Spinal Cord Tumors Research Articles

Diffuse Midline H3 K27-Altered Gliomas in the Spinal Cord: A Systematic Review

Background: Gliomas account for 80-90% of all intramedullary spinal cord tumors (IMSCTs). Though rare compared to brain tumors, spinal cord gliomas can cause significant morbidity and mortality. Diffuse midline gliomas (DMGs) with H3 K27M-mutation, first introduced in the 2016 WHO classification, are high-grade tumors with aggressive behavior and poor prognosis. The 2021 updated WHO classification renamed them "diffuse midline glioma, H3 K27-altered" to include other molecular changes. Limited single-institution data on spinal cord DMGs (DMGSCs) hinder comprehensive understanding and optimal treatment protocols. In this review, we summarize clinical and molecular features, management strategies, and survival impact in patients with DMG-SCs.
 Project Methods: A systematic review was performed following the (PRISMA) guidelines. PubMed, Ovid EMBASE, Scopus, and Web of Science were searched. Clinical characteristics, treatment protocols, and outcomes were analyzed.
 Results: A total of 26 studies with 259 patients were included. Most patients were male (63%), diagnosed at a mean age of 32 years (range, 4-72), and tumors were predominately located in the cervical (32%) or thoracic (43%) regions of the spinal cord. Primary management included surgical resection (97%), radiotherapy (78%), and chemotherapy (62%). Most common combination of treatment included surgical resection, radiotherapy, and chemotherapy (47%). The mean overall and progression free survival were 25 (range, 0.1-48) and 14 (range, 0.1-25) months, respectively. Gene alterations included p53 mutation (61%), loss of ATRX (46%), Olig- 2 positive (100%), and GFAP positive (80%). The mean Ki-67/MIB-1 was 23% (12-40%).
 Conclusion/Impact: DMG-SCs affect mostly the adult population and appear to resemble adult DMGs in terms of molecular features, management, and prognosis.

Intradural Extramedullary Spinal Tumors: A Clinical Study and Management without the Aid of Nerve Monitoring

Abstract Background: The incidence of primary spinal cord tumors is less and the true incidence is still not known and various studies are still being done. These tumors are benign and slow growing, and they generally present with pain – either radiculopathy or axial back pain or focal neurological deficits due to the loss of roots, myelopathy from spinal cord compression, or cauda equina symptoms due to chronic compression. Early diagnosis and operation are gratifying as the lesions are mostly benign and can be completely resected as well as preservation of functionality if operated as early as possible. Although rare, an inadvertent neurological injury during surgery is a concerning complication that can potentially be prevented with the assistance of intraoperative nerve monitoring (IONM). This technology enables real-time assessment of spinal cord function by providing feedback from sensory tracts, motor tracts, and individual nerve roots. However, the definitive requirement for IONM in the treatment of a highly curable condition is still under consideration. Objective: our study aims at studying the clinical features of intradural extramedullary tumors and their operative management without nerve monitoring. Material and Methods: Patients with intradural extramedullary (IDEM) spinal cord tumors who fit the inclusion criteria and who were willing to investigations, surgical procedures, and follow up were enrolled in the study, and consent was obtained. Patient assessment was done clinically by McCormick’s Scale and radiologically by magnetic resonance imaging. Patients who underwent operation were followed up. The data was collected and analysed using SPSS software. Results: Nineteen patients were enrolled in the study. The age group ranged from 6 years to 79 years. There were 13 females and 6 males in the study group. The common presenting complaints were backache and upper and lower limb pain. Nine out of the 19 patients underwent operative procedures after thorough radiological and clinical evaluation. Histopathology showed five cases of schwannoma and four cases of meningioma. The mean McCormick’s Scale preoperatively was 4.11, whereas postoperatively, it was 3.10. The operative procedures were performed without the aid of IONM, yet there were no inadvertent intraoperative injuries and postoperative outcomes were good. Our study data were comparable with other studies. Conclusion: IDEM tumors, though technically challenging to operate, have excellent results in terms of outcomes due to their benign characteristics as well as complete resectability. Therefore, it is essential to conduct a comprehensive examination and imaging for patients experiencing backaches and weakness. Following a careful evaluation, early surgical intervention should be considered, as the timeliness of the surgery contributes to enhanced outcomes. The unavailability of nerve monitoring did not portend any added risk of surgery if done meticulously though its aid would make the operative procedure safer and gross resection better.

