ArticleEuropean spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society2026
Minimally invasive extracavitary approach for selected ventral intradural extramedullary thoracic lesions: quantitative anatomical analysis and technical feasibility.
Article in European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeTo describe and evaluate the application of the minimally invasive extracavitary approach (miECA) for selected ventral intradural extramedullary thoracic lesions through a combined quantitative anatomical study and proof-of-concept clinical application.
backgroundSurgical treatment of ventral intradural extramedullary lesions of the thoracic spine remains technically demanding because the spinal cord lies directly within the operative corridor. Although conventional posterior approaches are effective in most cases, selected lesions may require substantial spinal cord mobilization to achieve adequate exposure, potentially increasing the risk of neurological morbidity.
methodsA quantitative anthropometric neuroimaging study was performed on a reference population to characterize the geometry of the miECA corridor to the ventral intradural (premedullary) space. Working distance (WD), maneuverability arc (MAC), and surgical angle of incidence (SAI) were measured using a previously validated operability score methodology. These data were integrated with a proof-of-concept clinical application to assess technical feasibility and safety. An illustrative case is presented.
resultsThe miECA provided a muscle-sparing, stability-preserving surgical corridor with favorable geometry, characterized by a median SAI of 55.0° (interquartile range [IQR] 50.0-60.0), a median MAC of 45° (IQR 40-65) and a median WD of 8.0 cm (IQR 6.0-9.0). This configuration enabled direct access to the ventral intradural premedullary space while minimizing the need for spinal cord mobilization. Endoscopic assistance further enhanced the visualization of the ventral intradural compartment. In the illustrative case, complete tumor resection was achieved without procedure-related neurological deterioration.
conclusionsThe miECA may represent a useful adjunct for carefully selected ventral intradural extramedullary thoracic lesions in which conventional posterior routes are expected to require substantial spinal cord manipulation. The present study establishes anatomical feasibility and provides preliminary technical guidance for future clinical applications.
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