The surgical challenge of ossified ventrolateral spinal meningiomas: tricks and pearls for managing large ossified meningiomas of the thoracic spine

2021 ◽  
pp. 1-11
Author(s):  
Jitendra Thakur ◽  
Christian T. Ulrich ◽  
Ralph T. Schär ◽  
Kathleen Seidel ◽  
Andreas Raabe ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Tumor Resection ◽  
Cord Compression ◽  
Technical Note ◽  
Burr Hole ◽  
Neurophysiological Monitoring ◽  
Simpson Grade ◽  
Spinal Meningiomas ◽  
Piecemeal Resection ◽  
Tumor Remnant

The authors present an illustrative technical note on microsurgical resection of ventrolateral completely ossified spinal meningiomas (OSMs) and a literature review of the surgical management of calcified spinal meningiomas or OSMs. These tumors are surgically demanding due to their solid consistency, especially when in a ventrolateral location with dislocation of the spinal cord. A challenging case with significant thoracic cord compression and displacement is described. Due to the firm consistency and the ventrolateral localization of the meningioma, a piecemeal resection was necessary. This could have resulted in a free-floating tumor remnant adherent to the spinal cord, impeding safe tumor resection. To avoid such a remnant, an anchoring burr hole was drilled at the border between the spinal cord and the adamantine tumor mass. Then, a microdissector was placed within the anchoring burr hole and the tumor was gently pulled laterally while drilling away the medial parts of the ossified tumor. This procedure was repeated until separation of the tumor from the spinal cord was possible and a gross-total resection (Simpson grade II) was manageable. Throughout the procedure, continuous intraoperative neurophysiological monitoring was performed.

Resection of 2 Intradural Extramedullary Cervical Spine Tumors in a Patient With Neurofibromatosis Type 2: 3-Dimensional Operative Video

2018 ◽  
Vol 16 (2) ◽  
pp. 274-274
Author(s):  
Simone E Dekker ◽  
Chad A Glenn ◽  
Thomas A Ostergard ◽  
Osmond C Wu ◽  
Fernando Alonso ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Cervical Spine ◽  
Treatment Options ◽  
Tumor Resection ◽  
Neurofibromatosis Type ◽  
Cord Compression ◽  
Neurofibromatosis Type 2 ◽  
3 Dimensional ◽  
Intradural Extramedullary

Abstract This 3-dimensional operative video illustrates resection of 2 cervical spine schwannomas in a 19-yr-old female with neurofibromatosis type 2. The patient presented with lower extremity hyperreflexity and hypertonicity. Magnetic resonance imaging (MRI) demonstrated 2 contrast-enhancing intradural extramedullary cervical spine lesions causing spinal cord compression at C4 and C5. The patient underwent a posterior cervical laminoplasty with a midline dural opening for tumor resection. Curvilinear spine cord compression is demonstrated in the operative video. After meticulous dissection, the tumors were resected without complication. The dural closure was performed in watertight fashion followed by laminoplasty using osteoplastic titanium miniplates and screws. Postoperative MRI demonstrated gross total resection with excellent decompression of the spinal cord. The postoperative course was uneventful. The natural history of this disease, treatment options, and potential complications are discussed.

scholarly journals Long-Term Follow-Up and Predictors of Functional Outcome after Surgery for Spinal Meningiomas: A Population-Based Cohort Study

Cancers ◽  
2021 ◽  
Vol 13 (13) ◽  
pp. 3244
Author(s):  
Jenny Pettersson-Segerlind ◽  
Alexander Fletcher-Sandersjöö ◽  
Charles Tatter ◽  
Gustav Burström ◽  
Oscar Persson ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Compression ◽  
Cord Compression ◽  
Magnetic Resonance Images ◽  
Motor Deficit ◽  
Tumor Control ◽  
Time To Surgery ◽  
Spinal Meningiomas

Spinal meningiomas are the most common adult primary spinal tumor, constituting 24–45% of spinal intradural tumors and 2% of all meningiomas. The aim of this study was to assess postoperative complications, long-term outcomes, predictors of functional improvement and differences between elderly (≥70 years) and non-elderly (18–69 years) patients surgically treated for spinal meningiomas. Variables were retrospectively collected from patient charts and magnetic resonance images. Baseline comparisons, paired testing and regression analyses were used. In conclusion, 129 patients were included, with a median follow-up time of 8.2 years. Motor deficit was the most common presenting symptom (66%). The median time between diagnosis and surgery was 1.3 months. A postoperative complication occurred in 10 (7.8%) and tumor growth or recurrence in 6 (4.7%) patients. Surgery was associated with significant improvement of motor and sensory deficit, gait disturbance, bladder dysfunction and pain. Time to surgery, tumor area and the degree of spinal cord compression significantly predicted postoperative improvement in a modified McCormick scale (mMCs) in the univariable regression analysis, and spinal cord compression showed independent risk association in multivariable analysis. There was no difference in improvement, complications or tumor control between elderly and non-elderly patients. We concluded that surgery of spinal meningiomas was associated with significant long-term neurological improvement, which could be predicted by time to surgery, tumor size and spinal cord compression.

