scholarly journals Cervical spine deformity associated with resection of spinal cord tumors

2006 ◽  
Vol 20 (2) ◽  
pp. 1-7 ◽  
Author(s):  
Daniel R. Fassett ◽  
Randy Clark ◽  
Douglas L. Brockmeyer ◽  
Meic H. Schmidt
Keyword(s):  
Spinal Cord ◽  
Cervical Spine ◽  
Sagittal Plane ◽  
Cervical Spinal Cord ◽  
Tumor Resection ◽  
Spine Deformity ◽  
Spinal Cord Tumors ◽  
Intramedullary Spinal Cord ◽  
Spine Deformities ◽  
Anterior Posterior

✓ Postoperative sagittal-plane cervical spine deformities are a concern when laminectomy is performed for tumor resection in the spinal cord. These deformities appear to occur more commonly after resection of intramedullary spinal cord lesions, compared with laminectomy for stenosis caused by degenerative spinal conditions. Postlaminectomy deformities are most common in pediatric patients with an immature skeletal system, but are also more common in young adults (< 25 years of age) in comparison with older adults. The extent of laminectomy and facetectomy, number of laminae removed, location of laminectomy, preoperative loss of lordosis, and postoperative radiation therapy in the spine have all been reported to influence the risk of postlaminectomy spinal deformities. When these occur, patients should be monitored closely with serial imaging studies, because a significant percentage will have progressive deformities. These can range from focal kyphosis to more complicated swan-neck deformities. General indications for surgical intervention include progressive deformity, axial pain in the area, and neurological symptoms attributable to the deformity. Surgical options include anterior, posterior, and combined anterior–posterior procedures. The authors have reviewed the literature on postlaminectomy kyphosis as it relates to resection of cervical spinal cord tumors, and they summarize some general factors to consider when treating these patients.

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.

Spinal Cord Mapping as an Adjunct for Resection of Intramedullary Tumors: Surgical Technique with Case Illustrations

Neurosurgery ◽  
2002 ◽  
Vol 51 (5) ◽  
pp. 1199-1207 ◽  
Author(s):  
Alfredo Quinones-Hinojosa ◽  
Mittul Gulati ◽  
Russell Lyon ◽  
Nalin Gupta ◽  
Charles Yingling
Keyword(s):  
Spinal Cord ◽  
Evoked Potentials ◽  
Motor Evoked Potentials ◽  
Cervical Spinal Cord ◽  
Tumor Resection ◽  
Neurological Deficits ◽  
Electromyographic Activity ◽  
Intramedullary Spinal Cord ◽  
Motor Tracts ◽  
Stimulation Of

Abstract OBJECTIVE Resection of intramedullary spinal cord tumors may result in transient or permanent neurological deficits. Intraoperative somatosensory evoked potentials (SSEPs) and motor evoked potentials are commonly used to limit complications. We used both antidromically elicited SSEPs for planning the myelotomy site and direct mapping of spinal cord tracts during tumor resection to reduce the risk of neurological deficits and increase the extent of tumor resection. METHODS In two patients, 3 and 12 years of age, with tumors of the thoracic and cervical spinal cord, respectively, antidromically elicited SSEPs were evoked by stimulation of the dorsal columns and were recorded with subdermal electrodes placed at the medial malleoli bilaterally. Intramedullary spinal cord mapping was performed by stimulating the resection cavity with a handheld Ojemann stimulator (Radionics, Burlington, MA). In addition to visual observation, subdermal needle electrodes inserted into the abductor pollicis brevis-flexor digiti minimi manus, tibialis anterior-gastrocnemius, and abductor halluces-abductor digiti minimi pedis muscles bilaterally recorded responses that identified motor pathways. RESULTS The midline of the spinal cord was anatomically identified by visualizing branches of the dorsal medullary vein penetrating the median sulcus. Antidromic responses were obtained by stimulation at 1-mm intervals on either side of the midline, and the region where no response was elicited was selected for the myelotomy. The anatomic and electrical midlines did not precisely overlap. Stimulation of abnormal tissue within the tumor did not elicit electromyographic activity. Approaching the periphery of the tumor, stimulation at 1 mA elicited an electromyographic response before normal spinal cord was visualized. Restimulation at lower currents by use of 0.25-mA increments identified the descending motor tracts adjacent to the tumor. After tumor resection, the tracts were restimulated to confirm functional integrity. Both patients were discharged within 2 weeks of surgery with minimal neurological deficits. CONCLUSION Antidromically elicited SSEPs were important in determining the midline of a distorted cord for placement of the myelotomy incision. Mapping spinal cord motor tracts with direct spinal cord stimulation and electromyographic recording facilitated the extent of surgical resection.

