Spinal Cord Tumors Research Articles

QOL-25. DETERMINING THE BURDEN OF SLEEP PATHOLOGY AMONG PEDIATRIC NEURO-ONCOLOGY PATIENTS

Abstract BACKGROUND Children with brain and spinal cord tumors are at higher risk for sleep disruption. The incidence and characteristics of sleep difficulties in this population is not well understood. Our aim is to use survey and chart review to retrospectively and prospectively evaluate the frequency, severity, and types of sleep difficulties experienced by pediatric patients who have brain and spine tumors. METHODS Pediatric patients with a diagnosis of a brain or spinal cord tumor and their parents were surveyed at three time points during routine visits with their neuro-oncology team. Parents and children completed the following self-reported standardized surveys: The San Diego Pediatric Sleep Survey (Child) and The San Diego Pediatric Sleep Survey (Parent). RESULTS Identified sleep disturbances include difficulty initiating sleep, excessive movement while asleep, increased incidence of nocturnal awakening, and snoring. We identified high rates of behavioral and environmental modifiers of sleep quality including sleeping in a shared bed with another family member and poor sleep hygiene. CONCLUSIONS Identification of sleep disruption and factors contributing to sleep difficulties in this high risk population will encourage proactive screening and recognition of these issues in future patients. Next steps include implementation of interventions such as referral to appropriate specialists, sleep hygiene modification, and parent/patient education. Early intervention may lead to overall improvement in quality of life and health, including increased academic success and job productivity in children and their caregivers.

METB-12. GIFT FROM A CHILD POSTMORTEM SPECIMEN DATASET EXTENSION OF THE PEDIATRIC BRAIN TUMOR ATLAS EMPOWERS PEDIATRIC BRAIN TUMOR RESEARCH

Abstract BACKGROUND Pediatric brain and spinal cord tumors are the leading cause of cancer-related mortality in children. An incomplete understanding of brain tumor biology and associated limited access to high-quality biological samples for research are the main factors driving the lack of clinical therapeutic development for pediatric brain tumors that recur or progress. Post-mortem tissue donation provides an unprecedented resource for addressing some of these limitations. METHODS The Gift from a Child (GFAC) program by the Swifty Foundation has a unique mission to increase post-mortem pediatric brain tissue donations through advocacy as well as the education of clinicians and families. Through GFAC’s strategic collaboration with the Children’s Brain Tumor Network (CBTN), CBTN has leveraged postmortem tissue to expand the Pediatric Brain Tumor Atlas (PBTA), a cross-histology multi-omics atlas resource. As part of the effort CBTN has sequenced and released data for over 350 post-mortem pediatric brain tumor specimens including multiple brain region sampling cases with specimen and sequencing quality metrics. RESULTS Here we present an assessment of postmortem samples and available multi-omic data on postmortem samples within the PBTA dataset. Data have been harmonized and released with no publication embargo. To access data, researchers can utilize existing open source data resources and platforms including PedCbioPortal and OpenPedCan to: (1) Identify tumor spatial and temporal specific alterations (2) Establish tumor evolution trajectory leading to therapeutic resistance and tumor progression; (3) Understand tumor heterogeneity longitudinally across multiple ‘omics layers; and (4) Identify and request specimens and derived tumor models. CONCLUSIONS Together, we present the largest deeply characterized cohort of postmortem pediatric brain tumor samples as powerful expansion of the PBTA cohort of >3,000 pediatric brain tumors. CBTN’s open-science model supported by the GFAC mission highlights the value and utility of autopsy-based specimen collection on behalf of improving outcomes for children with brain tumors.

