# Modified Hemilaminectomy for Bilateral Exposure in Intramedullary Spinal Cord Tumor Resection

## TL;DR

A modified surgical technique allows for effective removal of spinal cord tumors through a single incision, preserving neurological function and minimizing complications.

## Contribution

A novel hemilaminectomy technique is introduced for unilateral access to bilateral spinal cord tumor resection.

## Key findings

- Gross total resection was achieved in 92.9% of patients with no new permanent neurological deficits.
- The approach showed statistically significant functional recovery and no postoperative cord tethering.
- The technique is reproducible with a shallow learning curve for experienced surgeons.

## Abstract

What are the main findings?
A modified hemilaminectomy can provide bilateral dorsal spinal cord exposure and allow midline myelotomy through a unilateral posterior approach in selected cases.In this series, the technique was associated with satisfactory resection rates and preservation of postoperative neurological function.

A modified hemilaminectomy can provide bilateral dorsal spinal cord exposure and allow midline myelotomy through a unilateral posterior approach in selected cases.

In this series, the technique was associated with satisfactory resection rates and preservation of postoperative neurological function.

What are the implications of the main findings?
This approach may represent a viable minimally invasive option for carefully selected intramedullary spinal cord tumors.Preservation of posterior elements and tailored dural management could contribute to limiting postoperative morbidity and maintaining spinal cord–dural separation.

This approach may represent a viable minimally invasive option for carefully selected intramedullary spinal cord tumors.

Preservation of posterior elements and tailored dural management could contribute to limiting postoperative morbidity and maintaining spinal cord–dural separation.

Background: Posterior approaches to intramedullary spinal cord tumors traditionally rely on bilateral laminotomy or laminoplasty to ensure adequate midline exposure and contralateral dissection. Unilateral approaches are seldom applied in this context, due to concerns regarding insufficient visualization and limited working angles across the midline. Objective: To describe a modified hemilaminectomy technique designed to achieve safe midline myelotomy and bilateral tumor dissection through a unilateral corridor, preserving the structural and clinical benefits of minimally invasive posterior access. Methods: Fourteen patients with intramedullary spinal cord tumors underwent resection via a refined hemilaminectomy technique, which incorporated systematic thinning of the spinous process and strategic dural suspension. Pre- and postoperative neurological status was assessed using the modified McCormick scale. Surgical parameters, postoperative outcomes, and radiological follow-up were retrospectively collected. Results: Gross total resection was achieved in 13 of 14 patients (92.9%), with no new permanent neurological deficits. The mean surgical duration was 194.8 ± 55.9 min, and mean hemoglobin decrease was 1.47 ± 0.94 g/dL. Early postoperative improvement in McCormick grade was observed in 50% of cases, with statistically significant overall functional recovery (p = 0.013). No cases of postoperative cord tethering were identified on follow-up magnetic resonance imaging. The approach was technically reproducible and ergonomically favorable, with a shallow learning curve in surgeons experienced with conventional hemilaminectomy. Conclusions: The modified hemilaminectomy technique enables effective bilateral exposure and safe midline myelotomy through a unilateral approach, achieving high resection rates with minimal morbidity. It represents a feasible and reproducible alternative to bilateral approaches and warrants prospective validation.