Thrombocytopenia as an Independent Prognostic Indicator Following Extradural Spinal Tumor Resection

Abstract BACKGROUND Radical resection is the first-line option in managing cervical primary chondrosarcoma. Favorable anterior reconstruction is challenging after multilevel total spondylectomy in the cervical spine. OBJECTIVE To illustrate the application of piezoelectric surgery and three-dimensional (3D) printing techniques in spine surgery. METHODS A 27-yr-old patient was referred to our center with complaints of nocturnal neck pain and right upper extremity weakness. A 2-stage radical tumor resection was conducted using piezoelectric surgery with pathologically tumor-free margins. A 3D-printed titanium microporous prosthesis (3D-PTMP) was designed to reconstruct the anterior column of the cervical spine between C1 and T1 for stability. RESULTS The whole intraoperative blood loss was 2300 mL over the 2 procedures. The patient had an uneventful recovery, regaining ambulatory status 3 wk after the 2 operations without ventilator support or other severe complications. By the final 14-mo follow-up, the patient had achieved marked pain relief and favorable neurological improvement; a postoperative computed tomography scan indicated a good position of the 3D-printed construct between the endplates with no sign of tumor recurrence or implant subsidence. CONCLUSION The applications of piezosurgery in total spondylectomy and in 3D-PTMP in reconstruction can be a favorable alternative for managing multilevel cervical spinal tumors. Further studies are warranted to validate this surgical strategy.

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Recovery from complete hemiplegia following resection of a retrocentral metastasis: the prognostic value of intraoperative cortical stimulation

Journal of Neurosurgery ◽

10.3171/jns.2001.95.6.1050 ◽

2001 ◽

Vol 95 (6) ◽

pp. 1050-1052 ◽

Cited By ~ 20

Author(s):

Hugues Duffau

Keyword(s):

Tumor Resection ◽

Prognostic Indicator ◽

Acute Onset ◽

Motor Area ◽

Primary Motor Area ◽

Content Type ◽

Motor Responses ◽

Motor Mapping ◽

Intraoperative Electrical Stimulation ◽

Fine Print

✓ The goal in this study was to determine if intraoperative electrical stimulation mapping is useful during surgical resection of lesions located in the central region, even in cases of preoperative hemiplegia. This 45-year-old man with a retrocentral metastasis from an embryonal carcinoma of the testis suffered an acute complete hemiplegia after intratumoral bleeding. Emergency surgery was performed with the aid of intraoperative motor mapping despite the preoperative deficit. Cortical stimulations (CSs) elicited motor responses, allowing the detection and hence preservation of the primary motor area during tumor removal. Postoperatively, the patient recovered almost completely within 1 week; the tumor resection was total. It is possible that CSs give an early and valuable prognostic indicator of motor recovery in cases of complete hemiplegia, at least in patients with acute onset and short duration of the deficit. Consequently, if motor responses can be elicited by CSs, it becomes mandatory for the surgeon to respect the primary motor area despite the preoperative hemiplegia, with the aim of preserving the chances of an eventual recovery.

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Letter to the Editor: Tubular retractor selection in minimally invasive spinal tumor resection

Journal of Neurosurgery Spine ◽

10.3171/2013.10.spine13944 ◽

2014 ◽

Vol 20 (5) ◽

pp. 596-598 ◽

Cited By ~ 2

Author(s):

Lee A. Tan ◽

John E. O'Toole

Keyword(s):

Minimally Invasive ◽

Tumor Resection ◽

Spinal Tumor ◽

Tubular Retractor ◽

Letter To The Editor

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Neurophysiologic Intraoperative Monitoring for Spine Surgery: A Practical Guide From Past to Present

Journal of Intensive Care Medicine ◽

10.1177/0885066620962453 ◽

2020 ◽

pp. 088506662096245

Author(s):

Lauren K. Buhl ◽

Andres Brenes Bastos ◽

Richard J. Pollard ◽

Jeffrey E. Arle ◽

George P. Thomas ◽

...