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.

Intramedullary Spinal Cord Tumors Resected with CO2 Laser Microsurgical Technique: Recent Experience in Fifteen Patients

Neurosurgery ◽  
1988 ◽  
Vol 22 (3) ◽  
pp. 518-522 ◽  
Author(s):  
Hans-Dietrich Herrmann ◽  
Michael Neuss ◽  
Dietrich Winkler
Keyword(s):  
Spinal Cord ◽  
Co2 Laser ◽  
Cervical Spinal Cord ◽  
Frozen Section ◽  
Neurological Status ◽  
Histological Evaluation ◽  
Recent Experience ◽  
Spinal Cord Tumors ◽  
Intramedullary Spinal Cord ◽  
Gadolinium Dtpa

Abstract We have operated upon 15 intramedullary spinal cord tumors with the aid of a CO2 laser attached to the microscope. The operative technique is described. Most of the tumors were localized within the cervical spinal cord. Nine tumors were benign gliomas: 4 ependymomas, 1 subependymoma, 3 astrocytomas, and 1 ganglioglioma. Six were removed totally, and 3 were removed subtotally. The remaining 6 tumors consisted of 3 hemangioblastomas, 1 intramedullary neurofibroma, 1 lipoma, and 1 primary intramedullary melanoma. Neurological function postoperatively compared to the preoperative function of the upper extremities was unchanged in 13 patients (86.5%), improved in 1, and worse in 1 patient. In the lower extremities, the preoperative neurological status was unchanged in 11 patients (73.3%), improved in 1 patient, and worse in 3 patients (20%). Magnetic resonance imaging was superior to myelography and computed tomography in localizing these lesions. Enhancement with paramagnetic substances (e.g., gadolinium-DTPA) helps to localize solid tumor within cysts. Histological evaluation of small tissue biopsies or frozen section histology is unreliable. The entire lesion should be exposed in all cases, and an attempt should be made to remove the tumor totally or, if this is not possible, to resect as much of the center of the tumor as is possible until the cord is decompressed. The decision to administer further treatment is based on the histological features of the tumor. (Neurosurgery 22:518-522, 1988)

Central neurocytomas of the cervical spinal cord

1994 ◽  
Vol 81 (2) ◽  
pp. 288-293 ◽  
Author(s):  
Stephen B. Tatter ◽  
Lawrence F. Borges ◽  
David N. Louis
Keyword(s):  
Spinal Cord ◽  
Cervical Spinal Cord ◽  
Correct Diagnosis ◽  
Central Neurocytoma ◽  
Neurological Deficits ◽  
Resonance Imaging ◽  
Spinal Cord Tumors ◽  
Intramedullary Spinal Cord ◽  
Content Type ◽  
Fine Print

✓ Central neurocytoma is a neuronal neoplasm that occurs supratentorially in the lateral or third ventricles. The authors report the clinical, neuroradiological, and neuropathological features of two neurocytomas arising in the spinal cord of two men, aged 65 and 49 years. The patients presented with progressive neurological deficits referable to the cervical spinal cord. Magnetic resonance imaging revealed isodense intramedullary spinal cord tumors at the C3–4 level. Both tumors were initially misdiagnosed as gliomas. In Case 1 the correct diagnosis was made after electron microscopy revealed neuronal features. Immunostaining in Case 2 revealed that tumor cells were positive for synaptophysin and negative for glial fibrillary acidic protein, strongly indicating a neuronal tumor. It is suggested that this spinal cord neoplasm be included under the designation “central neurocytoma.”

