Everything you need to know
The excision of an intradural lesion refers to a surgical procedure that involves removing an abnormal growth or lesion located within the dura mater (also known as dura), one of the protective layers that surrounds the brain and spinal cord. The dura is the outermost of the three layers of protective tissue (meninges) that encase the central nervous system. The dura is thick and tough and contains fluid (CSF) that helps to shield the delicate brain and spinal cord from potential damage or injury. It plays a crucial role in protecting these vital organs and keeping them in place within the skull and vertebral column.
Intradural lesions are rare. However, when they do grow, they can compress the spinal cord. This can cause pain, numbness, and difficulty moving your arms and/or legs. Keep in mind that having a lesion doesn’t mean you have cancer. Intradural lesions can include tumours, cysts (pockets of fluid), haematomas (when blood pools outside a blood vessel – this is similar to a bruise), or other growths or structures that can develop within the dura mater. Lesions can develop at any level of your spine, from your neck to your lower back.
Before surgery
Firstly, you will have an appointment with one of our spinal consultants. If you don’t already have a confirmed diagnosis, they will take a history, conduct a physical exam, and refer you for an MRI scan of your spine. You may need to have some blood tests as well.
If your doctor diagnoses you with an intradural lesion, they will talk you through your options. Surgery can usually cure benign growths. If the lesion is malignant, surgery on its own will not be a cure. However, it should improve your symptoms and prevent them from getting worse. Your doctor will walk you through the potential risks and details of the procedure so you can make an informed decision.
If you decide to go ahead with surgery, we will help you prepare. This will involve conducting some pre-operative testing, such as blood tests and an electrocardiogram (ECG), which records the electrical signal from your heart. We will also test you for MRSA and give you some antibacterial soap and lotions to use in the run up to the procedure. This will help reduce your risk of contracting MRSA.
If you take any blood thinners—for example, Warfarin or aspirin, tell your doctor straight away, as you may need to stop taking these or modify your intake from a week before surgery. Your doctor will give you specific instructions if this is the case. You should also tell your doctor if you take nonsteroidal anti-inflammatory drugs, such as ibuprofen.
From midnight on the day of your surgery, do not eat or drink anything. This includes water, chewing gum and hard candies. Brush your teeth with toothpaste only on the morning of surgery. If you take any prescriptions medications, bring them to hospital with you. Your doctor will let you know if you can take these with a sip of water before your surgery or if you should wait until after.
On surgery day, it’s a good idea to wear loose, comfortable clothing and bring a small bag with things you might need during your stay. Items to remember include a toothbrush and toothpaste, your phone and a charger, a book, any prescription medications and a change of clothes.
Once you have arrived and are settled in your room, a nurse will help prepare you for your procedure by monitoring your vital signs, including blood pressure, body temperature and weight, and will also run through your medical history, medications and emergency contacts.
Your doctor will then check in on you, run you through the procedure once again and ask you to sign a consent form that confirms you are happy to go ahead with surgery.
During surgery
Firstly, you’ll have an intravenous (IV) line fitted into a vein. This is usually on an arm or hand. Through this, your surgical team can quickly give you medications and fluids. The surgical team will also place monitors on you so you can stay safe throughout the surgery.
After some final safety checks, surgery can start, and you’ll be given general anaesthesia. This means you will be asleep throughout the procedure.
Firstly, your surgeon will make an incision. This will usually be in the back of your neck or along the spine. However, occasionally, the surgeon will go in from the front or back. Your surgeon will have explained to you beforehand which approach will be taken and why.
After making the incision, your surgeon will remove some bone and ligament so they can access the lesion.
Once the surgical team arrives at the dura, your surgeon will use a high-powered microscope so they can better see the delicate spinal structures. This will help the surgeon be more precise and make your procedure safer. Then, very carefully, the lesion will be removed.
Depending on how much bone was removed, your surgeon may also perform a fusion (screws and rods anchored to the spinal bones) to help preserve stability in your spine. The lesion will then be sent to a lab, who will confirm whether it is benign or not.
To finish, your surgeon will close your incision with stitches or staples
You are then be taken to our recovery area, where specialist staff will monitor your vital signs, including blood pressure, heart rate and oxygen levels, as you wake up from anaesthesia.
After surgery
Once we’re happy you’re doing well, we will take you to your private room where you can start your recovery. We’ll encourage you to start moving soon after your operation, so one of our physiotherapists will guide you through some exercises and an occupational therapist will take you through an assessment as well. Depending on your specific situation, you may need to stay in our hospital for up to two weeks following your procedure.
Once the team have given you the all-clear, you can go home.
Once you get home, it’s important to check your incision every day to make sure it’s healing well. You should keep it clean and dry. Don’t take a bath or go swimming until your doctor has given you to go-ahead.
Your stitches or staples will be removed around two weeks after surgery. Our team will book an appointment for you to have this done in our hospital.
Managing pain after surgery can be difficult, and you may find that the intensity of your pain fluctuates as you heal. This is totally normal. As your spine heals in the months following surgery, this should improve.
Unfortunately, recovering from an intradural lesion excision can take a long time and you may be in recovery for a few months. If your lesion is diagnosed as cancerous, you may need additional treatments, such as radiation or chemotherapy, to help you get better.
Whilst you heal, it’s important to avoid activities that involve bending, twisting or lifting. As such, you should ask for help with your laundry, cleaning and gardening.
You will also not be able to drive for at least four weeks after surgery and your surgeon will let you know when it’s ok to start driving again. As a general rule, do not drive if you are taking pain medications.
The most important part of your recovery is walking, which increases blood flow to the spine and helps speed up the healing process. Try walking regularly, slowly at first and progressing over time.
How to pay for your treatment
If you’re… paying for yourself
Did you know you don’t need private medical insurance to come to St John & St Elizabeth Hospital? As a self-pay patient, you can access safe, outstanding quality health care at times to suit you.
For scans and tests, as well as to see most consultants, you’ll still need to be referred by a medical professional like your GP, but as a self-pay patient, the process is more straightforward. You won’t need authorisation from an insurance provider, and you’ll have greater choice of consultant and appointment times.
If you’re… insured
St John & St Elizabeth Hospital is approved by all major medical insurance companies. If you have a personal private health insurance policy, or your company provide it for you, you can use it to pay for your care from your initial consultation through to treatment, surgery and aftercare such as physiotherapy. Not all private health insurance plans cover the same things. It’s very important to check exactly what you are covered for with your insurance provider.