Can Qualitative Cervical Tractography Predict Clinical Findings as Effectively as It Aids Surgical Planning Today?

To investigate cervical spinal tractography (CST) and diffusion tensor imaging findings in patients with intramedullary cervical spinal cord (CSC) tumors and to evaluate the association between qualitative diffusion tensor tractography (DTT) findings and neurological examination findings (NEF). Neuroradiology case records were retrospectively evaluated to identify patients with intramedullary CSC tumors who underwent cervical spinal DTT. Conventional magnetic resonance imaging (MRI) and DTT were performed using a 3.0-T MRI system. Demographic data, CST and clinical findings, fractional anisotropy (FA), and apparent diffusion coefficient (ADC) were recorded. The sensitivity, specificity, and positive and negative predictive values (PPV and NPV, respectively) were calculated. This study enrolled 31 patients (16 women and 15 men) with a mean age of 35.2 ± 15.6 years (range: 1-70 years). The mean FA and ADC were 0.34 ± 0.45 and 1.88 ± 0.89, respectively. Physical examination revealed hemihypesthesia (19.3%), hemiparesis (16.1%), and quadriparesis (3.2%). Completely normal neurological findings were observed in 61.3% of the patients. DTT revealed deviation (n=15), deformation (n=11), and interruption (n=5) of the fibers. No significant relationship was observed between NEF and DTT findings (p=0.127). The sensitivity, specificity, PPV, and NPV of DTT for CSC tracts were 100%, 0%, 38.7%, and 0%, respectively. Although qualitative DTT of the CSC might be useful for planning and preservation of the fiber tracts during intramedullary tumor surgery, it did not exhibit significant association with clinical findings in this study. Qualitative DTT of CSC in patients with intramedullary tumors may not correlate well with NEF.

Intercepting Intracept: A Case Report of Idiopathic Arachnoiditis

Introduction: Determining the exact diagnoses for low back is challenging due to the myriad of causative factors. Consequently, rare diagnoses like arachnoiditis are often overlooked, causing patients with this condition to be ineffectively treated. Arachnoiditis involves inflammation of the arachnoid membrane enveloping the spinal cord, can is caused by diverse etiological factors, including infections, trauma, spinal cord contamination, tumors, and genetic predispositions. Case: In this case report, the author describe a 43-year-old female with a past medical history of anxiety and depression who presented with chronic back pain. The patient had previously undergone trials of various neuropathic and nociceptive modulating medications as well as transforaminal and caudal epidural corticosteroid injections, yielding minimal relief. On the evaluation, the patient’s lumbar spine MRI revealed findings suggestive arachnoiditis, a diagnosis that had also been missed on a previous MRI a year prior. Given this, the patient was advised to not undergo the Intercept procedure which had been previously recommended by another provider. Discussion: Given its resemblance to other neurologic conditions, the diagnosis of arachnoiditis involves a comprehensive approach with history, physical examination, and imaging modalities such as MRI or CT myelography serving as critical components. In this case, the patient did not have any history of infection or trauma, making the diagnosis more elusive, and requiring the team to pay more heed to the imaging finding. Although her imaging served supportive evidence or arachnoiditis, it is important to recognize its correlation with clinical findings and the severity of symptoms is not always consistent. Management of arachnoiditis requires a multi-faceted approach with steroids, neuropathic modulating medications, muscle relaxants, cognitive behavioral therapy, and physical therapy. Conclusion: This case report underscores the diagnostic challenges and clinical intricacies associated with spinal arachnoiditis. The presented patient's atypical symptoms and protracted diagnostic journey highlight the importance of ongoing vigilance and comprehensive evaluation in chronic pain management. Further research should investigate effective treatment modalities for this chronic and debilitating condition that is overlooked, given its similarity to other diagnoses and rare prevalence.

