Removal Of Spinal Cord Tumors Research Articles

Clinic and treatment of intramedullary ependymomas

Objective — to improve the results of treatment of patients with intramedullary ependymomas. Materials and methods. The results of treatment of 29 patients (14 men and 15 women aged 18 to 64 years) with intramedullary ependymomas operated on at the Romodanov Institute of Neurosurgery of the National Academy of Medical Sciences of Ukraine were analysed. All patients who were scheduled for surgery underwent magnetic resonance imaging (MRI) with paramagnetic contrast agent. The preoperative and postoperative neurological status was assessed using the modified McCormick scale. Results. Microsurgical technique for removal of spinal cord tumors was used in all 29 observations. According to the volume of tumor removal, operations with total (12 observations), subtotal (9 observations) and partial (8 observations) removal were distinguished. Removal of at least 95 % of the tumor volume, which was confirmed by visualization with a microscope during surgery and early postoperative MRI, was considered total. At the time of discharge from the hospital, in 11 patients (37.9 %) the neurological condition improved compared to the preoperative period, in 13 (44.8 %) it remained unchanged, and in 5 (17.2 %) there was an increase in neurological symptoms. 12 patients were examined 12—36 months after the operation. Improvement compared to the preoperative period was found in 10 patients, and no changes in 2. There were no cases of worsening of neurological symptoms during this period. MRI performed before discharge from the hospital showed almost normal spinal cord diameter in the area of surgical procedures, and MRI performed ≥ 3 months after total tumour removal showed atrophic changes in the spinal cord with ependymoma localisation at the thoracic level. Conclusions. Intramedullary ependymomas can be totally removed, and surgical intervention must be carried out immediately after the diagnosis before the appearance of signs of increasing neurological deficit. Thanks to the use of microsurgical techniques and an intraoperative microscope, it is possible to achieve positive functional results during the total removal of intramedullary tumors.

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.

A Novel Technique of Mixed Reality Systems in the Treatment of Spinal Cord Tumors

Several reports have compared spinal cord tumor removal techniques but none have clearly described the appropriate site and level of indication for laminectomy or laminoplasty. The approach method for tumor removal depends on the type and localization of the tumor and the surgeon's skill. Therefore, a system that can suggest various surgical techniques is useful for spinal cord tumor surgery. The mixed reality system introduced in this paper is an excellent system that can suggest various surgical procedures. Using this system for spinal cord tumor removal, we made the surgery less invasive; therefore, we introduced this system and demonstrated its usefulness. Stereoscopic data of the patients with spinal cord tumors were obtained from preoperative myelogram-CT data. Stereoscopic laminectomy models including tumors were created using Blender, a free three-dimensional (3D) image editing software. We observed these data as 3D object images using a head-mounted display (HMD). This HMD is commercially available and relatively inexpensive. The surgical procedure is determined by considering those 3D images, radiological diagnosis, and the skill of surgeons. Intraoperative confirmation of the laminectomy site could be performed using the HMD. The 3D visualization of pathological conditions resulted in correct preoperative surgical planning and less invasive surgery in all five cases. Stereoscopic images using HMDs allow us a more intuitive understanding of the positional relationship between the tumor and spinal structure. These 3D object images can bring us more accurate preoperative planning and proper determination of surgical methods.

체성유발전위가 운동유발전위보다 뚜렷하게 변화한 척수 종양 제거술 증례

체성유발전위가 운동유발전위보다 뚜렷하게 변화한 척수 종양 제거술 증례

Epidural chloroma and spinal cord compression

Epidural chloroma and spinal cord compression

Increased Intraoperative Motor Evoked Potentials and Motor Recovery after Spinal Cord Tumor Removal

Increased Intraoperative Motor Evoked Potentials and Motor Recovery after Spinal Cord Tumor Removal

UPDATES IN LAMINOPLASTY TECHNIQUES FOR TREATMENT OF MULTILEVEL CERVICAL STENOSIS

Background: The main goal of laminoplasty is to provide decompression of the spinal cord by widening the spinal canal, and used to gain wide access to the spinal canal to perform additional procedures, e.g. adequate dissection around the dural tube, duraplasty, and removal of spinal cord tumor. Objective: Across sectional cohort study to assess effectiveness and safety of laminoplasty in treatment of multilevel cervical canal stenosis and comparison of different techniques. Patients and Methods: We studied 20 patients with multilevel cervical canal stenosis undergoing cervical laminoplasty. All patients were subjected pre-operatively to full general and neurological clinical assessment, routine laboratory work and neuroimaging by plain X-ray, CT scan and MRI cervical spine. Results: This study included 20 patients (14 males and 6 females) and the mean age was 48.9 years. There were 7 patients with history of HTN and 5 patients with history of DM.There was a significant improvement post-operatively ofNurick grade score, Japanese Orthopedic Association scores and neck pain visual analog scale score. Conclusions: Laminoplasty is becoming an increasingly popular treatment for multilevel cervical stenosis due to cervical spondylotic myelopathy. Laminoplasty minimizes the risk of certain complications associated with other surgical options, such as graft and fusion-related complications.

