Intramedullary Spinal Cord Tumors: Long-Term Follow-Up After Surgery

Melanocytomas are tumors of the neuraxis seen predominantly in adults. The authors report a case of a thoracic intramedullary melanocytoma with long-term follow-up of 8 years postsurgery. Melanocytomas, although rare, must be included in the differential diagnosis of intramedullary spinal cord tumors.

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Predictive Value of Transcranial Evoked Potential Monitoring for Intramedullary Spinal Cord Tumors

Journal of Neurological Surgery Part A Central European Neurosurgery ◽

10.1055/s-0040-1710504 ◽

2021 ◽

Author(s):

Sebastian Ille ◽

Arthur Wagner ◽

Ann Kathrin Joerger ◽

Maria Wostrack ◽

Bernhard Meyer ◽

...

Keyword(s):

Spinal Cord ◽

Predictive Value ◽

High Sensitivity ◽

Extent Of Resection ◽

Spinal Cord Tumors ◽

Intramedullary Spinal Cord ◽

Neurophysiologic Monitoring ◽

Long Term Follow Up

Abstract Background Intraoperative neurophysiologic monitoring (IONM) has increased patient safety and extent of resection in patients with eloquent brain tumors. Despite its comprehensive capability for the resection of intramedullary spinal cord tumors (ISCTs), the application during the resection of these tumors is controversial. Methods We retrospectively analyzed the resection of ISCTs in 83 consecutive cases. IONM was performed in all cases. Each patient's motor status and the McCormick scale was determined preoperatively, directly after surgery, at the day of discharge, and at long-term follow-up. Results IONM was feasible in 71 cases (85.5%). Gross total resection was performed in 75 cases (90.4%). Postoperatively, patients showed new transient deficits in 12 cases (14.5%) and new permanent deficits in 12 cases (14.5%). The mean McCormick variance between baseline and long-term follow-up was − 0.08 ± 0.54. IONM's sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for the patient's motor status at the day of discharge was 75.0%, 64.7%, 45.5%, and 86.8%. It was 88.9%, 59.7%, 24.2%, and 97.4% for the motor outcome at long-term follow-up. Patients experienced postoperative complications in 15 cases (18.1%). Conclusion IONM, as performed in the present study, shows a high sensitivity and NPV but low specificity and PPV, particularly for the patient's motor status at the long-term follow-up. As far as practicable by a retrospective study on IONM, our results confirm IONM's usefulness for its application during the resection of ISCTs. However, these results must be approved by a prospective study.

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Intramedullary spinal cord ependymomas ? a study of 45 cases with long-term follow-up

Acta Neurochirurgica ◽

10.1007/bf01541785 ◽

1992 ◽

Vol 119 (1-4) ◽

pp. 74-79 ◽

Cited By ~ 90

Author(s):

L. Ferrante ◽

L. Mastronardi ◽

P. Celli ◽

P. Lunardi ◽

M. Acqui ◽

...

Keyword(s):

Spinal Cord ◽

Intramedullary Spinal Cord ◽

Long Term Follow Up

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Management and prognosis of symptomatic patients with intramedullary spinal cord cavernoma

Journal of Neurosurgery Spine ◽

10.3171/2011.5.spine10735 ◽

2011 ◽

Vol 15 (4) ◽

pp. 447-456 ◽

Cited By ~ 35

Author(s):

Jian-tao Liang ◽

Yu-hai Bao ◽

Hong-qi Zhang ◽

Li-rong Huo ◽

Zhen-yu Wang ◽

...

Keyword(s):

