The development of techniques for resection of spinal cord tumors by Harvey W. Cushing

2005 ◽  
Vol 2 (1) ◽  
pp. 92-97 ◽  
Author(s):  
Aaron A. Cohen-Gadol ◽  
Dennis D. Spencer ◽  
William E. Krauss
Keyword(s):  
Spinal Cord ◽  
Surgical Techniques ◽  
Spinal Tumors ◽  
Spinal Cord Tumors ◽  
Content Type ◽  
Improved Outcomes ◽  
Peter Bent Brigham Hospital ◽  
Operative Notes ◽  
Natural Histories ◽  
Fine Print

✓ Harvey Cushing's refinement of Halsted's meticulous surgical techniques facilitated safe resection of intradural spinal tumors. Although Cushing focused his attention on brain tumors at the Peter Bent Brigham Hospital, his numerous contributions to the treatment of intradural spinal tumors include the description of these tumors' natural histories and their histological classifications. The application of his experienced intracranial techniques to the resection of spinal tumors improved outcomes. The authors review selected operative notes and sketches to demonstrate his technique in the excision of the spinal cord tumors.

Spinal arachnoid cysts

1974 ◽  
Vol 41 (6) ◽  
pp. 728-735 ◽  
Author(s):  
Jacques J. Palmer
Keyword(s):  
Spinal Cord ◽  
Early Diagnosis ◽  
Arachnoid Cysts ◽  
Definitive Treatment ◽  
Spinal Cord Tumors ◽  
Content Type ◽  
Precise Diagnosis ◽  
Fine Print

✓ Six cases of symptomatic spinal arachnoid cysts are presented. All lesions but one were intradural. Although these cysts are frequently indistinguishable clinically from spinal cord tumors, their correct early diagnosis by myelography and treatment by excision or marsupialization gives gratifying results. The authors emphasize that precise diagnosis and definitive treatment are sometimes delayed because of intermittent symptoms.

Primary spinal syringomyelia

2005 ◽  
Vol 3 (6) ◽  
pp. 429-435 ◽  
Author(s):  
Ulrich Batzdorf
Keyword(s):  
Spinal Cord ◽  
Cerebrospinal Fluid ◽  
Fluid Flow ◽  
Craniovertebral Junction ◽  
Arachnoid Cysts ◽  
Spinal Cord Tumors ◽  
Content Type ◽  
Cerebrospinal Fluid Flow ◽  
Different Types ◽  
Fine Print

✓ In the present review the author describes the different types of syringomyelia that originate from abnormalities at the level of the spinal cord rather than at the craniovertebral junction. These include posttraumatic and postinflammatory syringomyelia, as well as syringomyelia associated with arachnoid cysts and spinal cord tumors. The diagnosis and the principles of managing these lesions are discussed, notably resection of the entity restricting cerebrospinal fluid flow. Placement of a shunt into the syrinx cavity is reserved for patients in whom other procedures have failed or who are not candidates for other procedures.

Intramedullary spinal cord tumors in patients older than 50 years of age: management and outcome analysis

2005 ◽  
Vol 2 (3) ◽  
pp. 249-255 ◽  
Author(s):  
Raj K. Shrivastava ◽  
Fred J. Epstein ◽  
Noel I. Perin ◽  
Kalmon D. Post ◽  
George I. Jallo
Keyword(s):  
Spinal Cord ◽  
Older Adult ◽  
Adult Population ◽  
Spinal Cord Tumors ◽  
Intramedullary Spinal Cord ◽  
Content Type ◽  
The Mean ◽  
Older Adult Population ◽  
Fine Print

