Spinal Cord Tumors Research Articles

78. An NCDB analysis of pediatric intramedullary spinal cord tumors

78. An NCDB analysis of pediatric intramedullary spinal cord tumors

P308. Utilizing machine learning for enhanced surgical outcomes: a national analysis of intramedullary spinal cord tumors

P308. Utilizing machine learning for enhanced surgical outcomes: a national analysis of intramedullary spinal cord tumors

83. Microscope-based augmented reality navigation technology for spinal cord tumor resection

83. Microscope-based augmented reality navigation technology for spinal cord tumor resection

Value of Spinal Cord Diffusion Imaging and Tractography in Providing Predictive Factors for Tumor Resection in Patients with Intramedullary Tumors: A Pilot Study.

This pilot study aimed to investigate the interest of high angular resolution diffusion imaging (HARDI) and tractography of the spinal cord (SC) in the management of patients with intramedullary tumors by providing predictive elements for tumor resection. Eight patients were included in a prospective study. HARDI images of the SC were acquired using a 3T MRI scanner with a reduced field of view. Opposed phase-encoding directions allowed distortion corrections. SC fiber tracking was performed using a deterministic approach, with extraction of tensor metrics. Then, regions of interest were drawn to track the spinal pathways of interest. HARDI and tractography added value by providing characteristics about the microstructural organization of the spinal white fibers. In patients with SC tumors, tensor metrics demonstrated significant changes in microstructural architecture, axonal density, and myelinated fibers (all, p < 0.0001) of the spinal white matter. Tractography aided in the differentiation of tumor histological types (SC-invaded vs. pushed back by the tumor), and differentiation of the spinal tracts enabled the determination of precise anatomical relationships between the tumor and the SC, defining the tumor resectability. This study underlines the value of using HARDI and tractography in patients with intramedullary tumors, to show alterations in SC microarchitecture and to differentiate spinal tracts to establish predictive factors for tumor resectability.

The Role of Radiotherapy, Chemotherapy, and Targeted Therapies in Adult Intramedullary Spinal Cord Tumors.

Intramedullary primary spinal cord tumors are rare in adults and their classification has recently evolved. Their treatment most frequently relies on maximal safe surgical resection. Herein, we review, in light of the WHO 2021 classification of central nervous system tumors, the knowledge regarding the role of radiotherapy and systemic treatments in spinal ependymomas, spinal astrocytomas (pilocytic astrocytoma, diffuse astrocytoma, spinal glioblastoma IDH wildtype, diffuse midline glioma H3-K27M altered, and high-grade astrocytoma with piloid features), neuro-glial tumors (ganglioglioma and diffuse leptomeningeal glioneuronal tumor), and hemangioblastomas. In spinal ependymomas, radiotherapy is recommended for incompletely resected grade 2 tumors, grade 3 tumors, and recurrent tumors not amenable to re-surgery. Chemotherapy is used in recurrent cases. In spinal astrocytomas, radiotherapy is recommended for incompletely resected grade 2 astrocytomas and grade 3 or 4 tumors as well as recurrent tumors. Chemotherapy is indicated for newly diagnosed high-grade astrocytomas and recurrent cases. In hemangioblastomas not amenable to surgery, radiotherapy is an effective alternative option. Targeted therapies are playing an increasingly important role in the management of some intramedullary primary spinal cord tumor subtypes. BRAF and/or MEK inhibitors have demonstrated efficacy in pilocytic astrocytomas and glioneuronal tumors, belzutifan in von Hippel-Lindau-related hemangioblastomas, and promising results have been reported with ONC201 in diffuse midline glioma H3-K27M altered.

Neurosteroids in Glioma: A Novel Therapeutic Concept.

Glioma, a diverse group of brain and spinal cord tumors arising from glial cells, is characterized by varying degrees of malignancy, with some types exhibiting highly aggressive behavior, rapid proliferation, and invasive growth patterns, posing significant therapeutic challenges. This review delves into the complex interactions between glioma cells, neurotransmitters, and neurosteroids, emphasizing their potential as therapeutic targets. Key neurotransmitters, like glutamate and gamma-aminobutyric acid (GABA), play crucial roles in glioma growth, invasion, and treatment response. This review examines the involvement of neurosteroids in glioma biology and explores innovative therapeutic strategies targeting these systems. It encompasses the biosynthesis and mechanisms of neurosteroids, interactions between gliomas and neurotransmitters, the spatial distribution of neurosteroid synthesis in gliomas, the role of ion channels, hormonal influences, enzyme modulation, and the neuroimmune system in glioma progression. Additionally, it highlights the potential of neurosteroids to modulate these pathways for therapeutic benefit.