Spinal Cord Tumor Surgery—Importance of Continuous Intraoperative Neurophysiological Monitoring After Tumor Resection

Spine ◽  
2012 ◽  
Vol 37 (16) ◽  
pp. E1001-E1008 ◽  
Author(s):  
Marie-Thérèse Forster ◽  
Gerhard Marquardt ◽  
Volker Seifert ◽  
Andrea Szelényi
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Tumor ◽  
Tumor Resection ◽  
Intraoperative Neurophysiological Monitoring ◽  
Neurophysiological Monitoring ◽  
Tumor Surgery

Partial Tumor Resection Combined with Chemotherapy for Multiple Myeloma Spinal Cord Compression

2014 ◽  
Vol 21 (11) ◽  
pp. 3661-3667 ◽  
Author(s):  
Jun Qian ◽  
Juehua Jing ◽  
Dasheng Tian ◽  
Huilin Yang
Keyword(s):  
Spinal Cord ◽  
Multiple Myeloma ◽  
Spinal Cord Compression ◽  
Tumor Resection ◽  
Cord Compression

HISTORY OF EVOLUTION OF POSTERO-LATERAL APPROACHES TO THE THORACIC SPINE: FROM CURE OF POTT’S DISEASE TO EPIDURAL TUMOR RESECTION

2022 ◽  
Author(s):  
Filippo Gagliardi ◽  
Edoardo Pompeo ◽  
Pierfrancesco De Domenico ◽  
Silvia Snider ◽  
Francesca Roncelli ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Tumor Resection ◽  
Cord Compression ◽  
Target Area ◽  
Pott’S Disease ◽  
History Of ◽  
The One ◽  
Optimal Approach ◽  
Surgical Manipulation ◽  
First Time

Since the end of the nineteenth century, the wide dissemination of Pott’s disease has ignited debates about which should be the ideal route to perform ventrolateral decompression of the dorsal rachis in case of paraplegia due to spinal cord compression in tuberculosis spondylitis. It was immediately clear that the optimal approach should be the one minimizing the surgical manipulation on both neural and extra-neural structures, while optimizing the exposure and surgical maneuverability on the target area. The first attempt was reported by Victor Auguste Menard in 1894, who described, for the first time, a completely different route from traditional laminectomy, called costotransversectomy. The technique was conceived to drain tubercular paravertebral abscesses causing paraplegia without manipulating the spinal cord. Over the following decades many other routes have been described all over the world, thus demonstrating the wide interest on the topic. Surgical development has been marked by the new technical achievements and by instrumental/technological advancements, until the advent of portal surgery and endoscopy-assisted techniques. Authors retraced the milestones of this history up to the present days, through a systematic review on the topic.

Spinal Cord Monitoring

2016 ◽  
pp. 798-832
Author(s):  
Jeffrey A. Strommen ◽  
Andrea J. Boon
Keyword(s):  
Spinal Cord ◽  
Evoked Potentials ◽  
Motor Evoked Potentials ◽  
Spinal Cord Tumor ◽  
Tumor Resection ◽  
Neurophysiological Monitoring ◽  
Spinal Root ◽  
Compound Muscle Action Potentials ◽  
Aneurysm Repair ◽  
Aortic Aneurysm Repair

Intraoperative neurophysiological monitoring is a valuable tool to preserve spinal cord and spinal root integrity during surgical procedures. A monitoring plan may include somatosensory evoked potentials (SEP), motor evoked potentials (MEP), compound muscle action potentials (CMAP), and electromyography (EMG). Such monitoring is individualized depending on the preoperative clinical deficit, the structures most at risk, and the surgical and anesthesia plan. The most common use of these techniques is in primary spine disease, where the spinal cord pathways will typically be monitored with both MEP and SEP. In cervical or lumbar spine surgeries, EMG monitoring will help protect the nerve root either during decompression or during pedicle screw placement. Monitoring during spinal cord tumor resection or vascular procedures (such as aortic aneurysm repair) not only helps prevent deficit, but also allows the surgeon to proceed with confidence and not unnecessarily terminate the procedure.

scholarly journals Giant Cervical Neurofibroma with Concomitant Deformity

2018 ◽  
Vol 23 (4) ◽  
pp. 323-327
Author(s):  
Gleidson C. Rodrigues ◽  
Andrei F. Joaquim ◽  
Enrico Ghizoni ◽  
Luciano Queiróz ◽  
Helder Tedeschi
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Compression ◽  
Tumor Resection ◽  
Deformity Correction ◽  
Cord Compression ◽  
Cervical Kyphosis

A 27 years-old woman presenting with a giant cervical neurofibroma with spinal cord compression and cervical kyphosis is reported. We discuss the surgical nuances of the multiple surgeries required to achieve a total tumor resection and deformity correction. An algorithm used in our institution to treat cervical kyphosis is also presented. 

scholarly journals Differences and characteristics of symptoms by tumor location, size, and degree of spinal cord compression: a retrospective study on 53 surgically treated, symptomatic spinal meningiomas

