Sample Report Laminectomy with Resection of Tumor
Preoperative Diagnosis: Likely metastatic tumor to spine, epidural T2-3 with spinal cord compression.
Postoperative Diagnosis: Metastatic epidural intraspinal tumor consistent with the lung mass, sarcomatoid carcinoma.
Procedure Performed: T12-L3 laminectomy and resection of epidural intraspinal metastatic tumor with microscope.
Anesthesia: General endotracheal.
Indications and Consent: The patient is a 63-year-old gentleman with recently diagnosed sarcomatoid cancer. He underwent needle biopsy of his lung mass. This is a left pericardial mass done with a blood patch. Because of low back pain and some weakness, he had MRI of the lumbar spine which showed some abnormal signal in the L1 virtual body, but bone scan showed no evidence of uptake. This was not consistent with any tumor. He has a lot of degenerative arthritis of the lumbar spine, and he has had two previous operations in the low back many years ago. There is no cord compression at this level. Unfortunately, as he has been here he has had some neurological deterioration in terms of his ability to walk, but not in terms of being able to move his legs. They have been weak and not able to support him this past week.
MRI spinal cord evaluation was then performed with repeat of the lumbar spine, and the lesion at L2-3 was identified as an epidural mass posterior dorsal to the cord, causing cord compression. His exam does not show myelopathy, but he is unable to bear weight. I discussed the surgical approach with the patient, and he requested the following be performed.
Details of Procedure: The patient was taken to the operating room. After induction of general endotracheal anesthesia, the patient was placed in the prone position on chest rolls. Head was placed in the Mayfield-Kees 3-point headholder. The upper thoracic area was prepped and draped in the usual aseptic fashion. A midline incision was made from about L1 to L3-4 and carried down through the investing fascia with Bovie electrocautery. The laminae of L1-3 were exposed with Bovie electrocautery and Cobb periosteal dissector. Cerebellar retractors were placed. Hemostasis was achieved with bipolar electrocautery and Bovie electrocautery. Spinous processes of L1, L2, and L3 were taken off, as was the base, with the Leksell rongeur. Then, using Black Max drill with a blue #24 tip under loupe magnification, the laminotomy was increased and then using microscope with 2- and 3-mm punches, the laminectomy was completed, more to the patient's left side than to the right. The tumor came into view. This was tougher and discolored tissue that was certainly different from the epidural fat. The tissue was sent off for frozen section and came back consistent with the same tissue that was obtained on the prior biopsy from his lung, specifically sarcomatoid carcinoma.
I resected all the tissue that was causing pressure on the spinal cord and chased off to the foramen on the left side, but certainly did not remove all of it. When I was done, the cord was completely decompressed and pulsating nicely. The edges of the tumor were cauterized with bipolar electrocautery. Wounds were irrigated with antibiotic solution. Hemostasis was also achieved with bone wax, as necessary.
A deep #15 round Jackson-Pratt drain was placed through a separate stab incision on the patient's right side of the wound, and then the wound was closed in multiple layers using interrupted 0 Vicryl in the muscular layer, second layer on the investing fascia, a third layer on the deep layer of superficial fascia, and then an interrupted subcuticular closure was accomplished with 3-0 Vicryl. Staples were placed to close the skin edge. A sterile dressing was applied. Needle and sponge counts were correct. Estimated blood loss was approximately 300 cc. Replacement was that of crystalloid only. There were no complications. Patient was extubated and taken to the recovery room in stable condition.
Postoperative Diagnosis: Metastatic epidural intraspinal tumor consistent with the lung mass, sarcomatoid carcinoma.
Procedure Performed: T12-L3 laminectomy and resection of epidural intraspinal metastatic tumor with microscope.
Anesthesia: General endotracheal.
Indications and Consent: The patient is a 63-year-old gentleman with recently diagnosed sarcomatoid cancer. He underwent needle biopsy of his lung mass. This is a left pericardial mass done with a blood patch. Because of low back pain and some weakness, he had MRI of the lumbar spine which showed some abnormal signal in the L1 virtual body, but bone scan showed no evidence of uptake. This was not consistent with any tumor. He has a lot of degenerative arthritis of the lumbar spine, and he has had two previous operations in the low back many years ago. There is no cord compression at this level. Unfortunately, as he has been here he has had some neurological deterioration in terms of his ability to walk, but not in terms of being able to move his legs. They have been weak and not able to support him this past week.
MRI spinal cord evaluation was then performed with repeat of the lumbar spine, and the lesion at L2-3 was identified as an epidural mass posterior dorsal to the cord, causing cord compression. His exam does not show myelopathy, but he is unable to bear weight. I discussed the surgical approach with the patient, and he requested the following be performed.
Details of Procedure: The patient was taken to the operating room. After induction of general endotracheal anesthesia, the patient was placed in the prone position on chest rolls. Head was placed in the Mayfield-Kees 3-point headholder. The upper thoracic area was prepped and draped in the usual aseptic fashion. A midline incision was made from about L1 to L3-4 and carried down through the investing fascia with Bovie electrocautery. The laminae of L1-3 were exposed with Bovie electrocautery and Cobb periosteal dissector. Cerebellar retractors were placed. Hemostasis was achieved with bipolar electrocautery and Bovie electrocautery. Spinous processes of L1, L2, and L3 were taken off, as was the base, with the Leksell rongeur. Then, using Black Max drill with a blue #24 tip under loupe magnification, the laminotomy was increased and then using microscope with 2- and 3-mm punches, the laminectomy was completed, more to the patient's left side than to the right. The tumor came into view. This was tougher and discolored tissue that was certainly different from the epidural fat. The tissue was sent off for frozen section and came back consistent with the same tissue that was obtained on the prior biopsy from his lung, specifically sarcomatoid carcinoma.
I resected all the tissue that was causing pressure on the spinal cord and chased off to the foramen on the left side, but certainly did not remove all of it. When I was done, the cord was completely decompressed and pulsating nicely. The edges of the tumor were cauterized with bipolar electrocautery. Wounds were irrigated with antibiotic solution. Hemostasis was also achieved with bone wax, as necessary.
A deep #15 round Jackson-Pratt drain was placed through a separate stab incision on the patient's right side of the wound, and then the wound was closed in multiple layers using interrupted 0 Vicryl in the muscular layer, second layer on the investing fascia, a third layer on the deep layer of superficial fascia, and then an interrupted subcuticular closure was accomplished with 3-0 Vicryl. Staples were placed to close the skin edge. A sterile dressing was applied. Needle and sponge counts were correct. Estimated blood loss was approximately 300 cc. Replacement was that of crystalloid only. There were no complications. Patient was extubated and taken to the recovery room in stable condition.