Identifying associations between sample characteristics, symptoms, and self-efficacy differences in adult patients with rare tumors of the central nervous system who participated in a novel web-based natural history study.

High self-efficacy is associated with improved self-care and reduced symptoms in cancer patients but has not been fully interrogated in adults with central nervous system (CNS) cancers. We aimed to identify the relationship between self-efficacy levels in managing emotions (SEMEM) and social interactions (SEMSI) by examining sample characteristics and symptom burden. Sample characteristics and patient-reported outcome (PRO) measures addressing self-efficacy (PROMIS SEMEM & SEMSI) and symptom burden (MDASI BT or SP) were collected in a novel web-based study of 158 adult patients diagnosed with rare CNS tumors. The sample was predominantly female (73%), diagnosed with an ependymoma (66%), and had a median age of 45 (19-75). Low SEMEM was associated with a longer duration of symptoms before surgery (r = -0.26) and female gender (92%) among brain tumor (BT) participants and in spinal cord tumors (SCT), those with lower education (r = 0.29). Reporting low SEMSI was associated with being married (42%), lower education (r = 0.22), and a prolonged time with symptoms before surgery (r = 0.29) in those with BTs, with no associations identified in SCT. More severe mood-related interference (including mood, enjoyment of life, and relationship with others) was associated with lower SEMEM among both locations (r = -0.61 brain, r = -0.28 spine) and SEMSI in BT participants (r = -0.54). Low self-efficacy was linked to a prolonged time between symptom onset and initial surgery, education, gender, and marital status and was associated with higher mood-related interference. Understanding characteristics associated with low self-efficacy underscores a need for future studies to tailor interventions that enhance self-efficacy.

A Concise Guide to D-Wave Monitoring during Intramedullary Spinal Cord Tumour Surgery.

D-waves (also called direct waves) result from the direct activation of fast-conducting, thickly myelinated corticospinal tract (CST) fibres after a single electrical stimulus. During intraoperative neurophysiological monitoring, D-waves are used to assess the long-term motor outcomes of patients undergoing surgery for intramedullary spinal cord tumours, selected cases of intradural extramedullary tumours and surgery for syringomyelia. In the present manuscript, we discuss D-wave monitoring and its role as a tool for monitoring the CST during spinal cord surgery. We describe the neurophysiological background and provide some recommendations for recording and stimulation, as well as possible future perspectives. Further, we introduce the concept of anti D-wave and present an illustrative case with successful recordings.

Retraction: Encapsulation of 5‐Fluorouracil in a Copper(II)‐based Porous Metal‐organic Framework: Drug Delivery and Inhibiting Human Spinal Cord Tumor Cells

Retraction: Encapsulation of 5‐Fluorouracil in a Copper(II)‐based Porous Metal‐organic Framework: Drug Delivery and Inhibiting Human Spinal Cord Tumor Cells

