Minimally Invasive Approach for the Treatment of Intradural Spinal Pathology

Ravi H. Gandhi, M.D; John W. Germ an, M.D.


Neurosurg Focus. 2013;35(2):e5 

In This Article


We have demonstrated that MIS approaches can be used to treat a large array of intradural pathology of both the intramedullary and extramedullary compartments. We have shown that neoplasms can be effectively and safely resected with a lower rate of CSF leakage and postoperative complications. We have confirmed earlier reports that resection of intradural, extramedullary neoplastic lesions,[4,12] intramedullary,[4,6] and cord detethering[11] can be accomplished. We have also described the use of MIS approaches to perform a Chiari decompression including intradural exploration and tonsillar resection, to perform a midline punctate myelotomy and cordotomy for intractable cancer related pain, for an intramedullary biopsy, and for syringosubarachnoid shunting. The use of a tubular retractor system and muscle splitting techniques allow for adequate visualization and a decrease in anatomical injury. This should allow for less postoperative pain and risk of spinal instability; however, this will require more extensive randomized, prospective trials to elucidate.