Abstract
BACKGROUND: Intramuscular myxomas (IMs) are rare benign neoplasms of fibroblastic origin, typically presenting in adults, with a female predominance. IMs are uncommonly located in the skeletal muscles, most frequently in the thighs, but rarely in the paraspinal region. IM may be located deeply in this region and that could present a challenge for complete resection. CASE PRESENTATION: A 66-year-old woman presented with progressive lower back pain and radicular symptoms, which were due to a paraspinal IM. CASE MANAGEMENT: The patient underwent a minimally invasive microsurgical resection assisted by a 45° endoscopic microinspection tool (QEVO) to enhance visualization and access the lateral compartment of the tumor. Microsurgical dissection assisted with endoscopic visualization allowed successful resection of the tumor, including its lateral compartment, without extensive muscle transection. No complications occurred during or after surgery, and the patient reported complete symptom relief with no recurrence after 2 years. TECHNOLOGY: This case demonstrates the value of integrating endoscopic tools in spinal surgery, particularly in cases where conventional microsurgical techniques are insufficient for complete tumor resection using less invasive approaches. The enhanced visualization provided by the 45° endoscope facilitated the successful resection of a paraspinal lesion, improving surgical precision and patient outcomes. CONCLUSIONS: The QEVO microinspection tool is an effective adjunct to microsurgical techniques, offering enhanced visualization and precision during tumor resection. This case highlights its potential to address the challenges posed by deeply located paralumbar tumors. As further research explores its use in spine surgery, this microinspection tool could become an important asset in minimally invasive spinal tumor resections, improving patient outcomes through better tissue preservation and complete resection.