Keyword(s):

Nervous System ◽

Peripheral Nervous System ◽

Spine Surgery ◽

Intraoperative Monitoring ◽

Effective Means ◽

Tumor Resection ◽

Spinal Tumor ◽

Adverse Outcomes ◽

Scoliosis Surgery ◽

Increased Risk

Intraoperative neuromonitoring was introduced in the second half of the 20th century with the goal of preventing patient morbidity for patients undergoing complex operations of the central and peripheral nervous system. Since its early use for scoliosis surgery, the growth and utilization of IOM techniques expanded dramatically over the past 50 years to include spinal tumor resection and evaluation of cerebral ischemia. The importance of IOM has been broadly acknowledged, and in 1989, the American Academy of Neurology (AAN) released a statement that the use of SSEPs should be standard-of-care during spine surgery. In 2012, both the AAN and the American Clinical Neurophysiology Society (ACNS) recommended that: “Intraoperative monitoring (IOM) using SSEPs and transcranial MEPs be established as an effective means of predicting an increased risk of adverse outcomes, such as paraparesis, paraplegia, and quadriplegia, in spinal surgery.” With a multimodal approach that combines SSEPs, MEPs, and sEMG with tEMG and D waves, as appropriate, sensitivity and specificity can be maximized for the diagnosis of reversible insults to the spinal cord, nerve roots, and peripheral nerves. As with most patient safety efforts in the operating room, IOM requires contributions from and communication between a number of different teams. This comprehensive review of neuromonitoring techniques for surgery on the central and peripheral nervous system will highlight the technical, surgical and anesthesia factors required to optimize outcomes. In addition, this review will discuss important trouble shooting measures to be considered when managing ION changes concerning for potential injury.

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Role of para-aortic lymph node sampling for patients with potentially resectable biliary cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.4_suppl.540 ◽

2020 ◽

Vol 38 (4_suppl) ◽

pp. 540-540

Author(s):

Hiromichi Ito ◽

Yoshihiro Ono ◽

Takafumi Sato ◽

Yosuke Inoue ◽

Yu Takahashi

Keyword(s):

Lymph Node ◽

Tumor Resection ◽

Staging System ◽

Exploratory Laparotomy ◽

Prognostic Indicator ◽

Biliary Cancer ◽

Long Term Outcomes ◽

Distal Cholangiocarcinoma ◽

Entire Cohort

540 Background: While paraaortic lymph node (PALN) metastasis has been known as poor prognostic indicator for patients with biliary cancer and is regarded as distant metastasis in AJCC staging system. However, preoperative diagnosis of PALN metastasis by current imaging studies is not accurate and the incidence of PALN metastasis among patients with potentially resectable biliary cancer and its impact on their long-term outcomes remain unclear. Methods: The patients who underwent exploratory laparotomy with PALN sampling for potentially resectable biliary cancer at our institution from 2006 through 2018 were included. All patients were appropriately staged preoperatively with CT/MRI and patients with suspected PALN metastasis preoperatively were not considered resectable disease, and thus, such patients were not included. The incidence of PALN metastasis and long-term outcomes (recurrence-free and overall survivals [RFS, OS]) for patients with/without PALN metastasis were compared. Results: Total 383 patients with three types of biliary cancers (164 perihilar cholangiocarcinoma [PHCC], 115 distal cholangiocarcinoma [DCC] and 104 gallbladder cancer [GBCA]) were included. The median age was 71 years and 65% were man. Majority of them (362 patients [95%]) completed planned resection and 9 patients (2%) died of post-operative complications. PALN metastasis was confirmed on 33 patients (9%) among the entire cohort; the yield of positive PALN sampling was the highest in the patients with GBCA (14%), followed by 9% in those with PHCC and 4% in those with DCC. Among 33 patients with positive PALN, 20 underwent tumor resection. Median RFS and OS following resection for the patients with PALN metastasis were 11 months and 22 months, respectively, compared to 46 months and 56 months for those without, respectively ( p< 0.001 for both RFS and OS). There were no survivors beyond 5-years among those with PALN metastasis. Conclusions: The yield of routine intraoperative PALN sampling is not small even among patients with potentially resectable biliary cancer and positive PALN indicates poor long-term outcomes. This procedure can provide the opportunity to avoid morbid operation for patients who unlikely benefits.

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A Novel Dural Reconstruction Method Following Spinal Tumor Resection

Neurosurgery Quarterly ◽

10.1097/wnq.0000000000000176 ◽

2016 ◽

Vol 26 (3) ◽

pp. 251-255 ◽

Cited By ~ 3

Author(s):

Brian D. Dalm ◽

Stephanus Viljoen ◽

George T. Gillies ◽

Hiroyuki Oya ◽

Matthew A. Howard

Keyword(s):

Tumor Resection ◽

Spinal Tumor ◽

Reconstruction Method

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Adamantinoma of the Spine

Neurosurgery ◽

10.1227/01.neu.0000223497.06588.4a ◽

2006 ◽

Vol 59 (2) ◽

pp. E426-E426 ◽

Cited By ~ 20

Author(s):