METB-15. ROLE OF DNA METHYLATION PROFILING IN THE MANAGEMENT OF PEDIATRIC CENTRAL NERVOUS SYSTEM TUMORS: A SINGLE INSTITUTIONAL SERIES

Abstract BACKGROUND DNA methylation profiling has now been integrated into the WHO classification of CNS tumors and serves as confirmatory means to diagnose CNS tumors in conjunction with genetic sequencing/microarray analysis. The practical impact on patient care in the retrospective and prospective settings is less known. METHODS Methylation analysis was performed on a cohort of previously and newly diagnosed children with CNS tumors at Children’s Hospital Orange County from 2022-2023. Data regarding histologic diagnosis, integrated molecular diagnosis, methylation classification, timing of result completion and functional impact of methylation results on patient diagnosis/management was evaluated. RESULTS Forty patients (21 boys, ages 5 weeks-17 years) with previously diagnosed (N=11) or newly diagnosed (N=21) CNS tumors were evaluated by methylation analysis at one or more institutions. The most common tumor types were diffuse type pediatric high-grade glioma (N=6) and ependymoma PFA (n=4). Methylation analysis revealed no match in two cases (ALK-EML4 fusion embryonal tumor and recurrent low grade glioneuronal tumor) and had insufficient DNA extraction in one patient with low grade glioneuronal spinal cord tumor. Among the 5 tumors with duplicate methylation analyses at two institutions, three Ependymoma PFA subgroups were concordant while two showed differing classifications (diffuse type pediatric high-grade glioma RTK1 subtype vs. non- classifiable and medulloblastoma group 4 vs. non-WNT, non-SHH). In patients with previously diagnosed CNS tumors, methylation either led to a change in classification or modification of diagnosis in 7 out of 11 patients. The average time from surgery to the receipt of methylation results for newly diagnosed patients was 24 days (range 4-90 days). CONCLUSION Methylation analysis was beneficial in both the previously diagnosed and newly diagnosed setting in patients with previously difficult to classify tumors following conventional molecular analysis. Changes in tumor classification or modifications in diagnosis were observed in the majority of patients.

OTHR-17. FACILITATING THE POSTMORTEM DONATION OF WHOLE BRAIN AND SPINAL CORD IN PEDIATRIC PATIENTS WITH CENTRAL NERVOUS SYSTEM CANCERS

Abstract BACKGROUND Postmortem tissue donation is often presented to families during end-of-life discussions. The sensitive nature requires every step to be handled with care, leading with empathy and delicately balancing scientific research and humanity. The Children’s National Hospital Postmortem Tissue Donation Workflow (The Workflow) provides a step-by-step guide for coordinating a successful donation. It outlines the order in which clinical research teams communicate with patient care teams, families and collaborators to make the donation possible. This program, established in 2010, aims to acquire more pediatric brain and spinal cord tumor specimens to further understand the disease biology. OBJECTIVE This paper aims to provide a template for coordinating a successful postmortem tissue donation. Ultimately, to broaden the network of tissue donation across all hospitals and institutions, thus furthering scientific research. METHOD In order to create The Workflow, Clinical Research Coordinators from Children’s National Hospital conducted numerous postmortem donations and noted the failures and successes of each case. This information was compiled into a stepwise workflow including email templates and checklists. It begins with contacting the care team, and the following hours to days are spent obtaining a pathologist for tissue procurement, and facilitating the shipment of samples. While these steps must be completed in a timely manner for sample integrity, we also prioritize the wishes of the family and act with compassion at the forefront. RESULTS/DISCUSSION Children’s National Hospital was designated as a Center of Excellence for postmortem coordination by the Swifty Foundation in 2018. Our team has since established and standardized a workflow for the donation process. The Children’s National Hospital Postmortem Workflow allows our research team to study brain tumors including DMGs, High and Low Grade Gliomas, and Medulloblastomas. The generosity of the families and hard work of each collaborator allows us to expand our knowledge of tumor biology.

Diffusion Tensor Imaging Identifies Cervical Spondylosis, Myelitis, and Spinal Cord Tumors.

