Spinal Cord Diffuse Leptomeningeal Glioneuronal Tumor Presenting without Leptomeningeal Dissemination

2021 ◽  
pp. 1-6
Author(s):  
Carlos Perez-Vega ◽  
Oluwaseun O. Akinduro ◽  
Bradley J. Cheek ◽  
Alexandra D. Beier
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Tumor ◽  
Tumor Resection ◽  
World Health ◽  
Glioneuronal Tumor ◽  
Pathology Report ◽  
Leptomeningeal Dissemination ◽  
Unique Type ◽  
Intramedullary Spinal Cord ◽  
Diffuse Leptomeningeal Glioneuronal Tumor

<b><i>Background and Importance:</i></b> Diffuse leptomeningeal glioneuronal tumor (DLGNT) represents a provisional entity in the 2016 World Health Organization classification of tumors; it is characterized by a widespread leptomeningeal growth and oligodendroglial-like cytology. To this day, 4 pediatric patients have been reported to present with an isolated spinal cord tumor in the absence of leptomeningeal dissemination. Gross total resection (GTR) was achieved in only 1 patient. We present the clinical and technical nuances of this unique type of tumor, as well as the second reported case of GTR in a patient with DLGNT. <b><i>Clinical Presentation:</i></b> A 4-year-old boy presented to the emergency department after an episode of flaccid paralysis of bilateral lower extremities. MRI showed an intramedullary spinal cord tumor centered at T8. The patient was taken to the operative room, where a laminectomy and tumor resection were performed; cystic and solid tumor components were identified. Pathology report was consistent with DLGNT. After achieving GTR, patient is free of recurrence after a 15-month follow-up. <b><i>Conclusion:</i></b> No standard treatment for DLGNT has been identified. Current literature report surgery and chemotherapy with variable success rates. DLGNT presenting as an isolated intramedullary tumor is an uncommon condition which progression appears to be halted when treated promptly. Identifying solid and cystic components of this tumor is crucial for achieving GTR.

scholarly journals Intramedullary spinal cord tumor resection

2012 ◽  
Vol 33 (Suppl1) ◽  
pp. 1
Author(s):  
Mari L. Groves ◽  
Patricia L. Zadnik ◽  
Pablo F. Recinos ◽  
Violette Renard ◽  
George I. Jallo
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Tumor ◽  
Tumor Resection ◽  
Progression Free Survival ◽  
Low Grade ◽  
High Definition ◽  
En Bloc ◽  
Intramedullary Spinal Cord ◽  
Free Survival ◽  
Intramedullary Spinal Cord Tumor

The authors present a case of a 27-year-old patient who presented with spastic gait and worsening difficulty walking over a 6 month period. Spinal MR imaging revealed a heterogeneously enhancing intramedullary spinal cord tumor (IMSCT) with associated syrinx in the cervical spine. The lesion was resected through posterior en bloc laminotomy, durotomy, and microscopic resection of the intramedullary component followed by laminoplasty reconstruction. Surgical resections with a goal of gross total resection can significantly improve overall survival and progression free survival in patients with low-grade IMSCT. The procedure is presented in an edited, high-definition format with accompanying narrative. The video can be found here: http://youtu.be/Ui9bn82PtP8.

Dorsal Column Mapping for Intramedullary Spinal Cord Tumor Resection Decreases Dorsal Column Dysfunction

2012 ◽  
Vol 25 (4) ◽  
pp. 205-209 ◽  
Author(s):  
Ankit Indravadan Mehta ◽  
Cindy A. Mohrhaus ◽  
Aatif M. Husain ◽  
Isaac O. Karikari ◽  
Betsy Hughes ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Tumor ◽  
Tumor Resection ◽  
Dorsal Column ◽  
Intramedullary Spinal Cord ◽  
Intramedullary Spinal Cord Tumor

Dorsal Column Mapping via Phase Reversal Method

Neurosurgery ◽  
2014 ◽  
Vol 74 (4) ◽  
pp. 437-446 ◽  
Author(s):  
Dinesh Nair ◽  
Vishakhadatta M. Kumaraswamy ◽  
Diana Braver ◽  
Ronan D. Kilbride ◽  
Lawrence F. Borges ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Evoked Potentials ◽  
Somatosensory Evoked Potentials ◽  
Spinal Cord Tumor ◽  
Tumor Resection ◽  
Dorsal Column ◽  
Neurological Deficits ◽  
Reliable Technique ◽  
Intramedullary Spinal Cord ◽  
Phase Reversal

