Intraoperative 3T MR Imaging for Spinal Cord Tumor Resection: Feasibility, Timing, and Image Quality Using a “Twin” MR–Operating Room Suite

Abstract Background Isolated onset of intracranial hypertension due to spinal cord tumor is rare, thus, easily leading to misdiagnosis and delay in effective treatment. Case presentation Herein, we describe a 45-year-old female patient who manifested isolated symptoms and signs of intracranial hypertension and whose condition was initially diagnosed as idiopathic intracranial hypertension and transverse sinus stenosis. The patient received a stent implantation; however, no improvements were observed. One year later her symptoms exacerbated, and during rehospitalization a spinal imaging examination revealed a lumbar tumor. Pathologic evaluation confirmed schwannoma, and tumor resection significantly improved her symptoms, except for poor vision. Conclusions Space-occupying lesions of the spine should be considered in the differential diagnosis of idiopathic intracranial hypertension, even in the absence of spine-localized signs or symptoms.

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Efficacy of intraoperative lumbar subarachnoid drainage for prevention of cerebrospinal fluid leak after spinal cord tumor resection

Journal of Orthopaedic Science ◽

10.1016/j.jos.2017.10.007 ◽

2018 ◽

Vol 23 (2) ◽

pp. 266-272 ◽

Cited By ~ 2

Author(s):

Kazuyoshi Kobayashi ◽

Kei Ando ◽

Kenyu Ito ◽

Mikito Tsushima ◽

Akiyuki Matsumoto ◽

...

Keyword(s):

Spinal Cord ◽

Cerebrospinal Fluid ◽

Spinal Cord Tumor ◽

Tumor Resection ◽

Cerebrospinal Fluid Leak ◽

Fluid Leak

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Intrinsic Spinal Cord Tumor Resection

Neurosurgery ◽

10.1227/00006123-200205000-00021 ◽

2002 ◽

Vol 50 (5) ◽

pp. 1059-1063 ◽

Cited By ~ 11

Author(s):

Jacques Brotchi

Keyword(s):

Spinal Cord ◽

Spinal Cord Tumor ◽

Tumor Resection

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Intrathecal morphine analgesia after cervical and thoracic spinal cord tumor surgery

Journal of Neurosurgery Spine ◽

10.3171/2014.8.spine1436 ◽

2014 ◽

Vol 21 (6) ◽

pp. 899-904 ◽

Cited By ~ 4

Author(s):

Beate Poblete ◽

Christoph Konrad ◽

Karl F. Kothbauer

Keyword(s):

Spinal Cord ◽

Intensive Care ◽

Rating Scale ◽

Intrathecal Morphine ◽

Spinal Cord Tumor ◽

Tumor Resection ◽

Numeric Rating Scale ◽

Thoracic Spinal Cord ◽

Dural Closure ◽

Thoracic Spinal

Object The aim of this study was to provide evidence for the effect of intrathecal morphine application after spinal cord tumor resection. Methods Twenty patients participated in a prospective open proof-of-concept study. During dural closure, morphine (7 μg/kg) was injected into the subarachnoid space. All patients were monitored in an intensive care setting postoperatively. Pain, additional opioids given, and vital parameters were recorded. Results Six patients received a mean morphine dose of 365 μg between C-3 and C-7 and 14 patients received a mean dose of 436 μg between T-2 and T-12. In the cervical and thoracic groups, the mean Numeric Rating Scale score was highest upon intensive care unit admission (1.2 and 2.5, respectively) and declined at 12 hours (0.5 and 0.8, respectively). Minimal extra morphine was required. Minor side effects occurred without consequence. Conclusions Intrathecal morphine for postoperative analgesia after resection of cervical and thoracic spinal cord tumors is effective and safe. These preliminary results require confirmation by larger comparative studies and further clinical experience.

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

Spine ◽

10.1097/brs.0b013e31824c76a8 ◽

2012 ◽

Vol 37 (16) ◽

pp. E1001-E1008 ◽

Cited By ~ 20

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

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Intramedullary spinal cord tumor resection

Neurosurgical FOCUS ◽

10.3171/2012.v2.focus12154 ◽

2012 ◽

Vol 33 (Suppl1) ◽

pp. 1

Author(s):

Mari L. Groves ◽

Patricia L. Zadnik ◽

Pablo F. Recinos ◽

Violette Renard ◽

George I. Jallo

Keyword(s):

