Hellow guys, Welcome to my website, and you are watching L3 Schwannoma Excision & Nerve Root Salvage using Mini-open Wiltse Approach (#budgetmealortho). and this vIdeo is uploaded by Dr Henry David Nava Dimaano at 2018-11-20T23:30:56-08:00. We are pramote this video only for entertainment and educational perpose only. So, I hop you like our website.
| Name | L3 Schwannoma Excision & Nerve Root Salvage using Mini-open Wiltse Approach (#budgetmealortho) |
| Video Uploader | Video From Dr Henry David Nava Dimaano |
| Upload Date | This Video Uploaded At 21-11-2018 07:30:56 |
| Video Discription | The patient is a 30+ year old lady who's been suffering from radiculopathic pain of her right lower extremity, mainly the hip & thigh levels. She basically feels lightning-like pain whenever she moves her right hip joint & thigh. She can't sit very well, nor walk well; and even lying down supine is painful. Her symptoms were initially diagnosed as having come from a right ovarian cyst; thus, she was operated for said cyst a few months back in a private hospital. But this treatment did not result in any post-op relief. And so, she was eventually referred to my senior consultant, Dr. Krypton Kho, who was my chief back during my Neurosurgery residency days in PGH. Dr Kho figured it was radicular (nerve root) impingement, and thus ordered for a plain lumbar MRI scan. As it turned out, it was a "dumbbell" tumor growing out of the right L3-L4 foraminal canal -- most likely a nerve sheath tumor of the L3 nerve root. Dr Kho messaged me from Dumaguete to show me the patient's MRI scans and ask me about my approach to such a relatively large tumor that was spilling out of the foraminal canal. His original idea was to go midline, do a full laminectomy, and excise the tumor starting from its central spinal canal end, going as far lateral as the exposure could allow. So I responded and said that it would be easier to just open up the foraminal canal via the same approach I use for my TLIF surgeries (i.e., a total facetectomy, with a much more extended laminotomy or hemilaminectomy). Of course, removing the facet joint that was essentially covering the intraforaminal component of the tumor would destabilize the L3-L4 motion segment, and would thus necessitate a fusion. Hence the TLIF that followed the tumor exposure & excision in this case. Cost of having the tumor surgery was a major consideration for the patient, since she had already spent a relatively large amount for the preceding ovarian cyst surgery that was done in a private hospital. Dr Kho's solution was to do this spine surgery out of a government hospital instead, thereby radically cutting down the costs and allowing the patient to avail of this surgery. Which is why we proceeded with the surgery in Negros Oriental Provincial Hospital, where the total cost of the spine surgery ended up at just one fourth the total estimated cost of a private hospital admission in Dumaguete -- basically equivalent to the cost of my enduro mountain bike. (And you can imagine how much more this surgery would've been had it been done in a private hospital in Cebu City, or in Metro Manila.) |
| Category | Science & Technology |
| Tags | Schwannoma | nerve root | dorsal root ganglion | DRG | foraminal canal | nerve sheath | tumor | neoplasm | Wiltse | transforaminal | TLIF | Dumaguete | NOPH | Negros Oriental | Krypton | neurosurgery | facet joint | facetectomy | hemilaminectomy | mini open |
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