scholarly journals Microsurgical resection of intramedullary spinal cord hemangioblastoma

2014 ◽  
Vol 37 (v2supplement) ◽  
pp. Video10 ◽  
Author(s):  
Paul C. McCormick
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Tumors ◽  
Pia Mater ◽  
Thoracic Spinal Cord ◽  
Intramedullary Spinal Cord ◽  
Glial Tumors ◽  
Tumor Margin ◽  
Thoracic Spinal ◽  
Microsurgical Techniques ◽  
Microsurgical Resection

Spinal cord hemangioblastomas account for about 10% of spinal cord tumors. They usually arise from the dorsolateral pia mater and are characterized by their significant vascularity. The principles and techniques of safe resection are different than those employed for the more commonly occurring intramedullary glial tumors (e.g. ependymoma, astrocytoma) and consist of circumferential detachment of the tumor margin from the surrounding normal pia. This video demonstrates the microsurgical techniques of resection of a thoracic spinal cord hemangioblastoma.The video can be found here: http://youtu.be/yT5KLi4VyAo.

Leptomeningeal spread of intramedullary spinal cord tumors

1988 ◽  
Vol 69 (2) ◽  
pp. 295-300 ◽  
Author(s):  
William O. Bell ◽  
Roger J. Packer ◽  
Kathy R. Seigel ◽  
Lucy B. Rorke ◽  
Leslie N. Sutton ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Recent Literature ◽  
Cervical Spinal Cord ◽  
Spinal Cord Tumors ◽  
Thoracic Spinal Cord ◽  
Intramedullary Spinal Cord ◽  
Content Type ◽  
Leptomeningeal Spread ◽  
The Past ◽  
Thoracic Spinal

✓ Three patients with intramedullary spinal cord tumors and secondary leptomeningeal spread of their tumors are presented. Two patients had astrocytomas and one had a ganglioglioma. Two tumors were located in the cervical spinal cord and one within the thoracic spinal cord. Review of the past and recent literature shows leptomeningeal dissemination of spinal cord tumors to be relatively rare, but it should be suspected and investigated in any patient whose condition deteriorates following removal of a spinal cord neoplasm.

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.

Dorsal arachnoid web with spinal cord compression: variant of an arachnoid cyst?

2000 ◽  
Vol 93 (2) ◽  
pp. 287-290 ◽  
Author(s):  
Christopher G. Paramore
Keyword(s):  
Spinal Cord ◽  
Subarachnoid Space ◽  
Rare Variants ◽  
Mass Effect ◽  
Arachnoid Cysts ◽  
Thoracic Myelopathy ◽  
Pia Mater ◽  
Thoracic Spinal Cord ◽  
Content Type ◽  
Thoracic Spinal

✓ Spinal arachnoid cysts are diverticula of the subarachnoid space that may compress the spinal cord; these lesions are most commonly found in the thoracic spine. Two patients who presented with thoracic myelopathy were noted on magnetic resonance imaging to have focal indentation of the dorsal thoracic cord, with syringomyelia inferior to the site of compression. Both patients were found at operation to have discrete arachnoid “webs” tenaciously attached to the dura mater and pia mater. These webs were not true arachnoid cysts, yet they blocked the flow of cerebrospinal fluid (CSF) and caused focal compression of the spinal cord. The mass effect appeared to be the result of a pressure gradient created by the obstruction of CSF flow in the dorsal aspect of the subarachnoid space. Both patients responded well to resection of the arachnoid web. Arachnoid webs appear to be rare variants of arachnoid cysts and should be suspected in patients with focal compression of the thoracic spinal cord.

scholarly journals Supratentorial Glioblastoma With Spinal Cord Intramedullary Metastasis

1993 ◽  
Vol 20 (1) ◽  
pp. 65-68 ◽  
Author(s):  
Mark G. Hamilton ◽  
Bruce I. Tranmer ◽  
Neil A. Hagen
Keyword(s):  
Spinal Cord ◽  
Clinical Problem ◽  
Malignant Astrocytoma ◽  
Thoracic Spinal Cord ◽  
Intramedullary Spinal Cord ◽  
Thoracic Spinal ◽  
Appropriate Treatment ◽  
Common Clinical Problem ◽  
Gross Examination ◽  
Intramedullary Spinal Cord Metastasis