Intramedullary Spinal Cord Tumors: The Do's and the Don'ts

Intramedullary Spinal Cord Tumors: The Do's and the Don'ts

Histopathological spectrum of primary spinal cord tumors: A retrospective study

Histopathological spectrum of primary spinal cord tumors: A retrospective study

A Case of an Iatrogenic Pseudomeningocele after Thoracic Spinal Cord Tumor Surgery with a Long-Term Follow-Up.

A Case of an Iatrogenic Pseudomeningocele after Thoracic Spinal Cord Tumor Surgery with a Long-Term Follow-Up.

FEATURES OF ESTROGEN AND PROGESTERONE RECEPTOR EXPRESSION IN MENINGIOMAS DEPENDING ON GENDER

Introduction. Meningiomas are non-malignant brain or spinal cord neoplasms originating from meningeal cells. The etiology of meningiomas remains insufficiently studied due to the subclinical course and relatively low incidence. Because meningiomas affect women more than twice as often as men, and there are recorded cases of the disease in pregnant women, it is advisable to investigate the role of female sex hormones in the development of this disease. Objective. Our work aimed to study the features of the expression of estrogen and progesterone receptors in meningioma tissue depending on the gender of the patients. Methods and matreials. A total of 50 samples were examined, of which 25 samples were from female patients (group W) and 25 from male patients (group M). The average age of patients in group W was 60.92±1.84 years, and group M was 59.88±3.39 years. Regardless of the equivalent indicators of average age, it is worth noting that the age of female patients varied 42 to 79 years and of male patients – 24 to 88 years. We examined the samples macroscopically, histologically and immunohistochemically (antibodies against estrogen and progesterone receptors). Results. When examined macroscopically, the meningioma had a characteristic spherical or plaque-like shape, grey colour, somewhat bumpy surface, moderate density, and fibrous structure on cross-section. During the histological examination, most samples in both groups were assigned to psammomatous or meningothelial histological subtypes, the characteristic histological patterns of which were concentric structures of flattened tumour cells and psammoma bodies. Conclusions. Immunohistochemical examination of meningioma tissue with antibodies against estrogen (ER) and progesterone (PR) receptors showed their more significant presence in samples of female patients compared to samples of male patients (p<0.001), which confirms the critical role of female sex hormones in etiology and pathogenesis meningioma.

Why do we so rarely recognise and treat the primary progressive form of multiple sclerosis?

The primary progressive form of multiple sclerosis is characterised by a systematic increase in disability from the onset of the disease, usually without overlapping relapses. It is estimated that it accounts for 10–15% of all cases of multiple sclerosis, occurs with similar frequency in both sexes, and its symptoms appear at an older age, usually after 40. The initial manifestation usually consists of pyramidal symptoms and myelopathy. The most typical symptoms include progressive gait and sphincter function impairment. Symptoms of cerebellar syndrome, truncal syndromes, as well as visual and cognitive disturbances are less common. The clinical course with characteristic symptomatology resulting from the location of the changes primarily in the spinal cord, followed by the occurrence of initial symptoms, means that this form of multiple sclerosis requires careful differential diagnosis. It should be differentiated primarily from diseases causing lower limb paresis (myelopathy associated with vitamin B12 deficiency, amyotrophic lateral sclerosis, spinal cerebellar ataxia, neuromyelitis optica spectrum disorder, Wernicke’s encephalopathy, Lyme disease, and spinal cord tumours). The diagnosis of primary progressive multiple sclerosis should be guided by the current 2017 McDonald diagnostic criteria. Understanding these criteria and being aware of the differences from the most common relapsing-remitting form of multiple sclerosis can be helpful in speeding up the diagnosis and implementing effective treatment. Even though new treatment options have emerged in recent years, primary progressive multiple sclerosis is still little known and too rarely recognised.

