Intramedullary Tumors Research Articles

Dorsal column mapping in resection of intramedullary spinal cord tumors: a prospective comparison of two methods and neurological follow-up

PurposeIn surgery for intramedullary spinal cord tumors (imSCT), distortion of the anatomy challenges the visual identification of dorsal columns (DC) for midline myelotomy. Dorsal column mapping (DCM) and spinal cord stimulation (SCS) can identify DC neurophysiologically. We compare application and feasibility of both methods.MethodsPatients with surgically treated imSCT were prospectively included between 04/2017 and 06/2019. The anatomical midline (AM) was marked. SSEPs at the DC after stimulation of tibial/median nerve with an 8-channel DCM electrode and cortical SSEP phase reversal at C3/C4 after SCS using a bipolar concentric probe were recorded. Procedural and technical aspects were compared. Standardized neurological examinations were performed preoperatively, 1 week postoperatively and after more than 12 months.ResultsThe DCM electrode detected the midline in 9/13 patients with handling limitations in the remaining patients. SCS was applicable in all patients with determination of the midline in 9/13. If both recordings could be acquired (6/13), concordance was 100%. If baseline SSEPs were poor, both methods were limited. SCS was less time-consuming (p = 0.001), cheaper, and easier to handle. In 92% of cases, the AM and neurophysiologic midlines were concordant. After myelotomy, 3 patients experienced > 50% reduction in amplitude of SSEPs. Despite early postoperative worsening of DC function, long-term follow-up showed significant recovery and improvement in quality of life.ConclusionDCM and SCS may help confirm and correct the AM for myelotomy in imSCT, leading to a favorable long-term neurological outcome in this cohort. SCS evolved to be superior concerning applicability, cost-effectiveness, and time expenditure.

Diffusion tensor imaging in evaluation of intradural spinal tumors – A case series

Diffusion tensor imaging (DTI) is an advanced magnetic resonance imaging (MRI) technique which utilizes diffusion measurements in multiple directions to provide information regarding tissue structure by parameters such as fractional anisotropy (FA) and apparent diffusion coefficient along with generation of fiber tractography maps. We investigated DTI using single shot echo planar imaging in 20 diffusion directions on 3T MRI in nine patients diagnosed with intradural spinal tumors and found significant reduWction in FA value within the lesion compared to FA value at normal cord. Tractography maps generated by DTI were useful in differentiating intramedullary from extramedullary location of tumor. Tractography also provided useful information regarding tract infiltration or displacement in cases of intramedullary neoplasms. Thus, DTI proved helpful in classification, characterization, and treatment planning of intradural spinal tumors.

Massive Intramedullary Ependymoma: A Case Report

Introduction: Intramedullary ependymoma (IE) is adults' most common intramedullary spinal tumor. Tumors usually extend one to eight segments in the cervical region. In this case report, we reported a patient with massive IE spanning from the fourth ventricle to the T4 segment of the spinal cord, which surgically treated with laminectomy from occiput to T4 Case Presentation: A 42-year-old man who is a known case of IE with progressive upper extremities paraesthesia and gait disturbance. Four years ago he refused surgery and presented with dysphagia. The patient's MRI demonstrated an intramedullary spinal cord tumor extending from the fourth ventricle to T4. Conclusions: massive spinal ependymoma is a rare, benign, slow-growing tumor, and patients present symptoms years before diagnosis. Upon confirmation of the diagnosis, the tumor must be surgically removed.

Intramedullary spinal cord metastasis from esophageal squamous cell carcinoma: case report and literature review

BackgroundIntramedullary spinal cord metastasis (ISCM) of malignant tumors rarely happens. To the best of our knowledge, only five cases of ISCM from esophageal cancer have been reported in literature. We here report the sixth descripted case of ISCM from esophageal cancer.Case presentationA 68-year-old male presented with weakness of right limbs and localized neck pain two years after diagnosed esophageal squamous cell carcinoma. The gadolinium enhanced Magnetic resonance imaging (MRI) of cervical spine showed a mixed-intense intramedullary tumor with typical more intense thin rim of peripheral enhancement in C4-C5. The patient died fifteen days after diagnosis of irreversible respiratory and circulatory failures. An autopsy was refused by his family.ConclusionsThis case highlights the importance of gadolinium enhanced MRI for diagnosis in ISCM. We believe that early diagnosis and surgery for selected patients shows helpfulness to save their neurologic function and improve quality of life.