Object. Intramedullary spinal cord tumors (IMSCTs) in the older-age adult population pose complex management issues regarding the extent of resection and functional outcome, especially in terms of quality of life. Historically, IMSCTs in the older adult population were treated with irradiation alone because it was assumed that functional recovery would be poor. The authors examined their IMSCT database and report the first large series of IMSCTs in patients older than 50 years of age. Methods. In this retrospective clinical and chart review there were 30 cases meeting inclusion criteria drawn from databases at three different institutions. A modified McCormick Scale was used to assess functional levels in all 30 patients pre- and postoperatively. The mean age of patients in this cohort was 59.8 years (range 50–78 years), and the mean follow- up period was 10.6 years (range 2–16 years). Ependymoma was the most common tumor (83%), and 55% were located in the thoracic spine. The most common presenting symptom was sensory dysesthesia, with rare motor loss. The prodromal period to treatment was 19.4 months. Based on the McCormick Scale score at last follow-up examination 67% of patients were clinically functionally the same, 9% were worse, and 24% were improved after surgery. There were two deaths due tumor progression (both malignant tumors) and one recurrence (anaplastic astrocytoma). All three patients in whom malignant astrocytomas were diagnosed underwent postoperative radiation therapy. Conclusions. In the population of patients older than age 50 years, thoracic ependymomas are the most common IMSCTs that present characteristically with sensory symptoms. The longer prodromal period in the older adult population may reflect the fact that their diagnosis and workup is inadequate. There was no significant increase in the length of stay in the neurosurgical ward. The authors recommend motor evoked potential-guided aggressive microsurgical resection, because the long-term outcome of benign lesions is excellent (good functional recovery and no tumor recurrence).

Preoperative embolization and intraoperative cryocoagulation as adjuncts in resection of hypervascular lesions of the thoracolumbar spine

2002 ◽  
Vol 97 (3) ◽  
pp. 294-300 ◽  
Author(s):  
Remi Nader ◽  
Brent T. Alford ◽  
Haring J. W. Nauta ◽  
Wayne Crow ◽  
Eric Vansonnenberg ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Tumor Resection ◽  
Thoracolumbar Spine ◽  
Spinal Tumors ◽  
Preoperative Embolization ◽  
Physical Separation ◽  
Content Type ◽  
Spinal Reconstruction ◽  
Estimated Blood Loss ◽  
Fine Print

Object. The purpose of this study was twofold. First the authors evaluated preoperative embolization alone to reduce estimated blood loss (EBL) when resecting hypervascular lesions of the thoracolumbar spine. Second, they compared this experience with intraoperative cryotherapy alone or in conjunction with embolization to minimize further EBL. Methods. Twelve patients underwent 13 surgeries for hypervascular spinal tumors. In 10 cases the surgeries were augmented by preoperative embolization alone. In one patient, two different surgeries involved intraoperative cryocoagulation, and in one patient surgery involved a combination of preoperative embolization and intraoperative cryocoagulation for tumor resection. When cryocoagulation was used, its extent was controlled using intraoperative ultrasonography or by establishing physical separation of the spinal cord from the tumor. In the 10 cases in which embolization alone was conducted, intraoperative EBL in excess of 3 L occurred in five. Mean EBL was of 2.8 L per patient. In one patient, who underwent only embolization, excessive bleeding (> 8 L) required that the surgery be terminated and resulted in suboptimum tumor resection. In another three cases, intraoperative cryocoagulation was used alone (in two patients) or in combination with preoperative embolization (in one patient). In all procedures involving cryocoagulation of the lesion, adequate hemostasis was achieved with a mean EBL of only 500 ml per patient. No new neurological deficits were attributable to the use of cryocoagulation. Conclusions. Preoperative embolization alone may not always be satisfactory in reducing EBL in resection of hypervascular tumors of the thoracolumbar spine. Although experience with cryocoagulation is limited, its use, in conjunction with embolization or alone, suggests it may be helpful in limiting EBL beyond what can be achieved with embolization alone. Cryocoagulation may also assist resection by preventing spillage of tumor contents, facilitating more radical excision, and enabling spinal reconstruction. The extent of cryocoagulation could be adequately controlled using ultrasonography or by establishing physical separation between the tumor and spinal cord. Additionally, somatosensory evoked potential monitoring may provide early warning of spinal cord cooling.