P285 Postoperative clinical motor findings correlations with IONM MEP results during intramedullary spinal cord tumor removal. Presentation of 2 cases

Objectives Description of two cases of IONM in intramedullary spinal cord tumors muscle MEPs and D-wave recordings, and its immediate postoperative outcomes correlation. Methods Muscle MEPs, D-wave and SSEPs were recorded in both patients. D-wave amplitude and muscle MEPs presence-absence, were the critical parameters for MEP interpretation. Results Case 1. A 64-year-old male presented with a history of progressive tingling paresthesia with clumsiness to fine movements in both hands. A cervical MRI scan revealed a lesion from C3–C4 level, compatible with ependymoma. During surgery, loss of muscle MEPs in the left TA, significantly decreasing MEPs in right and left AH, right TA, left APB and EXT and slightly decreasing MEPs in right APB and EXT, occurred. D-wave amplitude showed no change. Postoperatively, the patient had a transient quadriplegia, as expected from MEP data. After a week, he was able to reach the vertical position with some help. Case 2. A 61-year-old male presented with a history of dysesthesias and tingling sensation of lower extremities, causing the patient to fall. Weakness for right hand movementsA cervical-dorsal MRI study revealed a lesion from C6-T1 level, compatible with an ependymoma. During surgery, right leg muscle MEPs completely disappeared, and right leg MEPs significantly decreased. Muscle MEPs in right EXT slightly decreased. A drop of D-wave amplitude of about 40% was noted. After surgery, the patient had a transient paraplegia. In the following days, there was a bilateral improvement of paraparesis. Discussion Intraoperative loss of muscle MEPs as long as D-wave remains above 50% of the baseline value, indicates a temporary loss of motor function in the corresponding limb. Further D-wave amplitude declining will translate in permanent plegia. Conclusions Correct prediction of the clinical status during surgery is possible with a high certainty. Muscle MEPs, combined with D-wave amplitude recordings, provides useful intraoperative information and correctly correlate with postoperative recovery. Using this information, surgical strategy can be adapted before irreversible neurological damage is caused. Significance Present and stable IONM recordings allow complete resection of intramedullary tumors with confidence about the integrity of the motor pathways.

A retrospective observational study on the treatment outcomes of 26 patients with spinal cord astrocytoma including two cases of malignant transformation.

To determine the biologic behavior and prognostic factors of spinal cord astrocytoma, we reviewed surgical and clinical outcomes. Due to the rarity of spinal cord astrocytoma, there is a lack of research regarding this type of tumor and malignant transformation. We retrospectively reviewed the data from all patients on whom we performed spinal cord tumor removal between 1983 and 2014. Twenty-six patients were pathologically confirmed to have spinal cord astrocytoma or glioblastoma. Surgical extent and disease progression were confirmed by the surgeon based on operative findings, postoperative MRI, and outpatient department (OPD) follow-up. Pain or neurological deficit was the chief complaint for all patients. With MRI studies, there is a tendency for high-grade astrocytomas to show as enhanced and heterogeneous images. Two of the low-grade astrocytomas showed malignant transformation over the course of 4 and 11months, respectively. The overall survival (OS) for low-grade astrocytoma was 28-480months (mean 156.38months); the OS for high-grade astrocytoma was 1-36months (mean 12.00months). Two of 12 low-grade cases showed malignant transformations at 4 and 11months, respectively, based on pathological confirmation. With spinal cord astrocytomas, enhanced MRI results appeared similar to those of a malignant lesion. We suggest close observation and image correlation of low-grade astrocytomas, even when pathologically confirmed as low-grade. In this review, we found that histologic grade is the most important prognostic factor, although it is not always concordant with biologic behaviors.

Surgical results after unilateral laminectomy for the removal of spinal cord tumors.