A rare case of H3K27-altered diffuse midline glioma with multiple osseous and spinal metastases at the time of diagnosis

BackgroundH3K27-altered diffuse midline gliomas are uncommon central nervous system tumors with extremely poor prognoses.Case presentationWe report the case of a 24-year-old man patient with multiple, inter alia osseous metastases who presented with back pain, hemi-hypoesthesia, and hemi-hyperhidrosis. The patient underwent combined radio-chemotherapy and demonstrated temporary improvement before deteriorating.ConclusionsH3K27-altered diffuse midline glioma presents an infrequent but crucial differential diagnosis and should be considered in cases with rapid neurological deterioration and multiple intracranial and intramedullary tumor lesions in children and young adults. Combined radio-chemotherapy delayed the neurological deterioration, but unfortunately, progression occurred three months after the diagnosis.

Intramedullary melanotic schwannoma: a rare presentation of a rare tumor. Illustrative case.

Intramedullary melanotic schwannomas (IMSs) are rare spinal cord tumors, and a hemorrhagic IMS is an even rarer presentation of this uncommon lesion. The authors describe the second known case of a hemorrhagic IMS and briefly review the characteristics of IMSs. The patient's initial presentation and imaging indicated an intramedullary thoracic spinal cord tumor impairing lower extremity function. Intraoperatively, the lesion appeared pigmented and hemorrhagic. Pathologic analysis determined the tumor to be an IMS. Melanotic schwannomas vary in presentation and can resemble malignant melanoma but are differentiated by pathologic markers. Lesions typically present as extramedullary masses in the thoracic cord. Intramedullary presentation is rare but should be considered for pigmented tumors.

Role of Posterior Longitudinal Ligament Complex in Spinal Deformity Secondary to Surgical Resection of the Intradural Tumor.

In most cases, complete resection of the intradural tumor is accompanied by long-term neurological complications. Postoperative spinal deformity is the most common complication after surgical resection of intradural tumors, and posterior longitudinal ligament complex (PLC) plays an important role in postoperative spinal deformity. In this study, we investigated the role of PLC in spinal deformity after the surgical treatment of intradural tumors. We analyzed the data of 218 consecutive patients who underwent intradural tumor resection from 2000 to 2018 in this retrospective study. Before 2010, patients underwent laminoplasty without maintaining the integrity of PLC (laminoplasty group, n=155). After 2010, patients performed single-port laminoplasty to maintain the integrity of PLC (laminoplasty retain posterior ligament complex group, n=63). The score of quality of life, painful cortex, spinal cord movement, progressive kyphosis or scoliosis, perioperative morbidity, and neurological results were analyzed in the laminoplasty group and laminoplasty retain posterior ligament complex group. The distributed variable was shown as mean ± standard deviation and an independent t-test or one-way analysis of variance was calculated. There are 155 patients (71.1%) included in the laminoplasty group, and 63 patients (28.9%) in the laminoplasty retain posterior ligament complex group. The average age of patients was 42 ± 2.3 years, and the average modified McCormick score was 2. There were 158 (72.4%) patients with intramedullary tumors and 115 (52.7%) patients with extramedullary tumors. The length of hospital stays (8 days vs. 6 days; p=0.023) and discharge to inpatient rehabilitation (48.4% vs. 26.9%; p=0.012) were significantly lower in the laminoplasty retain posterior ligament complex group than the laminoplasty group. There was no significant difference in the risk of progressive deformity between the two groups at 18months after surgery (relative risk 0.12; 95% confidence interval [CI] 0.43-1.25; p=0.258) and at 20months after surgery (relative risk 0.24; 95% CI 0.21-2.1). Laminoplasty retains posterior ligament complex showed no impact on the spinal deformities compared with laminoplasty, but significantly improved the postoperative spinal activity, alleviated pain symptoms, and reduced hospital recovery time.