Anterolateral Foramen Magnum Meningioma: Case Report and Literature Review

Meningiomas are benign tumors dependent on arachnoid cells. Localization to the foramen magnum is rare and represents a surgical challenge. Surgical planning is crucial to choose an optimal approach and to avoid morbidity. We report a case of anterolateral meningioma of the craniocervical junction in a 49-year-old female patient with complaints of progressive weakness of the right arm for the past 6 months. Magnetic resonance imaging showed an extramedullary intradural tumor with dural insertion regarding the body of C1 vertebrae. The patient underwent surgery via suboccipital approach with a C1 laminectomy and a Simpson grade 2 resection was performed. The patient improved postoperatively and returned to her daily activities. We perform a literature review to discuss the considerations for the optimal surgical strategy for the approach of foramen magnum meningiomas.

Multimodal Intraoperative Neurophysiological Monitoring in Intramedullary Spinal Cord Tumors: A 10-Year Single Center Experience.

The study aimed at evaluating the efficacy and the ability of D-wave monitoring combined with somatosensory evoked potentials (SSEPs) and motor evoked potentials (MEPs) to predict functional outcomes in intramedullary spinal cord tumor (IMSCT) surgery. Between December 2011 and December 2020, all patients harboring IMSCT who underwent surgery at our institution were prospectively collected in a surgical spinal registry and retrospectively analyzed. Patient charts and surgical and histological reports were analyzed. The multimodal IONM included SSEPs, MEPs, and-whenever possible-D-waves. All patients were evaluated using the modified McCormick and Frankel grade at admission and 3, 6, and 12 months of follow-up. Sixty-four patients were enrolled in the study. SSEP and MEP monitoring was performed in all patients. The D-wave was not recordable in seven patients (11%). Significant IONM changes (at least one evoked potential modality) were registered in 26 (41%) of the 64 patients. In five cases (8%) where the SSEPs and MEPs lost and the D-wave permanently dropped by about 50%, patients experienced a permanent deterioration of their neurological status. Multimodal IONM (SSEP, MEP, and D-wave neuromonitoring) significantly predicted postoperative deficits (p = 0.0001), with a sensitivity of 100.00% and a specificity of 95.65%. However, D-waves demonstrated significantly higher sensitivity (100%) than MEPs (62.5%) and SSEPs (71.42%) alone. These tests' specificities were 85.10%, 13.89%, and 17.39%, respectively. Comparing the area under ROC curves (AUCs) of these evoked potentials in 53 patients (where all three modalities of IONM were registered) using the pairwise t-test, D-wave monitoring appeared to have higher accuracy and ability to predict postoperative deficits with strong statistical significance compared with MEP and SSEP alone (0.992 vs. 0.798 vs. 0.542; p = 0.018 and p < 0.001). The use of multimodal IONM showed a statistically significant greater ability to predict postoperative deficits compared with SSEP, MEP, and D-wave monitoring alone. D-wave recording significantly increased the accuracy and clinical value of neurophysiological monitoring in IMSCT tumor resection.

Long-term survival after cordectomy in a case of spinal cord diffuse midline glioma, H3K27-altered: illustrative case.

