Microsurgical resection of intramedullary spinal cord cavernous malformation. Operative video and technical nuances

2014 ◽  
Vol 37 (v2supplement) ◽  
pp. Video1
Author(s):  
James K. Liu
Keyword(s):  
Spinal Cord ◽  
Cavernous Malformation ◽  
Significant Risk ◽  
Complete Resection ◽  
Definitive Treatment ◽  
Intramedullary Spinal Cord ◽  
Cavernous Malformations ◽  
Spinal Stabilization ◽  
Progressive Myelopathy ◽  
Microsurgical Resection

Intramedullary spinal cord cavernous malformations account for approximately 5% of all intraspinal lesions. These lesions can present with either acute neurological compromise secondary to hemorrhage inside the spinal cord, or with chronic progressive myelopathy due to repeated microhemorrhages. Surgical resection of spinal cord cavernous malformations remains the definitive treatment strategy for symptomatic lesions. Because of the intimate relationship with surrounding eloquent neural tissue, these lesions can be technically challenging to remove with a significant risk for morbidity. In this operative video, the author demonstrates an illustrative step-by-step technique for microsurgical resection of a large intramedullary spinal cord cavernous malformation at C4–5 causing progressive myelopathy. Complete resection was achieved without neurologic compromise. The operative technique and surgical nuances, including the surgical approach, intradural cavernoma removal, and spinal stabilization are illustrated.The video can be found here: http://youtu.be/3FUjGSyrKO0.

scholarly journals Microsurgical resection of symptomatic intramedullary cervical spinal cord cavernous malformation

2019 ◽  
Vol 1 (1) ◽  
pp. V12
Author(s):  
Tomasz A. Dziedzic ◽  
Andrzej Marchel
Keyword(s):  
Spinal Cord ◽  
Postoperative Morbidity ◽  
Cavernous Malformation ◽  
Cervical Spinal Cord ◽  
Significant Risk ◽  
Neural Tissue ◽  
Complete Resection ◽  
Surgical Removal ◽  
Cavernous Malformations ◽  
Microsurgical Resection

Intramedullary cavernous malformations account for approximately 5% of all intraspinal lesions. Symptomatic lesions are treated with microsurgical resection. Due to surrounding eloquent spinal neural tissue, surgical removal of these lesions can be technically challenging. Surgical treatment carries a significant risk for postoperative morbidity. This video demonstrates the main steps for the microsurgical technique of resection of a symptomatic intramedullary cervical spinal cord cavernous malformation at the C2–3 level. Complete resection was achieved with minimal posterior column deficit. The operative technique and surgical nuances, including the patient’s positioning, surgical approach, intraspinal cavernous malformation removal, and closure, are illustrated.The video can be found here: https://youtu.be/UKttTiXlEb8.

scholarly journals Surgical Approaches to Intramedullary Cavernous Malformations of the Spinal Cord

2011 ◽  
Vol 68 (suppl_2) ◽  
pp. ons317-ons324 ◽  
Author(s):  
Alim P. Mitha ◽  
Jay D. Turner ◽  
Robert F. Spetzler
Keyword(s):  
Spinal Cord ◽  
Significant Risk ◽  
Definitive Treatment ◽  
Surgical Approaches ◽  
Clinical Aspects ◽  
Anatomical Location ◽  
Resonance Imaging ◽  
Intramedullary Spinal Cord ◽  
Cavernous Malformations ◽  
Imaging Characteristics

Abstract Background: Resection of intramedullary spinal cord cavernous malformations is associated with a significant risk of morbidity because of the high density of eloquent tissue within the spinal cord. Despite this risk, surgery remains the definitive treatment for symptomatic lesions. Objective: To review the clinical aspects of surgical approaches for spinal cord cavernous malformations. Methods: This article reviews the epidemiology, pathophysiology, clinical and imaging characteristics, and indications for surgical resection. Surgical issues and operative approaches by anatomical location are also detailed, drawing from evidence in the literature and from the senior author’s clinical experience. Results: The 3 primary approaches to spinal cord cavernous malformations—the posterior, posterolateral, and lateral approaches—are described and illustrated. Magnetic resonance imaging and intraoperative photographs of representative cases are included. Conclusion: Intramedullary spinal cord cavernous malformations are complex entities, and it is our hope that this article will improve readers’ understanding of their clinical characteristics, their indications for treatment, and the surgical pathways through which these lesions can be safely resected.

scholarly journals Intramedullary Cavernous Malformation of the Spinal Cord in Two Dogs