Diffusion tensor imaging (DTI) has been increasingly recognized for its capability to study microstructural changes in the neuropathology of brain diseases. However, the optimal DTI metric and its diagnostic utility for a variety of spinal cord diseases are still under investigation. To evaluate the diagnostic efficacy of DTI metrics for differentiating between cervical spondylosis, myelitis, and spinal tumors. This retrospective study analyzed DTI scans from 68 patients (22 with cervical spondylosis, 23 with myelitis, and 23 with spinal tumors). DTI indicators, including fractional anisotropy (FA), mean diffusivity (MD), radial diffusivity (RD) and axial diffusivity (AD), were calculated. The Kruskal-Wallis test was used to compare these indicators, followed by Receiver Operating Characteristic (ROC) curve analysis, to evaluate the diagnostic efficacy of each indicator across disease pairs. Additionally, we explored the correlations of DTI indicators with specific clinical measurements. FA values were significantly lower in tumor patients compared to those with cervical spondylosis (p < 0.0001) and myelitis (p < 0.05). Additionally, tumor patients exhibited significantly elevated MD and RD values relative to the spondylosis and myelitis groups. ROC curve analysis underscored FA's superior discriminative performance, with an area under the curve (AUC) of 0.902 for differentiating tumors from cervical spondylosis, and an AUC of 0.748 for distinguishing cervical myelitis from spondylosis. Furthermore, a significant negative correlation was observed between FA values and Expanded Disability Status Scores (EDSSs) in myelitis patients (r = -0.62, p = 0.002), as well as between FA values and Ki-67 scores in tumor patients (r = -0.71, p = 0.0002). DTI indicators, especially FA, have the potential in distinguishing spondylosis, myelitis, and spinal cord tumors. The significant correlation between FA values and clinical indicators highlights the value of FA in the clinical assessment and prognosis of spinal diseases and may be applied in diagnostic protocols in the future.

The Impact of Neurophysiological Monitoring during Intradural Spinal Tumor Surgery.

Surgery for spinal cord tumors poses a significant challenge due to the inherent risk of neurological deterioration. Despite being performed at numerous centers, there is an ongoing debate regarding the efficacy of pre- and intraoperative neurophysiological investigations in detecting and preventing neurological lesions. This study begins by providing a comprehensive review of the neurophysiological techniques commonly employed in this context. Subsequently, we present findings from a cohort of 67 patients who underwent surgery for intradural tumors. These patients underwent preoperative and intraoperative multimodal somatosensory evoked potentials (SSEPs) and motor evoked potentials (MEPs), with clinical evaluation conducted three months postoperatively. The study aimed to evaluate the neurophysiological, clinical, and radiological factors associated with neurological outcomes. In univariate analysis, preoperative and intraoperative potential alterations, tumor size, and ependymoma-type histology were linked to the risk of worsening neurological condition. In multivariate analysis, only preoperative and intraoperative neurophysiological abnormalities remained significantly associated with such neurological deterioration. Interestingly, transient alterations in intraoperative MEPs and SSEPs did not pose a risk of neurological deterioration. The machine learning model we utilized demonstrated the possibility of predicting clinical outcome, achieving 84% accuracy.

Diagnostic Accuracy of Somatosensory Evoked Potential and Transcranial Motor Evoked Potential in Detection of Neurological Injury in Intradural Extramedullary Spinal Cord Tumor Surgeries: A Short-Term Follow-Up Prospective Interventional Study Experience from Tertiary Care Center of India.