Assessment of intraoperative neurophysiological monitoring techniques in intramedullary spinal cord tumor removal surgery

ObjectiveIntraoperative neurophysiological monitoring in intramedullary spinal cord tumor removal surgery helps surgeons detect early warning signs of postoperative nerve damage, in order to reduce or prevent permanent neuron injury. We performed a study to evaluate the value of intraoperative neurophysiological monitoring techniques in intramedullary spinal cord tumor resection surgery. MethodsWe performed a retrospective study of 29 patients undergoing surgery for intramedullary spinal cord tumors and intraoperative neurophysiological monitoring from 2017 to 2021 at the University Medical Center, Ho Chi Minh City. Clinical assessment before and after surgery, intraoperative neurophysiological monitoring to find out the sensitivity, specificity, positive predictive value, and negative predictive value of intraoperative neurophysiological monitoring techniques were performed. ResultsOf the 29 patients, 4 patients had worse postoperative neurological symptoms (13.8%) at 1 day after surgery. The rate of postoperative worsening neurological symptoms decreased to 10.3% at the 1-month follow-up. SSEP (somatosensory evoked potential) had 75% sensitivity and 72% specificity in detecting postoperative nerve damage, while the sensitivity and specificity of MEP (motor evoked potential) were 100% and 80%, respectively. ConclusionBoth SSEP and MEP have a high sensitivity in detecting postoperative nerve damage, meanwhile, MEP is more sensitive than SSEP. These techniques help predict and possibly prevent timely neurological damage during intramedullary spinal cord resection surgery.

Hemilaminectomy for the removal of the spinal tumors: An analysis of 901 patients.

We report our experience with the use of hemilaminectomy approach for the removal of benign intraspinal tumors. A retrospective review of 1,067 patients who underwent hemilaminectomy in our hospital between 2013 and 2019 was analyzed. Baseline medical data were collected. One hundred sixteen patients were excluded due to degenerative diseases, spinal bone tumors, and malignant tumors. The remaining 901 patients (916 tumors) were enrolled. The Dennis Pain Scale (DPS) was used to assess improvement in pain before surgery and during long-term follow-up. Neurological status was assessed using the American Spinal Injury Association (ASIA) impairment scale. The age of the patients was 48.7 ± 15.3 years, the duration of symptoms was 16.5 ± 32.0 months, and the tumor size was 2.6 ± 1.4 cm. Three hundred two tumors were located in the cervical region, 42 in the cervicothoracic region, 234 in the thoracic region, 57 in the thoracolumbar region, and 281 in the lumbar and lumbosacral region. Twenty-three tumors were ventrally located, 677 were dorsal or dorsolateral, 63 were intramedullary, 87 were epidural, and the rest were dumbbell-shaped. The most common pathologies were schwannomas (601, 66.7%) and meningiomas (172, 19.1%). Total excision was achieved at 97.8%. The operative time was 94.3 ± 32.6 min and the blood loss during surgery was 96.9 ± 116.5 ml. The symptom of pain improved in 87.0% of patients during long-term follow-up, neurological function improved in 68.3% and remained unchanged at 30.5%. The hemilaminectomy approach was a rapid and safe procedure to remove intradural and extradural tumors. This approach has offered several advantages. It could be used for the resection of most extradural or intradural extramedullary lesions, even some intramedullary tumors.

Early Phase Functional Recovery after Spinal Intramedullary Tumor Resection Could Predict Ambulatory Capacity at 1 Year after Surgery.

