Laminoforaminotomy With a Novel Technique: The "3P Method" and Open-Door Laminoplasty for Cervical Dumbbell Tumor: 2-Dimensional Operative Video

Abstract

Spinal dumbbell tumors are hourglass-shaped tumors that consist of intraspinal, foraminal, and/or extraforaminal portions. Gross total resection of these tumors must be achieved to prevent recurrence. Total facetectomy could be performed to remove the foraminal and extraforaminal portions of the tumor; however, this process destabilizes the cervical spine and requires screw fixation. To achieve gross total resection while preserving the facet joint, we performed laminoforaminotomy with a novel technique called the "3P method" along with open-door laminoplasty. The 3P method involved the following steps: (1) "P"ulling the tumor with a pituitary forceps through laminoforaminotomy, (2) "P"ushing the Gelfoams into the foramen, and (3) "P"ressure increase due to the Gelfoams facilitating the pulling of the tumor. We report the case of a 52-year-old woman who presented with a 6-month history of tingling sensations in her right arm and bilateral legs. Physical examination showed decreased motor power in the right arm (elbow flexion and extension grade 4, hand grasping grade 4). Magnetic resonance imaging (MRI) showed a homogenously enhanced dumbbell tumor of approximately 2.3 x 1.2 x 3.5 cm at the C2-3 level. The patient underwent an operation that used 2 techniques: laminoforaminotomy with the 3P method for the foraminal portion and open-door laminoplasty for the intradural portion. Open-door laminoplasty was performed to prevent postoperative deformity. Gross total resection of the tumor was achieved, and postoperative MRI showed no residual tumor. Preoperative symptoms of tingling sensations were resolved. Informed consent was obtained from the patient before performing the operation.