection of intradural tumors under local anesthetic and sedation.
Herein, we report a case of thoracic intradural meningioma in a patient who presented with back and leg pain and gait disturbance and was found to have critical aortic stenosis, coronary artery disease, and severe chronic obstructive airway disease. She had her operation successfully under local anesthesia and sedation with significant improvement. We discuss the clinical presentation, imaging, and operative and anesthetic procedures.
Section snippets
Case Report
A 63-year-old female ex-smoker presented with 10 months' history of back pain and worsening bilateral leg pains. She had unremitting, progressively worsening pain that did not respond to maximal analgesic therapy. She reported reduced mobility over that period but no sphincter disturbances. Despite unsteadiness and ataxic gait on examination, she had normal power throughout her legs but altered light touch sensation and reduced joint position sense in her lower limbs, exaggerated patellar and
Discussion
Complete excision is the surgical aim of intradural spinal meningioma that causes spinal cord compression. The surgery is usually performed under general anesthesia on an urgent or semielective basis depending on the presenting symptoms and signs. However, rare patients may copresent with multiple comorbidities that may make general anesthesia high risk or even contraindicated. Performing the surgery under local anesthesia and sedation is an alternative option. Literature is lacking studies
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Cited by (4)
Awake C1-2 laminectomy, instrumentation, and fusion: Case report
2020, Journal of Neurosurgery: Spine
Conflict of interest statement: Dr. Shtaya is a clinical lecturer for the National Institute for Health Research. This paper was completed with no dedicated funding.