Romanian Neurosurgery (Nov 2024)
THE ROLE OF NEUROSURGERY IN THE TREATMENT OF VERTEBRAL METASTASES
Abstract
Introduction Vertebral metastases represent a significant clinical challenge due to their potential to cause severe pain, neurological deficits, and spinal instability. Neurosurgery plays a crucial role in the multidisciplinary approach to treating vertebral metastases, aiming to alleviate symptoms, maintain or restore neurological function, and stabilize the spine. This abstract reviews the current role of neurosurgery in the management of vertebral metastases, focusing on surgical indications, techniques, outcomes, and integration with other therapeutic modalities. Neurosurgical intervention is typically considered in cases of intractable pain, progressive neurological deficits, spinal instability, or failure of non-surgical treatments. Advances in imaging techniques have enhanced the ability to accurately diagnose and plan surgeries, while innovations in surgical technology have improved the precision and safety of these procedures. Surgical options range from minimally invasive techniques, such as vertebroplasty and kyphoplasty, to more extensive decompressive and stabilizing procedures like laminectomy, corpectomy, and spinal fusion. Outcomes of neurosurgical treatment are generally favorable, particularly when patients are carefully selected based on established criteria such as the Spinal Instability Neoplastic Score (SINS) and the Neurologic, Oncologic, Mechanical, and Systemic (NOMS) framework. These tools assist in determining the most appropriate surgical approach and the timing of intervention. Moreover, neurosurgery is often part of a comprehensive treatment plan that includes radiation therapy, chemotherapy, and targeted biological therapies, which can enhance overall treatment efficacy. A critical aspect of future radiotherapy strategies involves maintaining a minimum of 2 mm between nervous tissue and cancer cells. This margin is essential to prevent radionecrosis of nervous tissue, a serious complication that can arise from radiotherapy. Ensuring this safe distance can help protect neural structures while effectively targeting cancerous cells, thus optimizing therapeutic outcomes and minimizing adverse effects. Despite the benefits, neurosurgery for vertebral metastases carries risks, including infection, bleeding, and potential for further neurological injury. Therefore, patient selection and preoperative planning are critical to optimize outcomes. Future directions in this field may include the development of more refined surgical techniques, enhanced integration of multimodal treatments, and better prognostic tools to guide therapy. Conclusion Neurosurgery remains a cornerstone in the management of vertebral metastases, offering significant symptomatic relief and functional improvement. Ongoing advancements in surgical methods and interdisciplinary care continue to enhance patient outcomes. References Di Perna G, Cofano F, Mantovani et al. (2020) Separation surgery for metastatic epidural spinal cord compression: A qualitative review. J Bone Oncol. Sep 26-25. Versteeg, A. L., Verlaan, J. J., Sahgal, A., et al. (2021). The role of minimally invasive surgery in the management of spinal metastases and the emerging field of spinal oncology. Journal of Clinical Medicine, 10(4), 847. Bakar, D., Tanenbaum, J. E., Phan, K., et al. (2016). Decompressive surgery for spinal metastases: The role of minimally invasive surgery and its impact on patient outcomes. Global Spine Journal, 6(6), 600-608. Pennington, Z., Ahmed, A. K., Molina, C. A., et al. (2020). Safety and efficacy of 3D navigation-guided minimally invasive surgery for the treatment of spinal tumors: A multi-institutional analysis. Journal of Neuro-Oncology, 147(3), 607-617. Zuckerman, S. L., Laufer, I., Sahgal, A., et al. (2020). When less is more: The indications for minimally invasive spine surgery in oncology. Neurosurgical Review, 43(2), 327-338.
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