ABSTRACT BACKGROUND: Safe resection of intramedullary spinal cord tumors can be challenging, because they often alter the cord anatomy. Identification of neurophysiologically viable dorsal columns (DCs) and of neurophysiologically inert tissue, eg, median raphe (MR), as a safe incision site is crucial for avoiding postoperative neurological deficits. We present our experience with and improvements made to our previously described technique of DC mapping, successfully applied in a series of 12 cases. OBJECTIVE: To describe a new, safe, and reliable technique for intraoperative DC mapping. METHODS: The right and left DCs were stimulated by using a bipolar electric stimulator and the triggered somatosensory evoked potentials recorded from the scalp. Phase reversal and amplitude changes of somatosensory evoked potentials were used to neurophysiologically identify the laterality of DCs, the inert MR, as well as other safe incision sites. RESULTS: The MR location was neurophysiologically confirmed in all patients in whom this structure was first visually identified as well as in those in whom it was not, with 1 exception. DCs were identified in all patients, regardless of whether they could be visually identified. In 3 cases, negative mapping with the use of this method enabled the surgeon to reliably identify additional inert tissue for incision. None of the patients had postoperative worsening of the DC function. CONCLUSION: Our revised technique is safe and reliable, and it can be easily incorporated into routine intramedullary spinal cord tumor resection. It provides crucial information to the neurosurgeon to prevent postoperative neurological deficits.

scholarly journals Resection of Intramedullary Spinal Cord Tumor under Awake Anesthesia: A Novel Approach to Minimize Postoperative Motor Deficits

2017 ◽  
Vol 3 (1) ◽  
pp. 28-34
Author(s):  
Ahsan Ali Khan ◽  
Lukui Chen ◽  
Xiaoyuan Guo ◽  
Hong Wang ◽  
Guojian Wu ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Evoked Potential ◽  
Spinal Cord Tumor ◽  
Tumor Resection ◽  
Motor Deficits ◽  
Spinal Cord Tumors ◽  
Intramedullary Spinal Cord ◽  
Intramedullary Spinal Cord Tumor ◽  
Advantages And Disadvantages ◽  
Sensory Evoked

Objective To observe advantages and disadvantages of the resection of intramedullary spinal cord tumor under awake anesthesia. Methods Two patients with intramedullary spinal cord tumor underwent resection under awake anesthesia and followed up post-operatibely for any motor deficits. Results Patients who underwent tumor resection under awake (AAA) anesthesia combined with intraoperative NPM had no motor deficits postoperatively. More accurate and nondelayed responses were observed in the awake cycle of anesthesia and helped guide surgery, thus avoiding injuries to the spinal cord. Conclusion Intramedullary spinal cord tumors are not common, but only gross total resection (GTR) can provide complete remission of symptoms and progression-free survival. However, GTR sometimes results in motor function deficits postoperatively, particularly when the cervical cord is involved, and especially if surgery is done under general anesthesia with intraoperative neurophysiological monitoring (NPM) alone, because of delayed sensory evoked potential and motor evoked potential responses. We present two cases that underwent GTR of cervical intramedullary spinal cord tumors under an asleep-awake-asleep (AAA) cycle of anesthesia, combined with intraoperative NPM in which no postoperative motor deficits were observed on 6-months follow up.

Phase Reversal of Somatosensory Evoked Potentials Triggered by Gracilis Tract Stimulation: Case Report of a New Technique for Neurophysiologic Dorsal Column Mapping

Neurosurgery ◽  
2011 ◽  
Vol 70 (3) ◽  
pp. 783-783 ◽  
Author(s):  
Mirela V. Simon ◽  
Keith H. Chiappa ◽  
Lawrence F. Borges ◽  
Marc R. Nuwer ◽  
Vedran Deletis
Keyword(s):  
Spinal Cord ◽  
Evoked Potentials ◽  
Somatosensory Evoked Potentials ◽  
Spinal Cord Tumor ◽  
Tumor Resection ◽  
Dorsal Column ◽  
Intramedullary Spinal Cord ◽  
Phase Reversal ◽  
Dorsal Columns ◽  
A New Technique