This is a single-center retrospective cohort study with a university hospital setting. This study aims to evaluate the short-term course of physical function and walking ability after intramedullary spinal cord tumor (ISCT) resection and predict walking independence 1 year after surgery. Although several reports have shown the postoperative functional prognosis of spinal intramedullary tumors with long-term follow-up, no reports have identified the predictors associated with the functional outcome at an early stage. A total of 79 individuals who underwent ISCT resection at our institute between 2014 and 2019 were enrolled in the study, whose preoperative walking state was independent ambulator regardless of cane support with the Functional Independence Measure Locomotor Scale (FIM-L) score of ≥6. The FIM-L, the American Spinal Injury Association (ASIA) motor and sensory scores in the lower extremities, and the Walking Index for Spinal Cord Injury II (WISCI II) were assessed for walking independence, lower-limb function, and walking ability, respectively. These evaluations were performed at 4 time points: preoperatively, 1 week (1W), 2 weeks (2W), and 1 year after surgery. In the early phase after surgery, 71% and 43% of the participants were nonindependent ambulators at 1W and 2W, respectively. Histopathology indicated that patients with solid tumors (ependymoma, astrocytoma, or lipoma) showed significantly lower indices at 1W and 2W than those with vascular tumors (hemangioblastoma or cavernous hemangioma). Regarding tumor location, thoracic cases exhibited poorer lower-limb function at 1W and 2W and poorer walking ability at 2W than cervical cases. According to the receiver operating characteristic (ROC) analysis, 2 WISCI II points at 2W had the highest sensitivity (100%) and specificity (92.2%) in predicting the level of walking independence at 1 year postoperatively (the area under the ROC curve was 0.99 (95% confidence interval, 0.93-1.00). The higher the lower-limb function scores in the early phase, the better the improvement in walking ability is predicted 1 year after ISCT resection.

Spinal oncologic paraparesis: Analysis of neurological and surgical outcomes in patients with intramedullary, extramedullary, and extradural tumors.

Paraparesis due to oncologic lesions of the spine warrants swift neurosurgical intervention to prevent permanent disability and hence maintain independence of affected patients. Clinical parameters that predict a favorable outcome after surgical intervention could aid decision-making in emergency situations. Patients who underwent surgical intervention for paraparesis (grade of muscle strength <5 according to the British Medical Research Council grading system) secondary to spinal neoplasms between 2006 and 2020 were included in a single-center retrospective analysis. Pre- and postoperative clinical data were collected. The neurological status was assessed using the modified McCormick Disability Scale (mMcC) Score. In a univariate analysis, patients with favorable (discharge mMcC improved or stable at <3) and non-favorable outcome (discharge mMcC deteriorated or stable at >2) and different tumor anatomical compartments were statistically compared. 117 patients with oncologic paraparesis pertaining to intramedullary lesions (n=17, 15%), intradural extramedullary (n=24, 21%) and extradural lesions (n=76, 65%) with a mean age of 65.3 ± 14.6 years were included in the analysis. Thoracic tumors were the most common (77%), followed by lumbar and cervical tumors (13% and 12%, respectively). Surgery was performed within a mean of 36±60 hours of admission across all tumors and included decompression over a median of 2 segments (IQR:1-3) and mostly subtotal tumor resection (n=83, 71%). Surgical and medical complications were documented in 9% (n=11) and 7% (n=8) of cases, respectively. The median hospital length-of-stay was 9 (7-13) days. Upon discharge, the median mMcC score had improved from 3 to 2 (p<0.0001). At last follow-up (median 180; IQR 51-1080 days), patients showed an improvement in their mean Karnofsky Performance Score (KPS) from 51.7±18.8% to 65.3±20.4% (p<0.001). Localization in the intramedullary compartment, a high preoperative mMcC score, in addition to bladder and bowel dysfunction were associated with a non-favorable outcome (p<0.001). The data presented on patients with spinal oncologic paraparesis provide a risk-benefit narrative that favors surgical intervention across all etiologies. At the same time, they outline clinical factors that confer a less-favorable outcome like intramedullary tumor localization, a high McCormick score and/or bladder and bowel abnormalities at admission.