Spinal cord diffuse midline glioma, H3K27-altered, is an extremely rare entity with a poor prognosis. However, its optimal treatment remains poorly defined. Although cordectomy was introduced in the early 20th century, its efficacy has been questioned and shrouded behind the scenes. A 76-year-old male with recent-onset paraparesis of the lower extremities and paresthesia presented to our outpatient clinic. Magnetic resonance imaging revealed an intra-axial spinal cord tumor extending from T12 to L2. The patient underwent laminectomy and partial tumor resection, and the surgical specimen was histologically diagnosed as a diffuse midline glioma, H3K27-altered. Although standard chemoradiotherapy was implemented, the patient experienced local tumor recurrence 2 years later and underwent cordectomy at T9. The patient was alive at the 4-year follow-up after cordectomy without tumor recurrence. According to the literature, patients with lesions in the lower thoracic cord below T8 achieved a longer survival than those with lesions in the upper thoracic cord above T5. Cordectomy benefits selected cases of high-grade spinal cord gliomas. Maximal prevention of cerebrospinal fluid dissemination by tumor cells is indisputably important, and tumors located below the lower thoracic spine may be the key to success in establishing a long-term prognosis after cordectomy.

Clinical utility of intraoperative direct wave monitoring in patients with pre-operative motor deficits: Case series

Introduction and importanceD-wave (Direct waves) are Motor Evoked Potentials (MEPs) generated by a single transcranial stimulation and captured by attaching an epidural recording electrode caudal to the vulnerable area. Intraoperative neurophysiologic monitoring (IONM) is widely used in neurosurgery to recognize important neurological structures but can be challenging in the pediatric population due to incomplete neural development. Case presentationCase 1: A 48-year-old female presented to the outpatient department with complaints of difficulty walking for the past six months, numbness and weakness in bilateral lower limbs with recurrent falls for the past 1 month. Case 2: A 12-year-old boy presented to the emergency room with a history of inability to use both upper and lower limbs on the right side with tremulousness. Clinical discussionMagnetic resonance imaging (MRI) Spine in the first case revealed a D9-D10 calcified meningioma with significant spinal cord compression. In the second case, MRI Spine showed C1-C2 Intramedullary Space Occupying Lesion (SOL) and was planned for C1-C2 laminectomy with midline myelotomy. The first case was planned for microsurgical excision of the lesion under IONM guidance. The procedure went smoothly. Microsurgical gross total resection (GTR) of the intramedullary SOL under IONM Guidance was done for the second case. Postoperatively, the first patient showed no neurological compromise or complications. In the second case, following surgery, the child recovered gradually from surgery. ConclusionThis case series demonstrates the successful surgical management of two cases of spinal cord tumors through an IONM-guided surgery and the effective use of D waves in such challenging cases.

10235-TB-9 TRANSLATIONAL RESEARCH OF BORON NEUTRON CAPTURE THERAPY FOR SPINAL CORD AND SPINE TUMOR IN ANIMAL MODELS

Abstract BACKGROUND Boron Neutron Capture Therapy (BNCT) is a particle beam therapy that can target at the cellular level. This study evaluated the effectiveness of BNCT on spinal cord gliomas using animal models. METHODS F98 rat glioma or 9L rat gliosarcoma cell lines were implanted in rats' spinal cords to create a model. BPA, a boron compound, was administered and the biodistribution compared. Neutron irradiation was performed post-BPA injection, and the effectiveness was evaluated by survival period and hindlimb muscle strength using the Basso-Bresnahan-Beattie (BBB) score. RESULTS Significant boron accumulation was observed in tumors. In irradiation experiments, the BNCT group showed suppressed BBB score decrease and a significantly extended survival period compared to other groups. No cases of death or lower limb function decline were observed in the sham-BNCT group. CONCLUSION BNCT for spinal cord gliomas was shown to be safe and effective. The spinal cord is an organ at risk in irradiation for spinal cord and spine tumors. As it has a history of being a safety evaluation organ when applying BNCT to the central nervous system, BNCT may be applicable to cases such as recurrence after radiation therapy.

Multimodal Intraoperative Neurophysiological Monitoring in Cranial and Spinal Tumour Surgeries: A Descriptive Observational Study.