Spinal Cord ◽

Spinal Cord Tumor ◽

Tumor Resection ◽

Progression Free Survival ◽

Low Grade ◽

High Definition ◽

En Bloc ◽

Intramedullary Spinal Cord ◽

Free Survival ◽

Intramedullary Spinal Cord Tumor

The authors present a case of a 27-year-old patient who presented with spastic gait and worsening difficulty walking over a 6 month period. Spinal MR imaging revealed a heterogeneously enhancing intramedullary spinal cord tumor (IMSCT) with associated syrinx in the cervical spine. The lesion was resected through posterior en bloc laminotomy, durotomy, and microscopic resection of the intramedullary component followed by laminoplasty reconstruction. Surgical resections with a goal of gross total resection can significantly improve overall survival and progression free survival in patients with low-grade IMSCT. The procedure is presented in an edited, high-definition format with accompanying narrative. The video can be found here: http://youtu.be/Ui9bn82PtP8.

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Spinal Cord Diffuse Leptomeningeal Glioneuronal Tumor Presenting without Leptomeningeal Dissemination

Pediatric Neurosurgery ◽

10.1159/000518802 ◽

2021 ◽

pp. 1-6

Author(s):

Carlos Perez-Vega ◽

Oluwaseun O. Akinduro ◽

Bradley J. Cheek ◽

Alexandra D. Beier

Keyword(s):

Spinal Cord ◽

Spinal Cord Tumor ◽

Tumor Resection ◽

World Health ◽

Glioneuronal Tumor ◽

Pathology Report ◽

Leptomeningeal Dissemination ◽

Unique Type ◽

Intramedullary Spinal Cord ◽

Diffuse Leptomeningeal Glioneuronal Tumor

Background and Importance: Diffuse leptomeningeal glioneuronal tumor (DLGNT) represents a provisional entity in the 2016 World Health Organization classification of tumors; it is characterized by a widespread leptomeningeal growth and oligodendroglial-like cytology. To this day, 4 pediatric patients have been reported to present with an isolated spinal cord tumor in the absence of leptomeningeal dissemination. Gross total resection (GTR) was achieved in only 1 patient. We present the clinical and technical nuances of this unique type of tumor, as well as the second reported case of GTR in a patient with DLGNT. Clinical Presentation: A 4-year-old boy presented to the emergency department after an episode of flaccid paralysis of bilateral lower extremities. MRI showed an intramedullary spinal cord tumor centered at T8. The patient was taken to the operative room, where a laminectomy and tumor resection were performed; cystic and solid tumor components were identified. Pathology report was consistent with DLGNT. After achieving GTR, patient is free of recurrence after a 15-month follow-up. Conclusion: No standard treatment for DLGNT has been identified. Current literature report surgery and chemotherapy with variable success rates. DLGNT presenting as an isolated intramedullary tumor is an uncommon condition which progression appears to be halted when treated promptly. Identifying solid and cystic components of this tumor is crucial for achieving GTR.

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Spinal Cord Monitoring

Clinical Neurophysiology ◽

10.1093/med/9780190259631.003.0048 ◽

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.

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Magnetic resonance imaging of intramedullary spinal cord schwannomas

Journal of Neurosurgery Spine ◽

10.3171/spi.2003.99.1.0114 ◽

2003 ◽

Vol 99 (1) ◽

pp. 114-117 ◽

Cited By ~ 9

Author(s):

Cesare Colosimo ◽

Alfonso Cerase ◽

Luca Denaro ◽

Giulio Maira ◽

Romano Greco

Keyword(s):

Spinal Cord ◽

Magnetic Resonance ◽

Mr Imaging ◽

Spinal Cord Tumor ◽

Spinal Nerve ◽

Benign Tumors ◽

Imaging Features ◽

Spinal Nerve Root ◽

Resonance Imaging ◽

Intramedullary Spinal Cord

✓ Intramedullary spinal cord schwannomas are rare benign tumors for which resection is possible and safe. The purpose of this paper is to present the magnetic resonance (MR) imaging features in two cases of intramedullary spinal cord schwannoma to assist both neurosurgeons and pathologists in preventing misdiagnosis and resultant partial resection. The MR imaging evidence of a small- or medium-sized well-marginated intramedullary spinal cord tumor in a patient in whom no syringomyelia is present but in whom moderate edema with marked Gd enhancement can be seen should be considered in the differential diagnosis of intramedullary spinal cord schwannoma. In cases in which an associated thickened Gd-enhancing spinal nerve root is seen the diagnosis of schwannoma should be assumed.

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