2007 ◽  
Vol 44 (4) ◽  
pp. 528-532 ◽  
Author(s):  
E. MacKillop ◽  
N. J. Olby ◽  
K. E. Linder ◽  
T. T. Brown
Keyword(s):  
Spinal Cord ◽  
Cavernous Malformation ◽  
Postmortem Examination ◽  
Spinal Cord Lesion ◽  
Intraparenchymal Hemorrhage ◽  
Intramedullary Spinal Cord ◽  
Cavernous Malformations ◽  
Vascular Channels ◽  
Thin Walled ◽  
Cord Lesion

Intramedullary cavernous malformations (CVMs) of the spinal cord were diagnosed in 2 adult dogs that presented for paraparesis. An intramedullary spinal cord lesion was identified on a myelogram in the first dog, and expansion of the vertebral canal was evident on radiographs in the second. Extensive intraparenchymal hemorrhage was found on gross postmortem examination in both dogs, and a distinct lobulated intramedullary mass was evident in the second dog. Microscopically, both lesions were composed of dilated, thin-walled vascular channels with little-to-no intervening neural parenchyma. Both dogs had evidence of channel thrombosis along with perilesional hemorrhage and hemosiderin accumulation. The second dog had additional degenerative changes, including thickened fibrous channel walls with hyalinization, foci of mineralization, and occasional tongues of entrapped gliotic neuropil. CVMs appear to be an uncommon cause of both acute and chronic spinal cord disease in the dog.

Lateral Myelotomy for Resection of a Ruptured Intramedullary Cervico-Thoracic Cavernous Malformation

2020 ◽  
Author(s):  
Elizabeth E Ginalis ◽  
Yehuda Herschman ◽  
Nitesh V Patel ◽  
Fareed Jumah ◽  
Zhenggang Xiong ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Cavernous Malformation ◽  
Lateral Approach ◽  
Sudden Onset ◽  
Sensory Loss ◽  
Intramedullary Spinal Cord ◽  
Cavernous Malformations ◽  
Motor Weakness ◽  
Left Lower Extremity ◽  
The Right

Abstract BACKGROUND AND IMPORTANCE Intramedullary spinal cord cavernous malformations represent 5% to 12% of spinal vascular disease. Most patients present with acute or progressive neurological symptoms, including motor weakness or sensory loss. Surgical resection is the only definitive management and is recommended for symptomatic lesions that are surgically accessible. CLINICAL PRESENTATION A 35-yr-old woman presented with a sudden onset of pain and temperature sensation loss in the left lower extremity. Magnetic resonance imaging of the spine showed a hemorrhage located ventral and slightly lateral to the right of the midline of the spinal cord from C7 through T3. Ultimately, a right lateral myelotomy between the ventral and dorsal roots was performed, and the cavernous malformation was removed. Postoperative imaging confirmed gross total resection of the cavernous malformation. CONCLUSION In this article, we report a highly unusual case of a multisegment, ruptured intramedullary cavernous malformation that was ultimately resected through a lateral myelotomy approach. This case demonstrates that a lateral approach to the spinal cord substance can be utilized for ruptured cavernous malformation, especially if there is hemorrhage at the surface of the spinal cord. This can be used as an entry into the anterolateral compartment of the spinal cord, which would otherwise be regarded as a highly morbid approach due to the sensory deficits induced. We believe this entry point to the spinal cord is feasible in highly select cases such as this.

Clinical presentation and surgical outcome of intramedullary spinal cord cavernous malformations

2012 ◽  
Vol 16 (3) ◽  
pp. 308-314 ◽  
Author(s):  
Xianzeng Tong ◽  
Xiaofeng Deng ◽  
Huan Li ◽  
Zhuang Fu ◽  
Yulun Xu
Keyword(s):  
Spinal Cord ◽  
Mr Imaging ◽  
Surgical Outcome ◽  
Clinical Presentation ◽  
Acute Onset ◽  
Intramedullary Spinal Cord ◽  
Cavernous Malformations ◽  
Recent Onset ◽  
Characteristic Imaging ◽  
Microsurgical Resection