Brain Tumors in Pediatric Patients

Pediatric brain tumors are the most common solid tumors in children, comprising a diverse group of neoplasms that vary in histology, location, and behavior. Common types include astrocytomas, medulloblastomas, ependymomas, and brainstem gliomas. Symptoms often depend on the tumor's location and may include headaches, nausea, vomiting, balance issues, and cognitive or behavioral changes. Advances in imaging, surgical techniques, and therapies, including radiation and chemotherapy, have improved outcomes. However, treatment can have long-term effects on cognitive and physical development, making comprehensive care and follow-up essential for pediatric patients. Early published reviews on pediatric brain tumors may have several lacunae, such as limited data on long-term outcomes, emerging treatment modalities, and the genetic and molecular underpinnings of various tumor types. They might also inadequately address the psychosocial impacts on patients and families. Therefore, a comprehensive review is needed to synthesize the latest research on pediatric brain tumors, encompassing advancements in diagnosis, treatment, and survivorship care. This updated review will provide valuable insights for clinicians, researchers, and policymakers to improve managing and supporting children with brain tumors. The review covers various aspects of pediatric brain tumors, focusing on choroid plexus tumors and spinal cord tumors. It discusses treatment strategies, highlighting surgical, radiotherapy, and chemotherapy options. The review also details presenting signs and symptoms of brain tumors in children, such as headaches, nausea, vomiting, balance issues, and changes in behavior or cognition. These insights aim to enhance early diagnosis and effective management, improving outcomes for affected children. This review addresses gaps in earlier studies on pediatric brain tumors by providing comprehensive insights into choroid plexus and spinal cord tumors, updated treatment strategies, and detailed symptoms. It synthesizes recent research to enhance early diagnosis and management, meeting current needs for effective, tailored treatment and improving patient outcomes.

Pediatric intramedullary spinal cord tumors: A national cancer database analysis of demographics, patterns of care, and survival

ObjectiveQuery the National Cancer Database (NCDB) to delineate epidemiologic frequency, care patterns, and survival outcomes of pediatric intramedullary spinal cord tumors (IMSCTs). MethodsIMSCTs included ependymoma, astrocytoma, and hemangioblastoma. We examined data from the NCDB spanning 2004–2018, focusing on IMSCT in children aged 0–21 years. Our analysis included logistic and Poisson regression, Kaplan-Meier survival estimates, and Cox proportional hazards models. ResultsThis study included 1066 patients aged 0–21 years. 59.4 % of patients were male, while 83.1 % were white. The most common tumor histology was ependymoma (57.5 %), followed by astrocytoma (36.1 %) and hemangioblastoma (6.4 %). 24.9 % of patients received radiotherapy, with radiotherapy utilization being highest among patients aged 6–10 years. Chemotherapy utilization was highest in patients aged 0–5 years. 87.2 % of patients underwent surgical resection, with higher rates in patients aged 16–21 years. Overall survival did not differ significantly between resected and non-resected patients (p = 0.315). Patients in rural areas had worse OS than those in metro areas (HR = 4.42, p = 0.048). Patients with astrocytoma had worse OS compared to other histologies (HR = 2.21, p = 0.003). Astrocytoma patients were over twice as likely to have prolonged LOS compared to ependymoma patients (OR = 2.204, p < 0.001). ConclusionsIn summary, our analysis utilizing the NCDB database provides a comprehensive overview of demographics, care patterns, and outcomes for the largest cohort of pediatric IMSCTs to date. These insights underscore the complexity of managing IMSCTs and emphasize the need for tailored approaches to improve patient outcomes.

Myxopapillary ependymoma of the spinal cord: A case with literature review

Myxopapillary ependymoma is a rare spinal cord tumors. The intramedullary myxopapillary ependymomas are. Herewith case of a 41-year-old male complaint of a nonspecific low back pain, progressive inability to bend, right lower limb pain with numbness of six month duration. On clinical evaluation right lower limb weakness was noted while the sensations were normal. There was no any significant past history. MRI lumbo-sacral spine with whole spine screening was performed. It showed lobulated heterogenous intensity enhancing intra medullary mass lesion in thecal sac extending from L4-L5 to S1-S2 level. It measured about 52 x 28 x 21 mm. MRI features suggestive of neoplasm – ependymoma was made. The gross total surgical resection was performed. On histopathological findings reported as myxopapillary ependymoma grade 2. The tumor on immunohistochemistry showed positive for EMA, GFAP. While negative for CMYC. The Ki-67 proliferation index (MIB1) was 3%. On follow up there was no tumor recurrence. Rehabilitation therapy was initiated and follow up is advised.