Laser fluorescence spectroscopy in surgical treatment of intramedullary tumors: experience of the Burdenko Neurosurgery Center

To analyze efficacy of fluorescence navigation technique and laser fluorescence spectroscopy in surgical treatment of various spinal cord tumors. There were more than 1000 patients with intramedullary spinal cord tumors between 2001 and 2022. Intraoperative fluorescence navigation with laser spectroscopy was used in 47 cases. All patients underwent examination before and after surgery. We analyzed somatic, neurological and functional status (McCormick scale). MRI of the spinal cord and intraoperative fluorescence spectroscopy (OPMI Pentero 900 microscope with a fluorescent module, Carl Zeiss, Germany) were performed. To induce visible fluorescence, we used 5-ALA-Alasens (NIOPIK, Russia). Laser spectroscopy was carried out on a LESA-01-BIOSPEC analyzer (Biospec JSC, Russia). Morphological analysis of intramedullary spinal cord tumors was carried out in the laboratory of neuromorphology of the Burdenko Neurosurgery Center. In our sample, fluorescence navigation and laser fluorescence spectroscopy were used only in surgical treatment of intramedullary tumors. Laser fluorescence spectroscopy was valuable to identify fragments of intramedullary ependymoma and astrocytoma in 86% of cases, visual fluorescence - only in 81% of cases. Advisability of this technique for low-grade astrocytomas is unclear and requires further study. Visual fluorescence combined with laser spectroscopy is a promising method for intraoperative imaging of tumor remnants. This approach can improve safety, quality and results of surgical treatment.

Combined Intramedullary and Intradural Extramedullary Solitary Fibrous Tumor in Cervical Spine

Combined Intramedullary and Intradural Extramedullary Solitary Fibrous Tumor in Cervical Spine

A Rare Occurrence of Enchondroma in the Head of Femur in an Adult Male: A Case Report

Introduction: Enchondroma is a solitary, benign, and intramedullary cartilaginous tumor occurring most commonly in small bones of hands and feet contributing to 3–10% of all bone tumors. They originate from the growth plate cartilage which later on proliferates to form enchondroma. Lesions are central or eccentric and metaphyseal involvement is most common for long bones. We report a case of atypical occurrence of enchondroma in the head of femur in a young male. Case Report: A 20-year-old male patient presented with a history of pain in the left groin for 5 months. Radiological examination showed a lytic lesion in the head of femur. The patient was managed by safe surgical dislocation of the hip, curettage with autogenous iliac crest bone graft with countersunk screw fixation. Histopathology confirmed the lesion to be enchondroma. At the latest follow-up after 6 months, the patient was symptom-free and there was no evidence of any recurrence. Conclusion: Lytic lesions in the neck femur can have a good prognosis provided timely diagnosis and interventions are done. The present case of enchondroma in the head of femur represents a very rare differential diagnosis for the same and this must be kept in mind. So far, no such case has been reported in the literature. Magnetic resonance imaging and histopathology are of the essence to confirm this entity. Keywords: Enchondroma, atypical presentation, safe surgical dislocation of hip.

New classification and approaches to the treatment of schwannomatosis

Schwannomatoses is a new classification unit for all the hereditary diseases caused by chromosome 22 damage followed by multiple benign neoplasms of the peripheral and central nervous system. Schwannomatosis occurs as a result of damage to different genes: NF2, SMARCB1, LZRT1, loss of heterozygosity of the long arm of chromosome 22. Nevertheless, clinical manifestations are similar. Molecular diagnostics not only confirms the diagnosis, but also predicts the course of disease. Thus, the most severe clinical manifestations are observed in patients with violation of semantic sequences and reading frame shift in exons 2-13 of the NF2 gene. A more favorable course with less number of tumors is observed in patients with somatic mosaicism. Stereotactic irradiation and surgery are the main treatment options for schwannomatosis. However, there is evidence of effective targeted therapy with bevacizumab (inhibitor of vascular endothelial growth factor). Bevacizumab is used in patients with bilateral vestibular schwannomas and high risk of hearing loss, as well as for intramedullary tumor growth control.

Rare Cases of Primary Glioblastoma Multiforme in the Cervical Spinal Cord, Report of Two Cases and Literature Review

Glioblastoma multiforme (GBM) is a highly aggressive and malignant tumor that can arise in the central nervous system, including the spinal cord. We presented two cases of GBM in spinal cord and cerebellum, respectively. First, 36-year-old female who presented to our clinic with a two-month history of progressive lower and upper extremities weakness and numbness. He also reported difficulty with urination and defecation. Second patient was 19 years-old-man with history of extremities weakness and neck pain. MRI demonstrated enhanced intra-medullary tumor in cervical spine. Both patients underwent surgical resection, followed by radiation therapy and chemotherapy. Further researches are needed to identify optimal treatment strategies and improve outcomes for patients with GBM in the spinal cord. Close monitoring and follow-up care are essential to manage potential complications and optimize quality of life for affected individuals.