Spinal Cord ◽

Case Series ◽

Symptom Duration ◽

Incomplete Resection ◽

Spinal Angiography ◽

Intramedullary Spinal Cord ◽

Long Term Follow Up ◽

Group 5

Object The authors conducted a study to assess the clinical pattern, radiological features, therapeutic strategies, and long-term outcomes in patients with intramedullary spinal cord cavernomas (ISCCs) based on a large case series. Methods This retrospective study identified 96 patients (60 males, 36 females) surgically (81 cases) or conservatively (15 cases) treated for ISCCs between May 1993 and November 2007. Each diagnosis was based on MR imaging and spinal angiography evidence. For all surgically treated patients, the diagnosis was verified pathologically. The neurological outcomes pre- and postoperatively, as well as long-term follow-up, were assessed using the Aminoff-Logue Disability Scale. Results The mean age at the onset of symptoms was 34.5 years (range 9–80 years). Of the lesions, 68 (71%) were located in the thoracic spine, 25 (26%) in the cervical spine, and only 3 (3%) in the lumbar spine. The median symptom duration was 19.7 months. The clinical behavior of the lesion was a slow progression in 73 cases and an acute decline in 23 cases. Long-term follow-up data (mean 45.8 months, range 10–183 months) were available for 75 patients (64 surgical cases and 11 conservative cases). In the surgical group, a complete resection was achieved in 60 patients, and incomplete resection was detected in 4 patients after operation. At the end of the follow-up period in the operative group, 23 patients (36%) improved, 35 (55%) remained unchanged, and 6 (9%) worsened. In the nonoperative group, 5 patients improved, 6 patients remained unchanged, and none worsened. Conclusions For differential diagnosis, spinal angiography was necessary in some cases. For most symptomatic lesions, complete microsurgical resection of the symptomatic ISCC is safe and prevents rebleeding and further neurological deterioration. However, in patients whose lesions were small and located ventrally in the spinal cord, one can also opt for a rigorous follow-up, considering the high surgical risk.

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Delayed variations in the diagnostic accuracy of intraoperative neuromonitoring in the resection of intramedullary spinal cord tumors

Neurosurgical FOCUS ◽

10.3171/2021.2.focus201084 ◽

2021 ◽

Vol 50 (5) ◽

pp. E21

Author(s):

Gil Kimchi ◽

Nachshon Knoller ◽

Akiva Korn ◽

Yahel Eyal-Mazuz ◽

Yechiam Sapir ◽

...

Keyword(s):

Spinal Cord ◽

Diagnostic Accuracy ◽

Postoperative Period ◽

Intraoperative Neuromonitoring ◽

Spinal Cord Tumors ◽

Intramedullary Spinal Cord ◽

Over Time ◽

D Wave

OBJECTIVE The use of intraoperative neuromonitoring (IONM) has become an imperative adjunct to the resection of intramedullary spinal cord tumors (IMSCTs). While the diagnostic utility of IONM during the immediate postoperative period has been previously studied, its long-term diagnostic accuracy has seldom been thoroughly assessed. The aim of this study was to evaluate long-term variations in the diagnostic accuracy of transcranial motor evoked potentials (tcMEPs), somatosensory evoked potentials (SSEPs), and D-wave recordings during IMSCT excision. METHODS The authors performed a retrospective evaluation of imaging studies, patient charts, operative reports, and IONM recordings of patients who were operated on for gross-total or subtotal resection of IMSCTs at a single institution between 2012 and 2018. Variations in the specificity, sensitivity, positive predictive value (PPV), and negative predictive value (NPV) for postoperative functional outcome (McCormick Scale) were analyzed at postoperative day 1 (POD1), 6 weeks postoperatively (PO-6 weeks), and at the latest follow-up. RESULTS Overall, 28 patients were included. The mean length of follow-up was 19 ± 23.4 months. Persistent motor attenuations occurred in 71.4% of the cohort. MEP was the most sensitive modality (78.6%, 87.5%, and 85.7% sensitivity at POD1, PO-6 weeks, and last follow-up, respectively). The specificity of the D-wave was the most consistent over time (100%, 83.35%, and 90% specificity at the aforementioned time points). The PPV of motor recordings decreased over time (58% vs 33% and 100% vs 0 for tcMEP and D-wave at POD1 and last follow-up, respectively), while their NPV consistently increased (67% vs 89% and 70% vs 100% for tcMEP and D-wave at POD1 and last follow-up, respectively). CONCLUSIONS The diagnostic accuracy of IONM in the resection of IMSCTs varies during the postoperative period. The decrease in the PPV of motor recordings over time suggests that this method is more predictive of short-term rather than long-term neurological deficits. The increasing NPV of motor recordings indicates a higher diagnostic accuracy in the identification of patients who preserve neurological function, albeit with an increased proportion of false-negative alarms for the immediate postoperative period. These variations should be considered in the surgical decision-making process when weighing the risk of resection-associated neurological injury against the implications of incomplete tumor resection.