Comparison of microscopic full-laminectomy (open surgery) and microendoscopic minimally invasive hemilaminectomy for thoracic extramedullary spinal tumours

BackgroundMinimally invasive treatments for spinal cord tumours are common. The aim of this study was to compare the perioperative outcomes of patients with thoracic extramedullary spinal tumours (TEST) treated by microendoscopic minimally invasive surgery—hemilaminectomy through a homemade tubular retractor (MIS-TR) and microscopic full laminectomy (open surgery).MethodsBetween February 2016 and February 2021, 51 patients with TEST were included. According to their clinical data, patients were classified into the MIS-TR group (n = 30) and the open surgery group (n = 21) and assessed.ResultsIn both groups, the mean operation time, change in perioperative ASIA score, and modified Macnab score were comparable. The average postoperative hospital stay in the MIS-TR group was substantially shorter than that in the open surgery group (p < 0.0001). The mean blood loss volume in the MIS-TR group was substantially lower than that in the open surgery group (p = 0.001). The perioperative complication rate in the MIS-TR group was considerably lower than that in the open surgery group (p < 0.0001). At the 3-month follow-up, there was no substantial difference in the Oswestry Disability Index (ODI) score improvement between the two groups. Nonetheless, at the 12-month follow-up, the average ODI in the MIS-TR group was considerably lower than that in the open surgery group (p = 0.023). The main influencing factors for complete postoperative recovery were preoperative ASIA score (OR 7.848, P = 0.002), surgical complications (OR 0.017, P = 0.008) and age (OR 0.974, P = 0.393).ConclusionsMIS-TR is safer and more effective than open surgery for treating TEST, but the long-term recovery of MIS-TR is not better than that of open surgery.

Predictors of Functional Independence in Children with Spinal Cord Tumors After Surgery: From Physiotherapist Perspective

ABSTRACT Knowledge of the factors affecting functional outcomes has an important role in the development of the care plan in children with spinal cord tumors. Retrospective study was planned to determine predictors of functional independence in children with spinal cord tumors. Data from 80 children treated for spinal cord tumors over 2001–2020-year period was analyzed. Results showed that key predictors such as younger age, higher KPS, and better initial WeeFIM scores were strongly associated with improved functional outcomes. Further multicenter prospective studies are recommended to validate these findings and explore long-term functional outcomes to enhance rehabilitation strategies for this patient population.

Use of Drains in Spine Surgery Systematic Review &amp; Meta-Analysis

Abstract Background Wound suction drains have been used to decrease the rate of postoperative hematoma formation and thus wound infections for many years throughout all surgical subspecialties. Although the use of surgical drains dates back to the years of Hippocrates, in the orthopedic literature these drains have not been shown to be beneficial in decreasing the rates of these complications, especially in orthopedic procedures including fracture fixation or arthroplasty surgeries. However, these drains are still commonly used throughout the orthopedic community, including spine surgery. Aim of the Work This study aims to review the use of closed suction drains in spine surgery. It aims to perform a systematic review and meta-analysis of the outcome of use of drains, their method and provide intervention recommendation by the best available evidence. Material and Methods We followed the PRISMA statement guideline during this systematic review and meta-analysis preparation and performed all steps according to the Cochrane handbook of systematic reviews of intervention. We searched PubMed, Scopus, Cochrane Central Register of Controlled Trials, Web of Science, Embase, and Science Direct till September 2021 relevant keywords. We used the following search strategy for searching different databases. “Wound drain” OR “Suction drainage” OR “Drain” OR “Spine Surgery” OR “Spine” OR “SSI” OR “Surgical Site Infection” OR “Hematoma”) AND (“Vertebral Column” OR “Column, Vertebral” OR “Columns, Vertebral” OR “Vertebral Columns” OR “Spinal Column” OR “Column, Spinal” OR “Columns, Spinal” OR “Spinal Columns” OR Vertebra OR Vertebrae). All the references of the included studies were searched for relevant studies. Results In contrast to other spine procedures, posterior spinal fusion as a surgical treatment for adolescent idiopathic scoliosis necessitates big skin incisions, a lengthy operating duration, and a higher rate of blood transfusion. This meta-analysis comprised four studies. Surprisingly, drains had no effect on total blood loss, the rate of post-surgical infection, the rate of post-operation hematoma, or hospital stay. The drain group required greater blood transfusion than the non-drain group, according to. A drain could also result in a post-durotomy fistula. Drain use is not required after intra-dural spinal cord tumor surgery. Regarding the difference in hemoglobin between preoperative and day 3 postoperative 3 studies, no difference was found between the drain group and the no drain group in all spine surgeries. Conclusion The routine use of a drain in post-operative spine surgery appears to have no effect on the likelihood of post-operative surgical site infections or post-operative epidural hematoma, according to this study. It does, however, increase total estimated blood loss without lowering hemoglobin levels, and has no effect on hospital stay length. To further strengthen any meta- analysis in the future, high-quality studies addressing their use in the spine are require.

