Contents lists available at ScienceDirect Clinical Neurology and Neurosurgery journal homepage: www.elsevier.com/locate/clineuro Spinal anesthesia in surgical treatment of lumbar spine tumors Ahmet Öğrenci a , Ezgi Akar b, *, Orkun Koban a , Semra Işık c , Mesut Şener d , Mesut Yılmaz e , Sedat Dalbayrak a a Okan University, Department of Neurosurgery, Istanbul, Turkey b Haydarpaşa Numune Training and Research Hospital, Department of Neurosurgery, Istanbul, Turkey c Başkent University Hospital, Department of Neurosurgery, Istanbul, Turkey d Okan University, Department of Anesthesiology, Istanbul, Turkey e Neurospinal Academy, Department of Neurosurgery, Istanbul, Turkey ARTICLE INFO Keywords: Spinal anesthesia Lumbar spine Metastasis Tumor ABSTRACT Objective: This study aims to show the feasibility of spinal anesthesia in lumbar spinal tumor surgery; share our data and experience. Patients and methods: : A retrospective review of 14 patients with high risk for general anesthesia due to severe comorbidities was carried out. Patients who underwent surgeries under spinal anesthesia for lumbar vertebral column or spinal cord tumors at a single center between 2007–2019 were evaluated. The final pathological diagnosis, operation time, and surgical procedures were analyzed. Also, preoperative and postoperative ad- vantages and disadvantages were determined. A comparison was performed with other 184 patients who were operated for spinal tumors in the same period under general anesthesia. Results: Maximum operation time was found 220 min, and the average operation time was 166 min. The most primary diagnosis was vertebral column metastasis. The mean age was 65.5 years. None of the patients required general anesthesia during surgery; however, two patients needed additional spinal anesthesia preoperatively, which was performed by the surgeon. Lumbar decompression and fusion were the most performed procedures. Conclusion: Spinal anesthesia is a feasible and useful method of anesthesia in lumbar spinal tumor surgery for especially elderly patients with American Society of Anesthesiologists (ASA) 3 or 4 score and high risk of general anesthesia. 1. Introduction Single-dose spinal anesthesia is generally a preferred anesthetic method for surgical procedures that takes less than 4 h or for patients with high risk for general anesthesia. Spinal anesthesia is commonly used in lumbar region surgeries for degenerative spinal disease. There are known advantages of performing spinal anesthesia for the spinal column and spinal cord surgeries when the predicted duration of sur- gery is suitable [1,2]. Considering case reports about spinal tumor surgeries with regional anesthesia are limited in the literature. There is not any report about surgical treatment for spinal tumors under only spinal anesthesia. Patients with high risk for general anesthesia and additional comorbidities can be treated with surgery for spinal tumors under spinal anesthesia. Patients with high ASA score, metastasis, im- paired general condition, and patients in the elderly age group are candidates for surgery under spinal anesthesia. However, there is not enough data in the literature about spinal tumor surgery under spinal anesthesia and surgical outcomes. The purpose of this study was to evaluate the indications for spinal anesthesia and share outcomes of the patients. 2. Patients and methods A retrospective review of 14 patients with spinal column or cord tumor operated under spinal anesthesia between 2007 and 2019 was performed. The candidates for spinal anesthesia were as follows: 1- Patients with American Society of Anesthesiologists (ASA) 3 or 4 score in preoperative anesthesiology evaluation; 2- Patients whose duration of surgery was estimated to be less than 4 h; 3-Patients who were sui- table for spinal anesthesia. Regardless of what the preliminary diagnosis was, spinal anesthesia was applied. The main goal of surgery was neural tissue decompression and spinal column stabilization. After premedication with 0.5 mg atropine sulfate, a peripheral https://doi.org/10.1016/j.clineuro.2020.106023 Received 28 January 2020; Received in revised form 3 May 2020; Accepted 14 June 2020 ⁎ Corresponding author at: Haydarpaşa Numune Training and Research Hospital, Istanbul, Department of Neurosurgery, Uskudar, Istanbul, Turkey. E-mail address: ezgiaycicek@gmail.com (E. Akar). Clinical Neurology and Neurosurgery 196 (2020) 106023 Available online 20 June 2020 0303-8467/ © 2020 Elsevier B.V. All rights reserved. T