Leandro I. Dini ◽

Rodrigo Mendonça ◽

Carlos A. Adamy ◽

Glauco A. Saraiva

Keyword(s):

Tumor Resection ◽

Malignant Neoplasm ◽

Spinal Tumor ◽

Spine Deformity ◽

Anterior Plate ◽

Spinal Stabilization ◽

Limited Experience ◽

Left Mandible ◽

Rare Lesion ◽

Second Procedure

Abstract OBJECTIVE: We report a patient with a cervicothoracic spinal and a mandibular adamantinoma. Adamantinoma is a rare malignant neoplasm of bone and, to our knowledge, there have been only five cases of spinal adamantinoma reported. The pathogenesis of the adamantinoma, as well as the management of this extremely rare spinal tumor, is reviewed. CLINICAL PRESENTATION: A 55-year-old man was admitted to our service with cervical pain and signs of C8 and T1 radiculopathy. On physical examination, cervical spine deformity, swelling in the left mandible region, and signs of C8 and T1 radiculopathy were observed. Neuroradiology examinations showed an osteolytic mass of the C6, C7, and T1 vertebral bodies, extending into the lateral masses and transverse processes. After surgical procedures, the patient had clinical improvement. INTERVENTION: Corpectomy of C6, C7, and T1 was performed through a cervicothoracic anterior approach. Anterior stabilization of the spine was obtained using an autologous iliac crest graft and osteosynthesis with an anterior plate. On a second procedure, posterior tumor resection and spinal stabilization were performed. After the 1-year follow-up examination, a new anterior procedure was performed because of tumor recidivity and spine instability. CONCLUSION: Adamantinoma, an extremely rare lesion, is a locally aggressive tumor with slow growth and the potential to metastasize. Although it is an extremely rare occurrence in the spine, adamantinoma should be considered on the diagnosis of tumors of the vertebrae. Neuroradiological examinations are not specific in the differentiation of this tumor from other conditions. This fact, coupled with the limited experience that most physicians in general have in dealing with this tumor, makes the diagnosis and treatment of adamantinoma challenging.

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Improved patient quality of life following intradural extramedullary spinal tumor resection

Journal of Neurosurgery Spine ◽

10.3171/2016.4.spine151149 ◽

2016 ◽

Vol 25 (5) ◽

pp. 640-645 ◽

Cited By ~ 8

Author(s):

Matthew J. Viereck ◽

George M. Ghobrial ◽

Sara Beygi ◽

James S. Harrop

Keyword(s):

Quality Of Life ◽

Clinical Symptoms ◽

Tumor Resection ◽

Spinal Tumor ◽

Administrative Database ◽

Spinal Tumors ◽

Descriptive System ◽

Intradural Extramedullary

OBJECTIVE Resection significantly improves the clinical symptoms and functional outcomes of patients with intradural extramedullary tumors. However, patient quality of life following resection has not been adequately investigated. The aim in this retrospective analysis of prospectively collected quality of life outcomes is to analyze the efficacy of resection of intradural extramedullary spinal tumors in terms of quality of life markers. METHODS A retrospective review of a single institutional neurosurgical administrative database was conducted to analyze clinical data. The Oswestry Disability Index (ODI), visual analog scale (VAS) for pain, and the EQ-5D-3 L descriptive system were used to analyze quality of life preoperatively, less than 1 month postoperatively, 1–3 months postoperatively, 3–12 months postoperatively, and more than 12 months postoperatively. RESULTS The ODI scores increased perioperatively at the < 1-month follow-up from 36 preoperatively to 47. Relative to preoperative values, the ODI score decreased significantly at 1–3, 3–12, and > 12 months to 23, 17, and 20, respectively. VAS scores significantly decreased from 6.1 to 3.5, 2.4, 2.0, and 2.9 at the < 1-month, 1- to 3-, 3- to 12-, and > 12-month follow-ups, respectively. EQ-5D mobility significantly worsened at the < 1-month follow-up but improved at the 3- to 12-and > 12-month follow-ups. EQ-5D self-care significantly worsened at the < 1-month follow-up but significantly improved by the 3- to 12-month follow-up. EQ-5D usual activities improved at the 1- to 3-, 3- to 12-, and > 12-month follow-ups. EQ-5D pain and discomfort significantly improved at all follow-up points. EQ-5D anxiety and depression significantly improved at 1- to 3-month and 3- to 12-month follow-ups. CONCLUSIONS Resection of intradural extramedullary spine tumors appears to significantly improve patient quality of life by decreasing patient disability and pain and by improving each of the EQ-5D domains.

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