Intramedullary spinal cord tumors in children under the age of 3 years

1996 ◽  
Vol 85 (6) ◽  
pp. 1036-1043 ◽  
Author(s):  
Shlomo Constantini ◽  
John Houten ◽  
Douglas C. Miller ◽  
Diana Freed ◽  
Memet M. Ozek ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Glioblastoma Multiforme ◽  
Spinal Cord Tumor ◽  
Low Grade ◽  
New York University ◽  
Spinal Cord Tumors ◽  
Intramedullary Spinal Cord ◽  
Content Type ◽  
Fine Print

✓ Over a 13-year period extending from 1980 to 1993, 27 children less than 3 years of age underwent operation for removal of an intramedullary spinal cord tumor (IMSCT). The majority (18 of 27) of children had undergone surgery before being referred to New York University (NYU) Medical Center. The most common reasons for radiological investigation were pain (42%), motor regression (36%), gait abnormalities (27%), torticollis (27%), and progressive kyphoscoliosis (24%). Forty procedures were performed in 27 children. Nine children underwent two operations and two children underwent three procedures. A gross-total resection was achieved in 72% of the procedures. There was no surgical mortality. A comparison of the preoperative and 3-month postoperative functional grades for the first NYU procedure (NYU-1) yielded the following findings: 20 patients' conditions remained the same, five patients improved, and two patients deteriorated. The functional outcomes of a second operation (NYU-2) were similar. The majority of the children (24 of 27, 89%) had histologically determined low-grade lesions. There were 12 patients with low-grade astrocytomas (Grades I-III), eight with gangliogliomas, two with ganglioglioneurocytomas, one with a glioneurofibroma, and one child with a mixed astro/oligodendroglioma. Two children had anaplastic astrocytomas (Grades II–III) and one child had a glioblastoma multiforme. In a median follow-up review of 76 months, two patients died and two patients were lost to follow up. The 3- and 5-year progression-free survival (PFS) rates were 81.7% (standard error of the mean (SEM) 0.083) and 76.2% (SEM 0.094), respectively. Eight of 24 patients suffered a recurrence within a mean time of 45.4 ± 28.9 months. All were treated with surgery (NYU-2). Lesions recurred in three of 12 children with low-grade astrocytomas, two of eight children with gangliogliomas, one child with an anaplastic astrocytoma, one child with a ganglioglioneurocytoma, and one child with a glioblastoma multiforme. At follow-up review, most of these children were doing well. Sixteen are in functional Grades I or II and 18 children attend a normal school system. The authors conclude that surgery for the removal of IMSCTs in children less than 3 years of age can be performed radically and safely. The postoperative functional performance is determined by the degree of the preoperative deficit. It is, therefore, of utmost importance to diagnose and treat these children as early as possible. Spinal cord tumors should be recognized as potentially excisable lesions on their initial presentation and when they recur. The optimum treatment for malignant lesions is still to be determined.

Radical resection of intramedullary spinal cord tumors in adults

1985 ◽  
Vol 63 (4) ◽  
pp. 492-499 ◽  
Author(s):  
Paul R. Cooper ◽  
Fred Epstein
Keyword(s):  
Spinal Cord ◽  
Neurological Deficit ◽  
Radical Resection ◽  
Spinal Cord Tumors ◽  
Intramedullary Tumors ◽  
Duration Of Symptoms ◽  
Intramedullary Spinal Cord ◽  
Content Type ◽  
The Past ◽  
Fine Print

