Redefining Treatment of Complex Spinal Surgery: Endoscopic Decompression and Tumor Resection of Renal Cell Carcinoma and Nerve Sheath Tumor

Introduction: Endoscopic surgery has emerged as a minimally invasive alternative to traditional open procedures for the management of complex spinal pathologies, including spinal metastatic disease and nerve sheath tumors. We present two cases utilizing endoscopic transpedicular techniques for spinal decompression and resection—one involving a T12 metastatic renal cell carcinoma (RCC) with pathologic burst fracture, and the other, a left-sided L3 schwannoma.

Methods: Operative videos, imaging, and clinical outcomes were reviewed for two patients treated at our institution. The first case, a 71M, underwent T12 biportal endoscopic corpectomy and T9-L3 percutaneous fusion for RCC metastasis. The second case, a 51F, had L3-L4 endoscopic decompression and foraminotomy for a suspected schwannoma. Both surgeries utilized endoscopic drills, osteotomes, and rongeurs, with a transpedicular approach to access and decompress neural structures.

Results: In Case 1, the 71-year-old male presented with back pain and gait disturbance, with imaging showing a T12 burst fracture (SINS 13, Bilsky 3). Endoscopic decompression and fusion achieved adequate spinal alignment and decompression, confirmed on imaging. The patient was discharged on post-operative day 2 and underwent uneventful stereotactic radiation.

In Case 2, the 51-year-old female experienced severe left thigh pain in the L3 distribution. Imaging identified an L3 nerve sheath tumor, suspected schwannoma. Endoscopic decompression and piecemeal tumor resection were performed, with pathology confirming schwannoma and no residual tumor on intra-operative imaging. Both patients reported significant symptomatic relief post-surgery.

Conclusion : Endoscopic spinal surgery is a viable, minimally invasive approach for complex conditions like metastatic disease and nerve sheath tumors, achieving effective decompression, tumor resection, and stabilization with low morbidity. These cases demonstrate the adaptability of endoscopic techniques for managing diverse spinal pathologies, suggesting potential benefits in broader clinical application. Additional demonstrations and reporting of longer-term outcomes using these techniques will further inform patient selection and elucidate risks and benefits of this novel surgical approach.