ABSTRACT:A patient presented with myelopathy due to intramedullary thoracic spinal cord glioblastoma 10 months after treatment for a supratentorial glioblastoma. There was no supratentorial recurrence, and no evidence of gross leptomeningeal dissemination documented by CSF cytology, complete myelography, and MR1 imaging. Gross examination of the spinal cord and arachnoid at the time of exploratory thoracic spinal surgery was normal. However, histological review of thoracic arachnoid demonstrated microscopic deposits of glial fibrillary acidic protein (GFAP) positive tumour consistent with malignant astrocytoma. Intramedullary spinal cord metastasis of cerebral glioblastoma rarely occurs, but may develop in association with leptomeningeal tumour dissemination. As local control of primary tumours improves, distant metastasis is likely to become a more common clinical problem. Leptomeningeal gliomato-sis may be very difficult to document, even when clinically suspected and GFAP staining of a biopsy of arachnoid tissue can play an important role in confirming the diagnosis. This information can be critical to establish prognosis and develop an appropriate treatment strategy.

scholarly journals Changes in sagittal alignment after surgical excision of thoracic spinal cord tumors in adults

Spinal Cord ◽  
2019 ◽  
Vol 57 (5) ◽  
pp. 380-387
Author(s):  
Yoshiomi Kobayashi ◽  
Soya Kawabata ◽  
Yuichiro Nishiyama ◽  
Osahiko Tsuji ◽  
Eijiro Okada ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Sagittal Alignment ◽  
Surgical Excision ◽  
Spinal Cord Tumors ◽  
Thoracic Spinal Cord ◽  
Thoracic Spinal

Growth of Intramedullary Spinal Cord Dermoid Cyst from a Congenital Thoracic Dermal Sinus Tract after Negative Screening Ultrasound Imaging

2021 ◽  
pp. 1-6
Author(s):  
Liam G. Coulthard ◽  
Craig Robert Vonhoff ◽  
Ahmad M. Badran ◽  
Thomas E. Robertson ◽  
Martin J. Wood
Keyword(s):  
Spinal Cord ◽  
Dermoid Cyst ◽  
English Literature ◽  
False Negative ◽  
Dermal Sinus ◽  
Thoracic Spinal Cord ◽  
Intramedullary Spinal Cord ◽  
First Case ◽  
Thoracic Spinal ◽  
Screening Ultrasound

<b><i>Introduction:</i></b> Intramedullary thoracic dermoid cysts are rare lesions that are associated with dermal sinus tracts (DSTs). Current recommendations advocate for imaging-based screening of suspected DSTs shortly after birth to exclude associated inclusion lesions. <b><i>Case Presentation:</i></b> A 6-year-old male child presented with a 2-week history of progressive ataxia, lower limb weakness, and hyperreflexia. He was suspected to have a thoracic DST at birth, though initial screening ultrasound was negative for an inclusion lesion or intradural tract. On representation, MRI demonstrated a 3.9-cm intramedullary thoracic dermoid cyst causing significant spinal cord compression. Intraoperatively, a DST extending intradurally was found. The associated dermoid cyst was removed via intracapsular resection. <b><i>Conclusions:</i></b> Whilst dermoid cysts are presumed to progressively develop from DSTs, to our knowledge, this is the first case in English literature documenting a thoracic spinal cord intramedullary dermoid cyst following a negative screening ultrasound for a suspected DST. We use this case to highlight the false-negative rates associated with postnatal screening and advocate for early neurosurgical referral of suspected DSTs, regardless of imaging findings.

Laser-assisted microsurgical resection of thoracic intramedullary spinal cord ependymoma

2012 ◽  
Vol 33 (Suppl1) ◽  
pp. 1 ◽  
Author(s):  
James K. Liu
Keyword(s):  
Spinal Cord ◽  
Progression Free Survival ◽  
Neurophysiological Monitoring ◽  
Surgical Morbidity ◽  
Intramedullary Spinal Cord ◽  
Neurological Improvement ◽  
Formidable Challenge ◽  
Microsurgical Techniques ◽  
Microsurgical Resection ◽  
Spinal Cord Ependymoma

The surgical management of intramedullary spinal cord ependymomas remains a formidable challenge amongst neurosurgeons because of the potential risk of surgical morbidity. From on an oncological perspective, complete resection—if technically feasible—should be the goal of surgery, since this can result in excellent local control and progression-free survival. Advances in microsurgical techniques, intraoperative neurophysiological monitoring, and the use of lasers have contributed to our ability to achieve gross-total resection. This is also largely dependent on the presence of an identifiable surgical plane of dissection between the tumor and spinal cord, which appears to have a positive prognosis with overall neurological improvement. In this operative video manuscript, the author demonstrates an illustrative step-by-step technique for microsurgical resection of a thoracic intramedullary spinal cord ependymoma (T-3 to T-5) associated with an extensive cervicothoracic syrinx. The application of a handheld non-contact CO2 laser for performing the midline myelotomy is also highlighted. The operative technique and surgical nuances, including the surgical approach, intradural tumor removal, and closure, are illustrated in this video atlas. The video can be found here: http://youtu.be/itE2tuBFmgw.