Technical Considerations for the Surgical Management of a C2 Spinal Cord Hemangioblastoma and Subjacent Cervical Spondylotic Myelopathy: A 2-Dimensional Operative Video.

Hemangioblastomas are characterized as benign tumors of the central nervous system and are typically associated with von Hippel-Lindau disease in 20% to 30% of patients.1 Spinal hemangioblastomas are rare entities accounting for 2.1% of spinal cord tumors and are most frequently observed in the cervical spinal region.1-4 Treatment interventions include microsurgical resection and stereotactic radiosurgery.5 Understanding the granular detail of surgical management in these complex cases is necessary for optimal clinical outcomes. In this 2-dimensional operative video, we detail the technical nuances for resection of a World Health Organization Grade I hemangioblastoma in the upper cervical spine of a 51-year-old man. The lesion and severe adjacent canal stenosis resulted in extensive spinal cord compression, causing him to experience progressive myelopathic symptoms and neurological deficits. A C1-C7 laminectomy provided exposure of the hemangioblastoma and adequate decompression of the subjacent spondylotic disease. Intraoperative ultrasound was used to localize the tumor and perform a targeted durotomy. The sunburst-colored lesion was eccentric to the left side of C1-C2 and found in the epi-pial region, with pial thickening present in the surrounding area. The feeding vessels and deep draining vein were coagulated and cut. Low-power suction was used for traction/counter-traction dissection of the tumor planes. Owing to a multilevel laminectomy having been performed, hardware placement was performed from C2-T1. Adequate placement of all screws was confirmed with intraoperative 3-dimensional image acquisition. The patient provided informed consent for the operation and for sharing his clinical information, including digital media, for publication; Institutional Review Board not required per institutional policy.

SPINAL INTRADURAL EXTRAMEDULLARY TUMORS AND SIMILAR PATHOLOGIES: A SINGLE CENTER STUDY

Background: We wanted to analyze the neurological symptoms and prognosis of five spinal IDEM (intradural extramedullary) tumors cases diagnosed, and to emphasize that a spinal cord tumor can be found incidentally in evoluation of the proximal regions of the vertebral column in patients who were mistakenly operated for lumbar disc herniation on lumbar MRI, but whosesymptoms did not resolve. Objective: To emphasize the need for examinations such as MRI along the vertebral columna in patients with different spinal pathologies and whose symptoms and clinical signs do not improve. Methods: Patients with spinal IDEM tumors treated with surgical excision and followed for more than 2 years were retrospectively analyzed. Issessed pain with the visual analo scale (VAS), and neurological function with the Nurrick grade.Preoperative complaint time,location of tumor in sagital and axial sections in MRI and pathological diagnosis were investigated. Results: The pathological diagnosis in our study was meningioma in two cases,dural arteriovenous fistula in one case,teratoma in one case ,and myxopapilary epandimoma in one case.İn one case,disc herniation surgery was performed in another hospital due to misdiagnosis, but because the patient’s complaints were resistant. In examination, an IDEM tumor at T11 level was detected, and he was operated. In all cases the VAS score (mean) was reduced from 7.8 to 0.4 as well as the Nurrick grade (mean) was from 2.0 to 0.6. In the dAVF case, spasticity in the lower extremities, bladder and bowel disfunction continued. Conclusion: In cases with severe neurological deficits, MRI scanning of the proximal parts of the vertebral column will help in the differential diagnosis of the lesion occupying the intraspinal space.

Developing a piezoresistive sensor based bionic neurological intraoperative monitoring system for spine surgery skill training.