Intraoperative neurophysiological monitoring (IONM) involves monitoring the functional integrity of critical brain regions and pathways as well as identifying and preserving functionally viable neural tissues (mapping) during surgery using electrophysiological techniques. Multimodality combines various neurophysiological techniques to optimise diagnostic effectiveness and to improve the outcomes of the surgeries. The present study is a case series with comprehensive and illustrative descriptions of the neurophysiological changes in five neuromonitored cases of cranial and spinal cord tumour surgeries conducted with a multimodal approach. The cases were monitored with somatosensory evoked potentials (SSEP), transcranial motor evoked potentials (TcMEP), and both free run and triggered electromyography (fEMG and tEMG). No false negative outcomes were identified in the cases studied as there was an association of absence of change in SSEP and TcMEP both, with no neurological deficit postoperatively.Two cases were identified as having true positive neuromonitoring alerts.No false positive alerts were found in any case. Multimodal monitoring using SSEP, TcMEP, and EMG (fEMG and tEMG) in cranial and spinal tumour surgeries can improve performance with fewer false-negative and false-positive results. Neuromonitoring approaches used in combination can provide reliable information regarding postoperative neurological outcomes.

An incidental finding of xanthochromia during spinal anaesthesia in a patient posted for lower limb surgery

BackgroundXanthochromia is the yellowish discoloration of cerebrospinal fluid associated with serious conditions like subarachnoid haemorrhage and spinal cord tumour which raises concerns regarding safety when presented during spinal anaesthesia. There is limited literature regarding the clinical implications of spinal anaesthesia in xanthochromia.Case presentationWe report a case of a 31-year-old male patient with an incidental finding of xanthochromia cerebrospinal fluid during spinal anaesthesia. The patient with a history of fall was posted for lower limb orthopaedic surgery under subarachnoid block. In the process of administering the block, the pale yellow coloured cerebrospinal fluid was encountered.ConclusionWe conclude that proceeding with spinal anaesthesia in xanthochromia should be at the discretion of the anaesthesiologist and further investigations for the diagnosis can be considered for the management in such cases.

Clinical profile of paediatric spinal cord damage in a developing country’s rural-area tertiary hospital neurosurgery

BackgroundSpinal cord damage (SCD) is rare in children, hence the paucity of literature on the subject, particularly in developing countries. This study aims to define the clinical epidemiology of paediatric SCD in a Nigerian tertiary health facility.MethodsA retrospective review of a 42-month long prospectively collected clinical data on paediatric SCD in a rural neurosurgery unit.ResultsThere were 37 children (20 males) accounting for about 12% of the paediatric neurosurgical patients we managed during the study period. The mean age was 6.9 years (peak = 0–4 years, 43.2%). Traumatic spinal cord injury (SCI) was the cause of SCD in 54.1% (20/37) of the cases, spinal bifida in 37.8%, spinal cord tumour in 5.4%, and spinal tuberculosis in 2.7%. The mean age of patients with traumatic SCI was 11.5 years, while the median age for spinal bifida was 3 days. Traumatic SCI was caused by road traffic accident in 70% (14/20), and falls in 25%. The cervical spinal cord was the location of the spinal cord damage in 51.4% of all the cases in this study, lumbosacral in 24.3%, and sacral in 10.8%. Traumatic SCI was predominantly located in the cervical region in (90%, 18/20) while spinal bifida was most commonly lumbosacral (64.3%, 9/14).ConclusionSpinal cord damage accounted for more than a tenth (12.1%) of our paediatric neurosurgical workload in this rural neurosurgery, and are mostly due to traumatic SCI and spinal bifida.