CORTICAL WINDOW RECONSTRUCTION WITH CEMENT AUGMENTED SCREW FIXATION AFTER INTRALESIONAL CURETTAGE OF LOW-GRADE CHONDROSARCOMAS: A SIMPLE METHOD WITH CLINICAL RESULTS

Purpose:&#x0D; &#x0D; Intralesional curettage with a local adjuvant is a reliable surgical method in the treatment of low-grade chondrosarcomas (LGC). In order to maintain stability, some authors recommend osteosynthesis following intralesional treatment. However, larger osteosynthesis materials may increase complications as well as disturbing postoperative MRI evaluation. In this study, we describe a simple method of cortical window reconstruction with cement-augmented screw fixation.&#x0D; &#x0D; Methods:&#x0D; &#x0D; 22 patients with LGC were enrolled in this retrospective study who underwent surgical intervention between 2011-2021. All patients were treated in the same manner by intralesional curettage, cement augmentation and fixation with titanium screws embedded in the cement. The clinical outcome was assessed, using the MSTS Score.&#x0D; &#x0D; Results:&#x0D; &#x0D; The mean age at diagnosis was 44,5 and the mean follow up duration was 56,2 months. The mean long dimension of the cortical window was 4,8 cm for reconstructions with one screw and 6,2 cm for reconstructions with two screws. All of the patients showed excellent clinical outcomes with a mean MSTS score percentage of 91,3. We did not encounter any major complications postoperatively. On MRI evaluations, the image distortion due to thin titanium screw was minimal and cement bone interface was clearly visible without any disturbance.&#x0D; &#x0D; Conclusion:&#x0D; &#x0D; The convenient use of cement-augmented screw fixation may be a good tool for the reconstruction of cortical window in the treatment of intramedullary tumours of long bones and give a potential chance of obtaining better MRI images without any disturbances postoperatively.

What is the predictive value of intraoperative somatosensory-evoked potential monitoring for postoperative neurological deficit in intramedullary tumor resection?

The objective of this study is to determine the accuracy of somatosensory-evoked potential (SSEP) monitoring versus SSEP combined with motor-evoked potential monitoring (MEP) for predicting postoperative neurological deficits following intramedullary tumor resection. A systematic review was conducted to identify the studies examining postoperative neurological deficits following intramedullary tumor resection. The sensitivity, specificity, and diagnostic odds ratio (DOR) were calculated for each of the monitoring modalities (SSEP vs. SSEP/MEP) and presented by forest plots and receiver operating characteristic curves. The total cohort consisted of 303 patients for the SSEP group and 350 patients for the SSEP/MEP combined group. The specificity and sensitivity of SSEP monitoring were 76% and 55%, respectively. The DOR of SSEP monitoring is 5.6 (95% confidence interval [CI], 1.55–20.26, I2 = 0%). The specificity and sensitivity of SSEP/MEP monitoring were 86% and 80%, respectively. The DOR of SSEP/MEP monitoring is 30.32 (95% CI, 6.92–132.85, I2 = 0%). SSEP/MEP intraoperative monitoring offers higher sensitivity, specificity, and DOR for predicting postoperative neurological deficits following intramedullary tumor resection. Patients who had a postoperative neurological deficit were 30 times more likely to exhibit a SSEP or MEP change compared to approximately six times more likely to solely exhibit a SSEP change.