This research aims to tackle the limitations faced in surgical education nowadays, particularly in the complex field of spinal cord tumor removal surgery. An innovative flexible piezoresistive sensor designed to mimic a motor nerve was developed and integrated into a bionic spine surgery simulation system, allowing for the intraoperative nerve monitoring possible during simulated tumor removal surgeries. The motor nerve, fabricated using a combination of carbon nanotubes and silicone rubber, exhibited a strong correlation between applied force and resultant changes in resistance, as confirmed by experimental results. This creative system can play an important role in providing valuable feedback for training doctors, facilitating the assessment of surgical precision and success, and enabling doctors to take necessary precautions to minimize the risk of nerve damage in real surgical scenarios. Ultimately, this proposed system has the potential to elevate the standard of surgical education, foster skill development among doctors, and significantly contribute to enhanced patient care and recovery.

Incidence and Survival of Patients With Malignant Primary Spinal Cord Tumors: A Population-Based Analysis.

Epidemiological studies on spinal cord tumors are rare, and studies on primary intramedullary tumors are even rarer. The incidence and survival of patients with primary intramedullary spinal cord tumors have not been well documented. We aimed to study the incidence and survival of patients with primary spinal cord malignant and borderline malignant tumors based on data from the Surveillance, Epidemiology, and End Results (SEER) database and provide information for revealing the epidemiology and exploring the prognosis of patients with primary intramedullary tumors. Patients in the SEER database with microscopically diagnosed malignant and borderline malignant primary spinal cord tumors from 2000 and 2019 were included in this study. We analyzed the distribution of patients according to the demographic and clinical characteristics. Then, we extracted the incidence rate and 5-year relative survival for the whole cohort and different subgroups of the cohort. Finally, multivariate Cox proportional hazards models were used to analyze the independent prognostic factors associated with overall survival. A total of 5,211 patients with malignant and borderline malignant primary spinal cord tumors were included in this cohort study. Ependymoma, astrocytoma (including oligodendrogliomas and glioblastoma), lymphoma and hemangioblastoma were the most common pathological types. The age-adjusted incidence rates of primary spinal cord ependymoma was 0.18 per 100,000. The incidence rate for females was significantly lower than that for males. The incidence rate was highest in Caucasian. The incidence rate of ependymoma was significantly higher than that of other pathological types. The incidence of astrocytoma was highest among people aged 0-19 years, the incidence of ependymoma was highest among people aged 40-59 years, and the incidence of lymphoma was highest among people aged 60 years or older. The 5-year observed survival and relative survival rates for the whole cohort were 82.80% and 86.00%, respectively. Patients diagnosed with ependymoma had significantly better survival than their counterparts. We also found the impact of surgery and chemotherapy on the prognosis of patients with different tumors varies a lot. We conducted a population-based analysis of malignant and borderline malignant primary spinal cord tumors with the aim of revealing the epidemiology and survival of patients with primary intramedullary spinal cord tumors. Despite some shortcomings, this study provides valuable information to help us better understand the epidemiological characteristics of primary intramedullary spinal cord tumors.

State-of-the-Art and New Treatment Approaches for Spinal Cord Tumors.

Spinal cord tumors, though rare, present formidable challenges in clinical management due to their intricate nature. Traditional treatment modalities like surgery, radiation therapy, and chemotherapy have been the mainstay for managing these tumors. However, despite significant advancements, challenges persist, including the limitations of surgical resection and the potential side effects associated with radiation therapy. In response to these limitations, a wave of innovative approaches is reshaping the treatment landscape for spinal cord tumors. Advancements in gene therapy, immunotherapy, and targeted therapy are offering groundbreaking possibilities. Gene therapy holds the potential to modify the genes responsible for tumor growth, while immunotherapy harnesses the body's own immune system to fight cancer cells. Targeted therapy aims to strike a specific vulnerability within the tumor cells, offering a more precise and potentially less toxic approach. Additionally, novel surgical adjuncts are being explored to improve visualization and minimize damage to surrounding healthy tissue during tumor removal. These developments pave the way for a future of personalized medicine for spinal cord tumors. By delving deeper into the molecular makeup of individual tumors, doctors can tailor treatment strategies to target specific mutations and vulnerabilities. This personalized approach offers the potential for more effective interventions with fewer side effects, ultimately leading to improved patient outcomes and a better quality of life. This evolving landscape of spinal cord tumor management signifies the crucial integration of established and innovative strategies to create a brighter future for patients battling this complex condition.