Objective Intraoperative neuromonitoring (IONM) is an acknowledged tool for real-time neuraxis assessment during surgery. Somatosensory evoked potential (SSEP) and transcranial motor evoked potential (MEP) are commonest deployed modalities of IONM. Role of SSEP and MEP in intradural extramedullary spinal cord tumor (IDEMSCT) surgery is not well established. The aim of this study was to evaluate sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of SSEP and transcranial MEP, in detection of intraoperative neurological injury in IDEMSCT patients as well as their postoperative limb-specific neurological improvement assessment at fixed intervals till 30 days. Materials and Methods Symptomatic patients with IDEMSCTs were selected according to the inclusion criteria of study protocol. On modified McCormick (mMC) scale, their sensory-motor deficit was assessed both preoperatively and postoperatively. Surgery was done under SSEP and MEP (transcranial) monitoring using appropriate anesthetic agents. Gross total/subtotal resection of tumor was achieved as per IONM warning alarms. Sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of SSEP and MEP were calculated considering postoperative neurological changes as "reference standard." Patients were followed up at postoperative day (POD) 0, 1, 7, and 30 for convalescence. Statistical Analysis With appropriate tests of significance, statistical analysis was carried out. Receiver-operating characteristic curve was used to find cutoff point of mMC for SSEP being recordable in patients with higher neurological deficit along with calculation of sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of SSEP and MEP for prediction of intraoperative neurological injury. Results Study included 32 patients. Baseline mean mMC value was 2.59. Under neuromonitoring, gross total resection of IDEMSCT was achieved in 87.5% patients. SSEP was recordable in subset of patients with mMC value less than or equal to 2 with diagnostic accuracy of 100%. MEP was recordable in all patients and it had 96.88% diagnostic accuracy. Statistically significant neurological improvement was noted at POD-7 and POD-30 follow-up. Conclusion SSEP and MEP individually carry high diagnostic accuracy in detection of intraoperative neurological injuries in patients undergoing IDEMSCT surgery. MEP continues to monitor the neuraxis, even in those subsets of patients where SSEP fails to record.

Intradural extramedullary epidermoid cyst: Case report

Spinal epidermoid cysts are benign tumors. They are most commonly extramedullary intradural tumors. Intramedullary localization is the exception. In this review, we report the case of a 45-year-old patient with a dorsal intradural extramedullary epidermoid cyst, revealed by dorsal spinal pain and right lower limb weakness, we discuss the clinical aspects, radiological features, and neurosurgical treatment.

The disparity in pediatric spinal cord tumor clinical trials: A scoping review of registered clinical trials from 1989 to 2023.

Spinal cord tumors (SCTs) comprise 10% of all central nervous system (CNS) tumors. Pediatric SCTs are often excluded and underrepresented in clinical trials though exclusion rates haven't been reported. We reviewed all interventional clinical trials recruiting patients <21 years with SCTs on ClinicalTrials.gov between 1989 and 2023. Five hundred and two CNS tumor trials were identified, of which 255 included SCTs and/or spincal metastases. Among these, 96.5% were open to all CNS tumors (brain or spine); however, only 3.5% were exclusive to spine tumors. One trial was specific to pediatric spine tumors (inclusive of bone, soft tissue, and neural tumors); no trial was specific to primary pediatric SCTs. Most trials were located in North America, with multisite investigations being more common than single-institution designs. Trials frequently evaluated interventions/treatments (89%), supportive care/quality of life measures (7.1%), or diagnostic protocols (3.1%). Among included treatment paradigms, systemic therapies using cytotoxic chemotherapies, targeted therapies, and/or immunotherapies were more common among brain/spine trials, while radiotherapy, surgical adjuncts, and/or local drug delivery more frequently occurred in spinal tumor trials. Though SCTs comprise 10% of pediatric CNS tumors, they remain underrepresented in clinical trials. This lack of trials specific to advancing pediatric SCTs management highlights an area of clinical and research need.

Unveiling the Uncommon: Intradural Extramedullary Cord Lipoma Inducing Chest Wall Pain in a Middle-Aged Female Patient-A Case Report

BACKGROUND: Intradural extramedullary lipomas are rare spinal cord tumors that remain asymptomatic until compression of the spinal cord results in neurological symptoms. Anterior chest wall pain as the initial presentation is uncommon and can contribute to the delayed diagnosis, as it prompts clinicians to rule out other pathologies. CASE REPORT: The patient is a 44-year-old woman who presented with chronic anterior chest wall pain, instability, imbalance, and upper motor neuron signs. Imaging was obtained, and magnetic resonance revealed an intradural extramedullary mass composed of adipose tissue from T2 to T5, indicative of a spinal lipoma. Subsequently, the patient underwent complete excision and laminoplasty successfully, immediately improving all symptoms. CONCLUSIONS: Diagnosing intradural extramedullary lipomas is intricate and often incidental, with varied presentations depending on tumor localization and size. While uncommon, it is crucial to maintain a heightened level of suspicion when evaluating persistent, unexplained pain resistant to conservative treatments and accompanied by neurological symptoms. KEY WORDS: Chest wall pain, spinal cord lipomas, case report