Predictors of Ambulatory Function after Surgical Resection of Intramedullary Spinal Cord Tumors

Neurosurgery ◽  
2007 ◽  
Vol 61 (1) ◽  
pp. 99-106 ◽  
Author(s):  
Graeme F. Woodworth ◽  
Kaisorn L. Chaichana ◽  
Matthew J. McGirt ◽  
Daniel M. Sciubba ◽  
George I. Jallo ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Radiation Therapy ◽  
Relative Risk ◽  
Confidence Interval ◽  
Functional Status ◽  
Tumor Resection ◽  
Preoperative Radiation ◽  
Spinal Cord Tumors ◽  
Intramedullary Spinal Cord

Abstract BACKGROUND Contemporary treatment of intramedullary spinal cord tumors (IMSCTs) involves radical or subtotal tumor resection with adjuvant radiation and/or chemotherapy, depending on the tumor's histological type and grade as well as the extent of resection. Despite advances in surgical therapy, this approach continues to have significant morbidity. Although previous research is limited, identifying reliable predictors of functional status after tumor resection would be clinically useful for perioperative modification strategies. METHODS All patients who underwent surgery for IMSCTs at an academic tertiary care institution between 1995 and 2004 were retrospectively reviewed, and predictors of postoperative neurological functional status were assessed by multivariate logistical regression analysis. Neurological status was gauged by the ability to walk without assistance at the time of the last follow-up visit. RESULTS Seventy-eight IMSCT resections were performed during the study period. Preoperative (on the day of or the day before surgery) serum glucose greater than 170 mg/dl (relative risk, 0.03; 95% confidence interval, 0.00–0.27; P = 0.001) and preoperative radiation therapy (relative risk, 0.02; 95% confidence interval, 0.00–0.39, P = 0.012) were independently associated with poor functional status postoperatively. The ability to walk unassisted before surgery (relative risk, 17.1; 95% confidence interval, 1.89–154.5, P = 0.012), on other hand, was the only positive predictor of the ability to walk unassisted at the time of the last follow-up visit. CONCLUSION This study suggests that early surgical intervention after the onset of symptoms for patients with IMSCT may help preserve ambulatory function. Deferral of preoperative radiation therapy for less radiosensitive tumors and strict perioperative glucose control may also help maximize a patient's subsequent ambulatory status.

The Evolution of Intramedullary Spinal Cord Tumor Surgery

2009 ◽  
Vol 65 (suppl_6) ◽  
pp. ons84-ons92 ◽  
Author(s):  
Daniel M. Sciubba ◽  
Daniel Liang ◽  
Karl F. Kothbauer ◽  
Joseph C. Noggle ◽  
George I. Jallo
Keyword(s):  
Spinal Cord ◽  
New Technologies ◽  
Spinal Cord Tumor ◽  
Tumor Resection ◽  
Surgical Techniques ◽  
Surrounding Tissue ◽  
Tumor Surgery ◽  
Spinal Cord Tumors ◽  
Intramedullary Spinal Cord ◽  
Intramedullary Spinal Cord Tumor

Abstract Objective: Resections of intramedullary spinal cord tumors were attempted as early as 1890. More than a century after these primitive efforts, profound advancements in imaging, instrumentation, and operative techniques have greatly improved the modern surgeon’s ability to treat such lesions successfully, often with curative results. Methods: We review the history of intramedullary spinal cord tumor surgery, as well as the evolution and advancement of technologies and surgical techniques that have defined the procedure over the past 100 years. Results: Surgery to remove intramedullary spinal cord tumors has evolved to include sophisticated imaging equipment to pinpoint tumor location, laser scalpel systems to provide precise incisions with minimal damage to surrounding tissue, and physiological monitoring to detect and prevent intraoperative motor deficits. Conclusion: Modern surgical devices and techniques have developed dramatically with the availability of new technologies. As a result, continual advancements have been achieved in intramedullary spinal cord tumor surgery, thus increasing the safety and effectiveness of tumor resection, and progressively improving the overall outcomes in patients undergoing such procedures.

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.

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