scholarly journals Microsurgical Resection of Low-Grade Spinal Cord Astrocytoma: 2-Dimensional Operative Video

2018 ◽  
Vol 17 (3) ◽  
pp. E107-E108
Author(s):  
Mirza Pojskić ◽  
Kenan I Arnautović
Keyword(s):  
Spinal Cord ◽  
Motor Evoked Potentials ◽  
Prognostic Significance ◽  
Neurological Function ◽  
Intramedullary Tumor ◽  
Low Grade ◽  
Thoracic Spinal Cord ◽  
Thoracic Spinal ◽  
Microsurgical Resection ◽  
Spinal Cord Astrocytoma

Abstract This video demonstrates microsurgical resection of low-grade (Grade I) thoracic spinal cord astrocytoma. Astrocytomas are the most common pediatric intramedullary tumors and occur secondary to ependymomas in adults.1,2 The treatment goal should be radical gross total resection while preserving neurological function with intraoperative neuromonitoring.2-4 To our knowledge, this is the first video report on microsurgical resection of low-grade spinal cord astrocytoma.  A 58-yr-old female presented with gait disturbances has been featured in this video. A spinal MRI revealed T1/T2 hyperintense intramedullary tumor at T4, suggesting spinal cord astrocytoma versus ependymoma. Dura was opened in the midline and tacked to the surrounding muscle tissue with tacking sutures. The arachnoid was opened separately with microscissors, keeping it intact for closure at the end of surgery. Liga clips were applied to hold the arachnoid to the dura. Myelotomy was done in the midline,5 opening the posterior median sulcus over the length of the tumor and extending proximally and distally a few millimeters beyond the tumor.3,5 The tumor reduction was achieved by coagulation or debulking. Once sufficient debulking was achieved, dissection of the tumor margins toward surrounding cord was performed. Preoperative recording of motor-evoked potentials (MEPs) compared with continuous intraoperative MEPs were essential for preserving the neurological function and quality of life. The intraoperative finding of a clear tumor plane of resection carries positive prognostic significance and reduces the risk of complications.2,3,6  A pathohistological diagnosis showed a low-grade (Grade I) spinal cord astrocytoma (pilocytic). Follow-up MRI showed no sign of tumor or recurrence. The patient recovered fully and was neurologically intact. Written consent was obtained directly from the patient.

Nondysraphic pediatric intramedullary spinal cord lipomas

2010 ◽  
Vol 5 (2) ◽  
pp. 172-178 ◽  
Author(s):  
Karen L. Fleming ◽  
Laurence Davidson ◽  
Ignacio Gonzalez-Gomez ◽  
J. Gordon McComb
Keyword(s):  
Spinal Cord ◽  
Los Angeles ◽  
Retrospective Chart Review ◽  
Thoracic Spinal Cord ◽  
Intramedullary Spinal Cord ◽  
Institutional Review ◽  
Thoracic Spinal ◽  
Stabilization Procedure

Object Intramedullary spinal cord lipomas not associated with dysraphism are infrequently reported. When present, they typically occur in children and have a predilection for the cervical and thoracic spinal cord. The authors review the presentation, treatment, and disease course in 5 pediatric patients, and compare the outcomes with previously reported cases. Methods With institutional review board approval, a retrospective chart review was undertaken at Childrens Hospital Los Angeles. Results Four patients with intramedullary spinal cord lipomas and 1 patient with a lipoblastoma, none associated with dysraphism, were retrospectively reviewed. There were 2 boys and 3 girls ranging in age from 2 months to 4 years. Four patients underwent a laminectomy or laminoplasty with one or more subtotal resections. One patient initially underwent a decompressive laminoplasty without debulking. The median follow-up was 8 years (range 12 months–11 years). Two patients had regrowth of their lipoma, necessitating a second surgery in one patient and 3 debulking surgeries in the other. Postoperatively, 3 patients developed mild kyphosis, none significant enough to require orthopedic intervention. One patient underwent a stabilization procedure at the time of the initial laminectomy and tumor debulking. No patient received chemotherapy or radiation. At the most recent follow-up visit, patients demonstrated improved neurological function when compared with preoperative status. Conclusions In addition to a decompressive laminectomy, debulking of the lipoma provides the best long-term neurological outcome. Gross-total excision is not warranted and usually is not possible. Long-term follow-up is needed, and repeat debulking of the lipoma is indicated if there is an increase in tumor size due to hyperplasia of residual adipocytes, when tumor growth is associated with neurological deterioration.

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