Abstract Background and Importance: Reliable visual identification of the median raphae, essential for the preservation of function of the posterior dorsal columns during intramedullary spinal cord tumor resection, is not possible in many cases, because of distorted local anatomy. In such cases, intraoperative neurophysiologic mapping of the dorsal columns offers invaluable information to the surgeon, and guides the myelotomy. We hereby describe such a new technique. Clinical Presentation: A 41 -year-old man with a C3-C4 intramedullary spinal cord tumor underwent successful myelotomy and tumor resection. Dorsal column mapping was performed by use of an 8-contact minielectrode strip placed on the dorsal spinal cord. Direct electrical stimulation was applied via 2 adjacent contacts of the strip at a time, in an attempt to stimulate in succession the left and right dorsal columns. Somatosensory evoked potentials (SSEPs) were recorded after each stimulation, via scalp electrodes. A sharp change in polarity of the recorded scalp SSEPs (phase reversal) indicated when the stimulation of the opposite dorsal column occurred. Myelotomy was performed in between the minielectrode contacts identified as being situated closest to the raphe. The posterior tibial SSEPs were continuously monitored during and after myelotomy and until the dura closure. No changes from premyelotomy SSEPs were present. Postoperatively, the patient had preservation of the posterior column function. Conclusion: SSEP phase-reversal technique is a promising new method to identify the neurophysiologic midline in intramedullary tumor resection. Fast and easy to perform, its final role in neurophysiologic dorsal column mapping awaits confirmation in future applications.

Spinal Cord Tumor

2018 ◽  
pp. 141-148
Author(s):  
Rajiv R. Iyer ◽  
George I. Jallo
Keyword(s):  
Spinal Cord ◽  
Central Nervous System ◽  
Spinal Cord Tumor ◽  
Tumor Resection ◽  
Intraoperative Neuromonitoring ◽  
Neurological Dysfunction ◽  
Neurophysiological Monitoring ◽  
Intramedullary Spinal Cord ◽  
Dural Closure ◽  
Pilocytic Astrocytomas

Intramedullary spinal cord tumors (IMSCTs) are rare central nervous system lesions with heterogeneous patient presentations that often include pain and neurological dysfunction. In adults, ependymomas are the most common IMSCT, and in children, pilocytic astrocytomas are most frequent. The mainstay of treatment for IMSCTs is maximal safe surgical resection. Careful surgical planning and technique are critical for successful outcomes. This includes the choice of appropriate spinal levels for surgery, interpretation of real-time intraoperative neurophysiological monitoring, maintenance of meticulous hemostasis, careful microsurgical dissection, and watertight dural closure. Close attention to intraoperative neuromonitoring can allow for maximal tumor resection without permanent postoperative deficits in experienced hands. Transient postoperative deficits often improve with time. Aggressive resection often leads to excellent outcomes and should be attempted regardless of patient age.

scholarly journals High-resolution direct microstimulation mapping of spinal cord motor pathways during resection of an intramedullary tumor

2015 ◽  
Vol 22 (2) ◽  
pp. 205-210 ◽  
Author(s):  
Ravi Gandhi ◽  
Corinne M. Curtis ◽  
Aaron A. Cohen-Gadol
Keyword(s):  
Spinal Cord ◽  
Evoked Potentials ◽  
Motor Evoked Potentials ◽  
Spinal Cord Tumor ◽  
Tumor Resection ◽  
Intramedullary Tumor ◽  
Intramedullary Tumors ◽  
Intramedullary Spinal Cord ◽  
Supratentorial Gliomas ◽  
Microsurgical Techniques

Despite the use of advanced microsurgical techniques, resection of intramedullary tumors may result in significant postoperative deficits because of the vicinity or invasion of important functional tracts. Intraoperative monitoring of somatosensory evoked potentials and transcranial electrical motor evoked potentials has been used previously to limit such complications. Electromyography offers an opportunity for the surgeon to map the eloquent tissue associated with the tumor using intraoperative motor fiber stimulation. Similar to the use of cortical simulation in the resection of supratentorial gliomas, this technique can potentially advance the safety of intramedullary spinal cord tumor resection. The authors describe the use of intraoperative motor fiber tract stimulation to map the corticospinal tracts associated with an intramedullary tumor. This technique led to protection of these tracts during resection of the tumor.

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