Intramedullary Spinal Cord Tumors (IMSCTs): Outcome after surgical resection in 35 cases and review of literature

BACKGROUND Intramedullary Spinal Cord Tumors (IMSCTs) are rare and they represent only 5% of all spinal tumors. Ependymoma and astrocytoma are two most common IMSCTs. Due to recent advances in micro instruments, imaging and technology, aggressive surgical excision has become a safer possibility with better outcome. Aim of this study is to analyze functional outcome of patients after surgical resection of IMSCTs and review of literature.&#x0D; METHODOLOGY Over a period of 4 years, between May 2017 and January 2021, 35 patients were operated for IMSCTs under general anesthesia. Neurophysiological monitoring (NPM) was recently available and used only in last few cases. CUSA was used whenever required in these microsurgical procedures. This retrospective study was carried out after retrieving data from OT registers, inpatient files, OPD records, and statistical analysis was executed using SPSS software (version 18). Functional outcome was assessed by McCormick grading scale and mean follow up period was 2.5 years.&#x0D; RESULTS Out of 35 patients, 17 were male and 18 female. Mean age distribution was 27.57(+/-17.68). On admission, 30 patients had motor deficits, 18 had neck or back pain, 10 had sphincter dysfunction, 7 had kyphoscoliosis and 2 patients had normal neurology. MRI with IV contrast of these 35 patients revealed intramedullary lesions at cervical (11), cervicomedullary (4), thoracic (8), cervicothoracic (2), thoracolumbar (3), conus (6) and lumbar (1) regions. 22 patients had gross total and 13 had subtotal resection. Histological examination confirmed 30 glial tumors (ependymoma &amp; astrocytoma), 2 dermoid/epidermoid, 2 neurenteric cysts and 1 secondary. Postoperative complication was 17% and there was no surgery related 30 days’ mortality. Functional outcome was measured by McCormick grade before and after microsurgical resection. Preoperatively 3(8.5%) patients had low grade or independent and 32 (91.4%) had high grade or dependent. Postoperatively and at the time of discharge 14 (40%) of patients had low grade or independent and 21 (60%) were dependent or high grade. On last followed up (4 years) 15 (48.3%) had low grade and 16 (51.6%) had high grade or dependent. In our series, on followed up of 4 years, recurrence rate was 5(14.2%), They were 2 astrocytoma, 1 secondary, and 2 myxopapillary ependymomas. Two patients with myxopapillary ependymoma were operated twice and no radiotherapy was advocated. 8 (22.6%) patients received local radiation and recurrence rate was 17.2%.&#x0D; CONCLUSION Safe resection of intramedullary lesion is possible with the aid of modern neurosurgical tools, however, functional outcome relies on preoperative neurological status of the patients, extent of excision and histology of tumor. Risk factors for recurrence of IMSCTS are extent of resection and histological behavior of tumor.

Description of the Diversity in Surgical Indication and Surgical Strategies for Primary Spinal Cord Tumors: A Nationwide Survey by the Neurospinal Society of Japan.

To assess the current management of primary spinal cord tumors (PSCTs) and determine whether and to what extent there are differences in surgical strategies for PSCTs. The Neurospinal Society of Japan conducted a survey between April 1 and 30, 2021. Certified spine surgeons were requested for information on the frequency of surgeries in 2020 and the surgical strategies adopted for each PSCTs. The following tumor histologies were focused: schwannoma, meningioma, and cauda equina tumor as extramedullary tumors; and ependymoma, hemangioblastoma, astrocytoma, and cavernoma as intramedullary tumors. The participants were divided according to their response as follows: experts, who had experienced ≥ 100 surgeries for PSCTs, and nonexperts. Among 308 participants (63%), 35 (11%) were experts. The total number of PSCTs in 2020 was 802 of which 564 tumors were extramedullary and 223 were intramedullary. Schwannoma accounted for 53% of the extramedullary tumors, and ependymoma accounted for 39% of the intramedullary tumors. Surgical strategies significantly differed among both the experts and nonexperts groups. Some discrepancies in the adopted surgical strategies were observed between groups. Some of the nonexperts, and none of the experts, ruled out surgery for schwannomas (Eden type 4), astrocytomas, or cavernomas. Five nonexperts (2.2%), and none of the experts, resected the entire dura for meningiomas. A nationwide survey revealed that a sufficient consensus did not exist regarding surgical strategies for PSCTs. A disease-specific registry for PSCTs is necessary in academic societies.