Object Intramedullary spinal cord cavernous malformations (CMs), once thought to be extremely rare, have been diagnosed more frequently since the advent of MR imaging. In the literature, however, only a few studies include more than 10 cases. The aim of this study was to discuss the clinical presentation of intramedullary spinal cord CMs and the outcome of microsurgery for these histologically benign but clinically progressive lesions. Methods The authors retrospectively reviewed the records of 20 patients who underwent microsurgery for intramedullary spinal cord CMs. All patients had undergone pre- and postoperative MR imaging, and they were all treated using microsurgical resection. The diagnosis of spinal cord CMs was based on pathological criteria. The pre- and postoperative neurological states of the patients were classified according to the McCormick scale and Frankel scale. The microsurgical outcomes are presented and discussed. Results In most cases, CMs can be diagnosed on the basis of MR imaging findings, since these lesions have certain characteristic imaging patterns. Patients with intramedullary spinal cord CMs may present with either a rapid, acute onset of symptoms or slow, progressive neurological decline. The CMs in 19 of 20 patients in this series were totally resected, and most patients neurologically improved postoperatively. As previously reported, the authors confirm that the treatment of choice for symptomatic intramedullary CMs is total removal of the lesion to avoid recurrence and the possibility of further hemorrhage. Conclusions This study has defined the clinical features of symptomatic intramedullary spinal cord CMs. Surgery is the mainstay treatment. Surgical outcome is associated with low mortality with a high probability of functional recovery, especially when symptoms are not severe and are of relatively recent onset.

C5-C6 Cervical Spinal Cord Cavernous Malformation Microsurgical Resection: 2-Dimensional Operative Video

2018 ◽  
Vol 16 (1) ◽  
pp. E7-E7
Author(s):  
Alejandro Enriquez-Marulanda ◽  
Abdulrahman Y Alturki ◽  
Kimberly Kicielinski ◽  
Ajith J Thomas ◽  
Christopher S Ogilvy
Keyword(s):  
Spinal Cord ◽  
Cavernous Malformation ◽  
Cervical Spinal Cord ◽  
Lower Limbs ◽  
Motor Deficits ◽  
Cavernous Malformations ◽  
Neurophysiologic Monitoring ◽  
Left Limb ◽  
Patient Consent ◽  
Microsurgical Resection

Abstract We describe the case of a previously healthy 44-yr-old female patient presenting with a sudden onset of numbness, paresthesias, and decreased sensation in her lower limbs. Physical examination revealed a decreased sensation to vibration and light touch in her lower extremities, primarily in the left limb. Impaired proprioception was also evident primarily in the left toe. Full strength with 2+ reflexes was observed in all extremities. Magnetic resonance imaging demonstrated an exophytic lesion in the posterior aspect of the cervical spinal cord at the C5-C6 level, with a hemosiderin halo, consistent with a cavernous malformation. Given the evidence of past hemorrhage and the location of the lesion, microsurgical intervention was indicated. A midline cervical C5-C6 laminectomy under neurophysiologic monitoring was performed, and complete resection of the lesion was achieved with mild improvement of the sensitive symptoms and no evidence of new motor deficits. Any microsurgical resection of a cervical spinal cord lesion can be technically difficult and adequate patient selection with evaluation of the accessibility to the lesion is key.1 Surgical resection of cavernous malformations in selected patients eliminates the risk of future hemorrhage and may achieve satisfactory outcomes comparable to patients who undergo conservative management.2 In the following video illustration, we narrate this operative case, and highlight the nuances of this approach. Patient consent was obtained for the submission of the video to this journal.

Microsurgical resection of intramedullary spinal cord ependymoma

2014 ◽  
Vol 37 (v2supplement) ◽  
pp. Video9
Author(s):  
Paul C. McCormick
Keyword(s):  
Spinal Cord ◽  
Growth Rate ◽  
Spinal Cord Tumor ◽  
Intramedullary Spinal Cord ◽  
Clear Margin ◽  
Intramedullary Spinal Cord Tumor ◽  
Link Type ◽  
Microsurgical Resection ◽  
Spinal Cord Ependymoma ◽  
Posterior Midline

Ependymomas are the most commonly occurring intramedullary spinal cord tumor in adults. With few exceptions these tumors are histologically benign, although they exhibit some biologic variability with respect to growth rate. While unencapsulated, spinal ependymomas are non-infiltrative and present a clear margin of demarcation from the surrounding spinal cord that serves as an effective dissection plane. This video demonstrates the technique of microsurgical resection of an intramedullary ependymoma through a posterior midline myelotomy.The video can be found here: http://youtu.be/lcHhymSvSqU.

scholarly journals Surgical treatment of primary intramedullary spinal cord tumors in adult patients

2008 ◽  
Vol 66 (1) ◽  
pp. 59-63 ◽  
Author(s):  
Mario Augusto Taricco ◽  
Vinicius Monteiro de Paula Guirado ◽  
Ricardo Bragança de Vasconcellos Fontes ◽  
José Pindaro Pereira Plese
Keyword(s):  
Spinal Cord ◽  
Previous Treatment ◽  
Cervical Cord ◽  
Spinal Cord Tumors ◽  
Intramedullary Tumors ◽  
Treatment Protocols ◽  
Intramedullary Spinal Cord ◽  
Neurological Outcomes ◽  
Neurological Morbidity ◽  
Microsurgical Resection

