Battistelli Marco, Valeri Federico, D'Ercole Manuela, Izzo Alessandro, Rapisarda Alessandro, Polli Filippo Maria, Montano Nicola
Department of Neuroscience, Neurosurgery Section, Università Cattolica del Sacro Cuore, Rome, Italy.
Department of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
Front Surg. 2024 Sep 2;11:1433273. doi: 10.3389/fsurg.2024.1433273. eCollection 2024.
The paraspinal approach was first introduced in 1968 and later refined by Leon Wiltse to gain access to the lateral interevertebral foraminal region. However, challenges can arise due to unfamiliarity with this approach, unique patient anatomy, or in case of revision surgery, potentially elevating the risk of complications and/or poor outcome.
Here we report on two cases in which the intraoperative Oarm CT neuronavigation was used during a Wiltse approach. Under general anesthesia, the spinous process near the surgical level is exposed through a midline incision. The patient's reference anchor is then attached to the exposed spinous process. Intraoperative CT is acquired and transferred to the Stealth Station S8 Surgical Navigation System (Medtronic). The Wiltse approach is now performed through a paramedian incision under neuronavigation guidance and perfectly tailored to the patient's unique anatomy.
The first case was a patient harboring a left lumbar intraextraforaminal schwannoma and the second one was a patient with an extraforaminal lumbar disc herniation at the adjacent level of a previous lumbar instrumentation. We were able to easily identify and remove both the lesions minimizing the surgical approach with no complication and optimal clinical outcome.
Our cases demonstrate the feasibility of application of intraoperative O-arm CT-neuronavigation to the Wiltse approach. In our opinion, this technique helps in minimizing the surgical approach and rapidly identifying the lesion of interest. Further studies are needed to address the effective utility and advantages of intraoperative CT-neuronavigation in this specific surgical scenario.
椎旁入路于1968年首次被引入，后来由利昂·威尔茨进行了改进，以进入外侧椎间孔区域。然而，由于对该入路不熟悉、患者独特的解剖结构或翻修手术的情况，可能会出现挑战，从而潜在地增加并发症风险和/或导致不良结果。
在此，我们报告两例在威尔茨入路手术中使用术中O型臂CT神经导航的病例。在全身麻醉下，通过中线切口暴露手术节段附近的棘突。然后将患者的参考锚钉附着于暴露的棘突上。获取术中CT并传输至Stealth Station S8手术导航系统（美敦力公司）。现在在神经导航引导下通过旁正中切口进行威尔茨入路，使其完全根据患者独特的解剖结构进行调整。
第一例患者患有左侧腰段椎间孔外神经鞘瘤，第二例患者在前次腰椎内固定相邻节段患有椎间孔外腰椎间盘突出症。我们能够轻松识别并切除这两个病变，将手术入路最小化，且无并发症发生，临床效果良好。
我们的病例证明了术中O型臂CT神经导航应用于威尔茨入路的可行性。我们认为，该技术有助于最小化手术入路并快速识别感兴趣的病变。需要进一步研究以探讨术中CT神经导航在这种特定手术场景中的有效作用和优势。
