Spinal intradural microsurgery in a nascent neurosurgical department: Lessons learned from the first 25 cases.
Henry Pesach Shapiro, Hamzeh Zaghal, Nevo Margalit, Iddo Paldor, Yair Barzilay, Gustavo Rajz, Avner Michaeli, Shira Simcha Nouriel, John Sloan Winestone
Author Information
Henry Pesach Shapiro: Department of Neurosurgery, Shaare Zedek Medical Center, Shmuel Bait 12, Jerusalem, Israel; Faculty of Medicine, The Hebrew University, Jerusalem, Israel.
Hamzeh Zaghal: Faculty of Medicine, The Hebrew University, Jerusalem, Israel; Department of Medicine, Shaare Zedek Medical Center, Jerusalem, Israel.
Nevo Margalit: Department of Neurosurgery, Shaare Zedek Medical Center, Shmuel Bait 12, Jerusalem, Israel; Faculty of Medicine, The Hebrew University, Jerusalem, Israel.
Iddo Paldor: Department of Neurosurgery, Shaare Zedek Medical Center, Shmuel Bait 12, Jerusalem, Israel; Faculty of Medicine, The Hebrew University, Jerusalem, Israel; The Alexander Silberman Institute of Life Sciences, The Hebrew University of Jerusalem, Edmond J. Safra Campus - Givat Ram, Jerusalem, Israel.
Yair Barzilay: Spine Unit of the Department of Orthopedics, Shaare Zedek Medical Center, Shmuel Bait 12, Jerusalem, Israel; Faculty of Medicine, The Hebrew University, Jerusalem, Israel.
Gustavo Rajz: Department of Neurosurgery, Shaare Zedek Medical Center, Shmuel Bait 12, Jerusalem, Israel; Faculty of Medicine, The Hebrew University, Jerusalem, Israel.
Shira Simcha Nouriel: Department of Neurosurgery, Shaare Zedek Medical Center, Shmuel Bait 12, Jerusalem, Israel.
John Sloan Winestone: Department of Neurosurgery, Shaare Zedek Medical Center, Shmuel Bait 12, Jerusalem, Israel; Faculty of Medicine, The Hebrew University, Jerusalem, Israel. Electronic address: winestone@szmc.org.il.
BACKGROUND: Between 2017 and 2021, the newly established Department of Neurosurgery at Shaare Zedek Medical Center in Jerusalem, a high volume metropolitan hospital, operated on 25 intradural lesions in 24 patients (one patient had multiple tumors). In this retrospective study, we review results and lessons learned as experienced surgeons opened a new service line. METHODS: A multidisciplinary team was assembled and led by experienced neurosurgeons with skills in both microneurosurgery and complex spine care. Standard operative techniques were used. A chart review was done to assess complications and outcome. RESULTS: 25 lesions were reviewed in 24 patients (14 female; 10 male) between the ages of 11-82 years of age. In 14 cases, gross total resection (GTR) was achieved; 11 cases underwent partial resection. Of the 11 non-GTR cases, 3 were initially planned as biopsies. In one case, there was a significant neurologic decline directly related to surgery. In a separate case, there was iatrogenic instability, necessitating further treatment. CONCLUSIONS: We identify six lessons learned in a nascent neurosurgical department, noting that surgical excellence is of paramount importance, but that the surgeon must also expand his/her role from master technician to team leader. Both microsurgical expertise for neural anatomy and understanding of spinal biomechanics for osseous anatomy is mandatory for surgery of SIDT. This retrospective analysis of our case series demonstrates experienced neurosurgeons can successfully deploy a new service line for challenging cases to the benefit of the hospital and local community.