✓ The management of patients with intramedullary spinal cord tumors is controversial. In the past, these tumors have often been treated with biopsy or subtotal removal followed by irradiation — a therapy that is usually associated with early tumor recurrence and progressive neurological impairment. In an attempt to improve on the outcome of patients with intramedullary tumors, the authors performed radical resection in most of the 29 adult patients who had surgery for these tumors within the past 30 months. The mean duration of symptoms was 9½ years, and all patients presented because of progressive neurological deficit. Patients were evaluated with metrizamide myelography-computerized tomography scanning and intraoperative ultrasound imaging to define the site of the tumor and cystic components. There were 14 ependymomas, 11 astrocytomas, two lipomas, and one case each of intramedullary fibrosis and astrogliosis. Solid tumor spanned a mean of five spinal cord segments and 16 tumors were associated with cysts. Twenty tumors were in the cervical and/or cervicothoracic regions. Total removal was achieved in 14 patients and “99% removal” in seven others. In 21 of 29 patients (72%), the neurological condition was stabilized or improved as a result of the operation. Postoperative deterioration occurred for the most part in patients who could not walk or who had minimal motor function at the time of operation, and these patients are no longer considered as operative candidates. Radical resection of intramedullary tumors can be achieved, with stabilization or improvement of neurological deficit in the majority of patients.

Magnetic resonance imaging of spinal meningiomas and neurinomas

1987 ◽  
Vol 66 (5) ◽  
pp. 695-700 ◽  
Author(s):  
Gerhard Schroth ◽  
Armin Thron ◽  
Lothar Guhl ◽  
Karsten Voigt ◽  
Hans-Peter Niendorf ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Spinal Cord ◽  
Magnetic Resonance ◽  
Spinal Tumors ◽  
Resonance Imaging ◽  
Content Type ◽  
Spinal Cord Diseases ◽  
Spinal Meningiomas ◽  
Magnetic Resonance Imaging Mri ◽  
Fine Print

The detection and delineation of spinal tumors by magnetic resonance imaging (MRI) after intravenous administration of gadolinium (Gd)-diethylenetriaminepenta-acetic acid (DTPA) is demonstrated in eight cases of neurinoma or meningioma. The advantages of Gd-DTPA-enhanced MRI over other MRI techniques used in more than 100 cases of spinal cord diseases are described.

Anterolateral decompression for metastatic epidural spinal cord tumors

1985 ◽  
Vol 62 (3) ◽  
pp. 344-348 ◽  
Author(s):  
M. Chris Overby ◽  
Allen S. Rothman
Keyword(s):  
Spinal Cord ◽  
Radiation Therapy ◽  
Neurological Status ◽  
Cord Compression ◽  
Metastatic Carcinoma ◽  
Anterior Decompression ◽  
Spinal Cord Tumors ◽  
Posterior Stabilization ◽  
Content Type ◽  
Fine Print

✓ Since 1981, 12 patients with epidural spinal cord compression from metastatic carcinoma have been treated surgically by a modified costotransversectomy approach for anterolateral decompression. Before surgery, all patients had received dexamethasone, and had deteriorated neurologically despite radiation therapy, chemotherapy, or steroid therapy. Postoperatively, nine patients (75%) improved neurologically and were ambulatory, two (17%) had no change in neurological status, and one patient was unchanged initially but deteriorated and died 8 weeks later. Anterolateral decompression by a modified costotransversectomy approach should be considered for management of ventrally located tumors or when posterior stabilization is considered a possible requirement following a proposed anterior decompression.

Closure of extensive and complicated laminectomy wounds

1987 ◽  
Vol 67 (1) ◽  
pp. 59-64 ◽  
Author(s):  
Barry M. Zide ◽  
Jeffrey H. Wisoff ◽  
Fred J. Epstein
Keyword(s):  
Spinal Cord ◽  
Cerebrospinal Fluid ◽  
Wound Closure ◽  
Surgical Techniques ◽  
Radical Excision ◽  
Intramedullary Spinal Cord ◽  
Content Type ◽  
Alternative Method ◽  
High Incidence ◽  
Fine Print

✓ Fifty-eight patients with previously irradiated intramedullary spinal cord astrocytomas underwent laminectomy for radical excision of their tumors. A high incidence of postoperative cutaneous cerebrospinal fluid fistulas and large pseudomeningoceles following routine closure prompted the development of an alternative method of wound closure using mobilized musculofascial flaps. The authors describe the surgical techniques and pitfalls to be avoided during the closure of complicated laminectomy wounds.

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.”

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