2020 ◽  
Vol 32 (6) ◽  
pp. 931-940
Author(s):  
Satoshi Yamaguchi ◽  
Arnold H. Menezes ◽  
Kiyoharu Shimizu ◽  
Royce W. Woodroffe ◽  
Logan C. Helland ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Retrospective Study ◽  
Spinal Cord Compression ◽  
Tumor Location ◽  
Cord Compression ◽  
Sensory Disturbance ◽  
Mr Images ◽  
Spinal Level ◽  
Motor Weakness ◽  
Spinal Meningiomas

OBJECTIVEThe differences in symptoms of spinal meningiomas have rarely been discussed from the perspective of tumor characteristics. The main purpose of this paper was to define the differences, if any, in symptoms in patients with spinal meningiomas with respect to tumor size, location, and degree of spinal cord compression. The authors also sought the threshold of spinal cord compression that causes motor weakness.METHODSThe authors conducted a retrospective study of 53 cases of spinal meningiomas that were surgically treated from 2013 to 2018. Symptoms related to the tumor were classified as motor weakness, sensory disturbance, pain, and bowel/bladder dysfunction. Based on MR images, tumor location was classified by spinal level and by its attachment to the dura mater. Tumor dimensions were also measured. Occupation ratios of the tumors to the spinal canal and degree of spinal cord flattening were sought from the axial MR images that showed the highest degree of spinal cord compression.RESULTSMotor weakness and sensory disturbance were significantly more common in thoracic spine meningiomas than in cervical spine meningiomas (p < 0.001 and p = 0.013, respectively), while pain was more common in meningiomas at the craniovertebral junction (p < 0.001). The attachment, height, width, depth, and volume of the tumor showed no significant difference irrespective of the presence or absence of each symptom. In cases of motor weakness and sensory disturbance, occupation ratios and spinal cord flattening ratios were significantly larger. However, these ratios were significantly smaller in the presence of pain. Multivariate logistic regression analysis revealed that occupation ratio independently contributed to motor weakness (OR 1.14, p = 0.035) and pain (OR 0.925, p = 0.034). Receiver operating characteristic curve analysis suggested that occupation ratio with a value of 63.678% is the threshold for the tumor to cause motor weakness.CONCLUSIONSThe study showed the difference in clinical presentation of spinal meningiomas by spinal level, occupation ratio, and spinal cord flattening ratio. An occupation ratio of approximately 64% could be utilized as the threshold value of tumor growth to cause motor weakness. Tumor growth in the cervical spine might cause pain symptoms before causing motor weakness. The relationship between the tumor and its symptomatology should be discussed with respect to tumor size relative to the surrounding spinal canal.

scholarly journals Spinal cord untethering after fetal myelomeningocele repair

2021 ◽  
Vol 3 (3(September-December)) ◽  
pp. e862021
Author(s):  
Leopoldo Mandic Furtado ◽  
José Aloysio Da Costa Val Vilho ◽  
José Antônio Lima Vieira ◽  
Aieska Kellen Dantas dos Santos
Keyword(s):  
Spinal Cord ◽  
Tethered Cord ◽  
In Utero ◽  
Technical Note ◽  
Tethered Cord Syndrome ◽  
Neurophysiological Monitoring ◽  
Fetal Life ◽  
Myelomeningocele Repair

The incidence of tethered cord syndrome after myelomenigocele (MMC) repair is higher in patients undergoing in utero than postnatally. However, a paucity of studies have described the details of untethering in children which MMC was corrected during fetal life. In this technical note, we describe the  spinal cord untethering of a girl after MMC in utero repair, highlighting the main steps regarding the anatomic recognition as well as neurophysiological monitoring finding role.

scholarly journals Purely extradural spinal meningioma: A case report and literature review

2021 ◽  
Vol 12 ◽  
pp. 431
Author(s):  
Cher Shui ◽  
John Turchini ◽  
Mark Davies
Keyword(s):  
Spinal Cord ◽  
Hematological Malignancies ◽  
Sensory Level ◽  
Case Description ◽  
Spinal Meningioma ◽  
Total Resection ◽  
Simpson Grade ◽  
History Of ◽  
Spinal Meningiomas ◽  
Progressive Paraparesis

Background: Purely extradural spinal meningiomas (ESMs) are exceptionally rare and are often incorrectly diagnosed as metastases, hematological malignancies, or schwannomas. Here, we report a 66-year-old female who presented with an isolated extradural ESM. Case Description: A 66-year-old female presented with a 2.5-year history of a progressive paraparesis (i.e. T7 level) associated with a T5 sensory level. The MR showed a heterogeneously enhancing lesion circumferentially involving the spinal cord from T3 to T5, with left-sided T4/5 foraminal extension. Following a Simpson Grade 2 resection, the patient rapidly recovered full neurological function. Conclusion: The vast majority of the rarely encountered purely ESM are benign. Although gross total resection is optimal, additional adjunctive treatments are available for those treated with subtotal resections.

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