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Long-term incidence and risk factors for development of spinal deformity following resection of pediatric intramedullary spinal cord tumors

Journal of Neurosurgery Pediatrics ◽

10.3171/2014.1.peds13317 ◽

2014 ◽

Vol 13 (6) ◽

pp. 613-621 ◽

Cited By ~ 33

Author(s):

Raheel Ahmed ◽

Arnold H. Menezes ◽

Olatilewa O. Awe ◽

Kelly B. Mahaney ◽

James C. Torner ◽

...

Keyword(s):

Risk Factors ◽

Spinal Cord ◽

Spinal Deformity ◽

Pediatric Patients ◽

Survival Outcomes ◽

Spinal Cord Tumors ◽

Intramedullary Spinal Cord ◽

Surgical Fusion

Object Spinal deformity in pediatric patients with intramedullary spinal cord tumors (IMSCTs) may be either due to neurogenic disability or due to secondary effects of spinal decompression. It is associated with functional decline and impairment in health-related quality-of-life measures. The authors sought to identify the long-term incidence of spinal deformity in individuals who had undergone surgery for IMSCTs as pediatric patients and the risk factors and overall outcomes in this population. Methods Treatment records for pediatric patients (age < 21 years) who underwent surgical treatment for histology-proven primary IMSCTs between 1975 and 2010 were reviewed. All patients were evaluated in consultation with the pediatric orthopedics service. Clinical records were reviewed for baseline and follow-up imaging studies, surgical fusion treatment, and long-term skeletal and disease outcomes. Results The authors identified 55 patients (30 males and 25 females) who were treated for pediatric IMSCTs between January 1975 and January 2010. The mean duration of follow-up (± SEM) was 11.4 ± 1.3 years (median 9.3 years, range 0.2–37.2 years). Preoperative skeletal deformity was diagnosed in 11 (20%) of the 55 patients, and new-onset postoperative deformity was noted in 9 (16%). Conservative management with observation or external bracing was sufficient in 8 (40%) of these 20 cases. Surgical fusion was necessary in 11 (55%). Posterior surgical fusion was sufficient in 6 (55%) of these 11 cases, while combined anterior and posterior fusion was undertaken in 5 (45%). Univariate and multivariate analysis of clinical and surgical treatment variables indicated that preoperative kyphoscoliosis (p = 0.0032) and laminectomy/laminoplasty at more than 4 levels (p = 0.05) were independently associated with development of spinal deformity that necessitated surgical fusion. Functional scores and 10-year disease survival outcomes were similar between the 2 groups. Conclusions Long-term follow-up is essential to monitor for delayed development of spinal deformity, and regular surveillance imaging is recommended for patients with underlying deformity. The authors' extended follow-up highlights the risk factors associated with development of spinal deformity in patients treated for pediatric IMSCTs. Surgical fusion allows patients who develop progressive deformity to achieve long-term functional and survival outcomes comparable to those of patients who do not develop progressive deformity.

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Long-Term Follow-Up After Spinal Cord Injury in Canada

PsycEXTRA Dataset ◽

10.1037/e513252007-001 ◽

2006 ◽

Author(s):

Mark I. Tonack ◽

Sander L. Hitzig ◽

B. Catharine Craven ◽

Kent A. Campbell ◽

Kathryn A. Boschen ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Cord Injury ◽

Long Term Follow Up

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OPEN HAEMORRHOIDS SURGERY IN SPINAL CORD INJURY PATIENTS

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v4i11.1532 ◽

2020 ◽

Vol 4 (11) ◽

Author(s):

Khaled Hassan

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Anal Fissure ◽

Open Surgery ◽

Anal Fissures ◽

Cord Injury ◽

Long Term Follow Up ◽

Grade Iii

This Pilot retrospective research conducted on the results of open surgery in patients with Grade III and IV haemorrhoids With SCI. No major complications had arisen at 6 weeks post-operative and all wounds had healed, but 1 patient Anal fissure recurrence. 75% of patients reported a substantial increase in anorectal anorexia during long-term follow-up. With symptoms. Five patients reported recurrences: three haemorrhoids (18 percent) and two anal fissures (25 percent). Keywords: Haemorrhoids, Pilot retrospective research, Anorectal Anorexia.

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