BACKGROUND: Primary spinal cord intramedullary tumors are rare and present with insidious symptoms. Previous treatment protocols emphasized biopsy and radiation/chemotherapy but more aggressive protocols have emerged. OBJECTIVE: To report our experience. METHOD: Forty-eight patients were diagnosed with primary intramedullary tumors. The cervical cord was involved in 27% and thoracic in 42% of patients. Complete microsurgical removal was attempted whenever possible without added neurological morbidity. RESULTS: Complete resection was obtained in 33 (71%) patients. Neurological function remained stable or improved in 32 patients (66.7%). Ependymoma was the most frequent tumor (66.7%). CONCLUSION: Neurological outcome is superior in patients with subtle findings; aggressive microsurgical resection should be pursued with acceptable neurological outcomes.

Surgical treatment for intramedullary spinal cord melanocytomas

2008 ◽  
Vol 9 (1) ◽  
pp. 48-54 ◽  
Author(s):  
Eric M. Horn ◽  
Peter Nakaji ◽  
Stephen W. Coons ◽  
Curtis A. Dickman
Keyword(s):  
Spinal Cord ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Complete Resection ◽  
Intramedullary Spinal Cord ◽  
Local Infiltration ◽  
Patients Âgés ◽  
Patient Demographics

Spinal meningeal melanocytomas are rare lesions that are histologically benign and can behave aggressively, with local infiltration. The authors present their experience with intramedullary spinal cord melanocytomas consisting of 3 cases, which represents the second largest series in the literature. A retrospective chart review was performed following identification of all spinal melanocytomas treated at the author's institution, based on information obtained from a neuropathology database. The charts were reviewed for patient demographics, surgical procedure, clinical outcome, and long-term tumor progression. Three patients were identified in whom spinal melanocytoma had been diagnosed between 1989 and 2006. The patients' ages were 37, 37, and 48 years, and the location of their tumor was C1–3, T9–10, and T-12, respectively. All 3 had complete resection with no adjuvant radiotherapy during follow-up periods of 16, 38, and 185 months, respectively. One patient demonstrated a recurrence 29 months after resection and the other 2 patients have demonstrated asymptomatic recurrences on imaging studies obtained at 16 and 38 months following resection. With these cases added to the available literature, the evidence strongly suggests that complete resection is the treatment of choice for spinal melanocytomas. Even with complete resection, recurrences are common and close follow-up is needed for the long term in these patients. Radiation therapy should be reserved for those cases in which complete resection is not possible or in which there is recurrence.

Microsurgical Resection of an Intramedullary Spinal Cord Hemangioblastoma Through an Anterior Cervical Approach: 2-Dimensional Operative Video

2020 ◽  
Author(s):  
Kyle Lindsey McCormick ◽  
Nikita Alexiades ◽  
Paul C McCormick
Keyword(s):  
Spinal Cord ◽  
Tumor Resection ◽  
Residual Tumor ◽  
Complete Recovery ◽  
Surgical Removal ◽  
Intramedullary Spinal Cord ◽  
Dural Closure ◽  
Cervical Approach ◽  
Anterior Cervical Approach ◽  
Microsurgical Resection

Abstract This video demonstrates the microsurgical removal of an intramedullary spinal cord hemangioblastoma through an anterior cervical approach. While most spinal hemangioblastomas arise from the dorsal or dorsolateral pial surface and can be safely resected through a posterior approach,1,2 ventral tumors can present a significant challenge to safe surgical removal.3-5 This patient presented with a progressively symptomatic ventral pial based hemangioblastoma at the C5-6 level with large polar cysts extending from C3 to T1. The tumor was approached through a standard anterior cervical exposure with a C5 and C6 corpectomy. Following midline durotomy, the tumor was identified and complete microsurgical resection was achieved. The principles and techniques of tumor resection are illustrated and described in the video. Following tumor resection and dural closure, a fibular allograft was inserted into the corpectomy defect and a C4-C7 fixation plate was placed. The patient was maintained in a supine position for 36 h. He was discharged home on postoperative day 3 in a cervical collar. The patient did well with near-complete recovery of neurological function. Postoperative magnetic resonance imaging at 6 wk showed a substantial resolution of the polar cysts and no evidence of residual tumor. The patient featured in this video consented to the procedure.

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