ObjectiveTo reduce the risk of postoperative spinal instability or deformity, unilateral laminectomy (UL) has been recommended to remove spinal space-occupying lesions. The purpose of this study was to determine whether there were any advantages of UL for removal of spinal cord tumors.MethodsFrom May 1995 to May 2010, 94 patients with spinal cord tumors, who underwent tumor removal via UL in our institute, were enrolled in this study. Intramedullary spinal cord tumors were excluded. Simple radiographs were obtained for accessing the restoration of the spinal column. Spinal magnetic resonance imaging (MRI) was also obtained during the follow-up period to evaluate tumor recurrence.ResultsThere were 51 women and 43 men; their mean age was 47.8 years (range, 9-83 years). The mean follow-up period was 52.6 months (range, 24 month-16 years). The sites of the tumors were cervical in 21 cases, thoracic in 37, lumbar in 33, and sacral in 3. These cases included 85 intradural extramedullary (IDEM) and 9 extradural (ED) lesions. IDEM tumors consisted mainly of neurilemmomas (56.3%) and meningiomas (22.3%).Tumors were totally removed in 80 cases and subtotally removed in 14 cases. Postoperative neurological status was improved in 53 cases, unchanged in 31 cases, and worsened in 10 cases. During follow-up, MRI showed tumor recurrence in 4 patients. Histopathologically, three cases were meningiomas and one case was neurilemmoma. None of the patients showed spinal instability or kyphotic deformity at last follow-up.ConclusionUL is an optimal approach for providing sufficient exposure of spinal cord tumors without development of postoperative spinal instability and regional sagittal imbalance in any location of spinal column. In cases of meningioma, careful long-term follow up is needed due to it's relatively high recurrence rate after removal via UL.

筋肉温存型腰椎椎弓間除圧術 (MILD) のアプローチを応用した脊髄腫瘍摘出術

筋肉温存型腰椎椎弓間除圧術 (MILD) のアプローチを応用した脊髄腫瘍摘出術

Ｔｈｒｅａｄｗｉｒｅ ｓａｗ（Ｔ‐ｓａｗ）を用いた頚髄腫よう摘出術の経験

Ｔｈｒｅａｄｗｉｒｅ ｓａｗ（Ｔ‐ｓａｗ）を用いた頚髄腫よう摘出術の経験

Intraoperative Monitoring of Spinal Cord Function Using Motor Evoked Potentials via Transcutaneous Epidural Electrode During Anterior Cervical Spinal Surgery

Because false-positive results are not infrequent when monitoring somatosensory evoked potentials during surgery, monitoring of motor evoked potentials (MEPs) has been proposed and successfully used during the removal of spinal cord tumors. However, this often requires direct visual placement of an epidural electrode after a laminectomy. We evaluated the use of MEPs, recorded via a transcutaneously placed epidural electrode, to monitor motor pathway functional integrity during surgery on the anterior cervical spine. Sixteen patients underwent anterior cervical vertebral decompression and fusion for cervical myelopathy and/or radiculopathy. Before surgery, an epidural monitoring electrode was placed transcutaneously at the midthoracic level and was used to record MEPs after transcranial cortical electrical stimulation. Electrode placement was successful in all patients but one, and satisfactory baseline spinal MEPs were obtained except for one patient who had cerebral palsy with significant motor dysfunction. Patients showed no significant changes in spinal MEPs during surgery, and all had baseline or better motor function postoperatively. None had complications from epidural electrode placement or electrical stimulation. We conclude that motor pathways can be monitored safely during anterior cervical spinal surgery using spinal MEPs recorded via a transcutaneously placed epidural electrode, that MEP preservation during surgery correlates with good postoperative motor function, and that cerebral palsy patients may possess too few functional motor fibers to allow MEP recording.

Cryoprobe-assisted removal of spinal cord tumors: Technical note

The application of a cryosurgical contact probe to assist in the removal of intraspinal neoplasms is described. Most often used by ophthalmic surgeons for intraocular extraction purposes, these .89–3 mm cryoprobes provide an ideal safe “handle” when attached to intramedullary or extramedullary spinal cord tumors and facilitate dissection and removal with standard microsurgical techniques.

Analysis of cervical instability resulting from laminectomies for removal of spinal cord tumor.

Thirty-four patients with cervical cord tumor were followed in order to investigate the incidence of postoperative deformity or instability after laminectomies. Seven cases (20%) presented cervical instability, including three cases that required spinal fusion. Analysis of these cases revealed the identification of some risk factors that are involved in the pathogenetic mechanism of cervical instability, which are: age at operation, preoperative curvature in neutral position, number of removed laminas, C2 laminectomy, and destruction of facet joints. The number of these risk factors present in each case was shown to be directly related to the incidence of cervical instability. Patients who had not developed instability demonstrated 1.2 factors on average, while patients who had developed instability showed a mean of 2.5 factors. Patients who had additionally required spinal fusion presented 3 risk factors, including C2 laminectomy and destruction of facet joints.

Laminectomy for the removal of spinal cord tumors.

Laminectomy for the removal of spinal cord tumors.