The frequency of various spinal cord tumors (SCTs) in surgically treated patients at Shiraz Shahid Chamran Hospital from 2012 to 2022

Abstract Aim The incidence of spinal cord tumors (SCTs) in a population considering sex, age, histopathology, and emplacement position of tumors is different between various regions. Therefore, the present study aimed to evaluate the frequency of various SCTs in surgically treated patients in a reference spinal surgery center in Shiraz, Iran. Method Documented information related to 109 SCT patients surgically treated was collected from the archive of Shahid Chamran Hospital (the reference center of spinal cord surgery in the south of Iran) in Shiraz from 2012 to 2022. This information includes demographics, medical history, histology, and position of SCTs within the spinal cord. Result The population of patients included 65 men and 44 women, with a mean age of 44.7 years old. Most patients (26 cases) were in the age group of 50–59 years. Neurological function in most patients (51 cases) was equivalent to level D of the ASIA impairment scale (AIS), and the most common complaints of patients (83 cases) were related to pain. Finally, anatomic and histologic evaluations indicated that intradural and schwannoma tumors were the most common types of tumors, with 64 and 25 cases, respectively. Conclusions In the present study, most of the findings are consistent with the previous reports. Schwannoma and ependymoma tumors were the most common types of SCTs and the most common types of intramedullary tumors, respectively. The sixth decade of life was the most common age of incidence. Neurological function in most patients with SCT was equivalent to levels of D and E of AIS. However, regarding the factor of gender, our results are similar to those of the Asian population. More comprehensive studies in the future likely reveal the probable role of environmental, genetic, and hormonal factors in the etiology of SCTs.

What Factors Predict the Development of Neurologic Deficits Following Resection of Intramedullary Spinal Cord Tumors: A Multi-Center Study

Intramedullary spinal cord tumors are challenging to resect, and their postoperative neurological outcomes are often difficult to predict, with few studies assessing this outcome. We reviewed the medical records of all patients surgically treated for Intramedullary spinal cord tumors at our multisite tertiary care institution (Mayo Clinic Arizona, Mayo Clinic Florida, Mayo Clinic Rochester) between June 2002 and May 2020. Variables that were significant in the univariate analyses were included in a multivariate logistic regression. "MissForest" operating on the Random Forest algorithm, was used for data imputation, and K-prototype was used for data clustering. Heatmaps were added to show correlations between postoperative neurological deficit and all other included variables. Shapley Additive exPlanations were implemented to understand each feature's importance. Our query resulted in 315 patients, with 160 meeting the inclusion criteria. There were 53 patients with astrocytoma, 66 with ependymoma, and 41 with hemangioblastoma. The mean age (standard deviation) was 42.3 (17.5), and 48.1% of patients were women (n= 77/160). Multivariate analysis revealed that pathologic grade >3 (OR=1.55; CI=[0.67, 3.58], P= 0.046 predicted a new neurological deficit. Random Forest algorithm (supervised machine learning) found age, use of neuromonitoring, histology of the tumor, performing a midline myelotomy, and tumor location to be the most important predictors of new postoperative neurological deficits. Tumor grade/histology, age, use of neuromonitoring, and myelotomy type appeared to be most predictive of postoperative neurological deficits. These results can be used to better inform patients of perioperative risk.

Adult Intramedullary Mature Teratoma of the Spinal Cord: An Unusual Case with a Review of the Literature

Intraspinal teratoma is a rare subtype of spinal cord tumors, accounting for only 0.2% to 0.5% of cases. These tumors consist of a mixture of two or more germ cell layers, including the ectoderm, endoderm, and mesoderm. They often contain epithelial tissues, fatty tissues, and follicles derived from these three layers, which can be visualized on magnetic resonance imaging (MRI) in most cases. However, in our patient, a 35-year-old woman with an intradural oval intramedullary teratoma at the L4 level, the tumor exhibited features similar to those of a schwannoma. On MRI, the tumor appeared as a 2-cm mass attached to the end of the spinal cord, with intermediate signal intensity on T2-weighted images and iso-intensity without enhancement on T1-weighted images. L4 laminoplasty with tumor removal was performed under intraoperative monitoring. The tumor was found to be firm with a cyst containing mucoid and fatty tissue posteriorly. Near-total resection was achieved, although the tumor margin was indistinct. A literature review revealed spinal cord tethering and the presence of fatty tissue without MRI enhancement as characteristic findings of teratomas and dermoid cysts.