Non-dysraphic intramedullary spinal cord lipoma: A case report

Introduction: Intramedullary nondysraphic spinal lipomas are extremely rare among primary spinal cord tumors. These patients present with nonspecific sensory symptoms followed by deterioration of motor symptoms. As the safety margins for neurological preservation are thin, meticulously locating the extent of the tumor and choosing the resection modalities is essential. Case Report: We report a rare case of a 35-year-old male who presented with progressive difficulty in walking for six months associated with numbness and tingling sensation in the bilateral upper and lower limbs. He was diagnosed with nondysraphic intramedullary cervicothoracic lipoma and underwent subtotal resection of the tumor. Conclusion: Nondysraphic intramedullary spinal cord lipomas are rare and may present as nonspecific neurological symptoms. Hence, they should be considered differentials of intramedullary spinal cord tumors. Surgery appears to be the mainstay of treatment.

A rare case of atypical intradural extramedullary glioblastoma diagnosed utilizing next-generation sequencing and methylation profiling: illustrative case.

Primary spinal cord tumors, especially primary spinal cord glioblastoma multiforme (PSC-GBM), are exceptionally rare, accounting for less than 1.5% of all spinal tumors. Their infrequency and aggressive yet atypical presentation make diagnosis challenging. In uncertain cases, a surgical approach for tissue diagnosis is often optimal. A 76-year-old male presented with a rapidly progressing clinical history marked by worsening extremity weakness, urinary retention, and periodic fecal incontinence alongside diffuse changes on neuraxis imaging. The patient, in whom subacute polyneuropathy was initially diagnosed, received multiple rounds of steroids and intravenous immunoglobulin without clinical improvement. Histopathological review of the biopsy tissue yielded an initial diagnosis of spindle cell neoplasm. Next-generation sequencing (NGS) is done routinely on all neuropathology specimens at the authors' institution, and methylation profiling is pursued in difficult cases. Ultimately, NGS and methylation profiling results were essential to an integrated final diagnosis of GBM. PSC-GBM is a rare but highly aggressive occurrence of this tumor. Prolonged back pain, rapid neurological decline, and imaging changes warrant the consideration of lesional biopsy for precise disease characterization. In inconclusive cases, NGS has proved invaluable for clinical clarification and diagnosis, underscoring its importance for integrated diagnoses in guiding appropriate treatment strategies.

Predictive Factors of Long-Term Neurologic Outcome and Progression-Free Survival in Intramedullary Spinal Cord Tumors: A 10-year Single-Center Cohort Study and Review of the Literature

Intramedullary spinal cord tumors (IMSCTs) are a rare subgroup of neoplasms, encompassing both benign, slow-growing masses, and malignant lesions; radical surgical excision represents the cornerstone of treatment for such pathologies regardless of histopathology, which, on the other hand, is a known predictor of survival and neurologic outcome postsurgery. The present study aims to investigate the relevance of other factors in predicting survival and long-term functional outcomes. We conducted a review of current literature on functional outcomes of IMSCTs, as well as a 10-years prospective analysis of a wide cohort of patients with diagnosis of IMSCTs who underwent surgical resection at our institution. Our series encompasses 60 patients with IMSCTS, among which 36 ependymomas, 6 cavernous angiomas, 5 hemangioblastomas, 6 WHO Grade I-IV astrocytomas, 3 intramedullary spinal metastases and 4 miscellaneous tumors. GTR was achieved in 76,67% of patients, with high preoperative McCormick grade, syringomyelia and changes at neurophysiologic monitoring being the strongest predictors at multivariate analysis (P= 0.0027, P= 0.0017 and P= 0.001 respectively). Consistently with literature, preoperative neurologic function is the most important factor predicting long-term functional outcome (0.17, CI 0.069-0.57 with P= 0.0018), advocating for early surgery in the management of IMSCTs, whereas late complications such as myelopathy and neuropathic pain were present regardless of preoperative function.

Functional outcomes in intradural extramedullary spinal tumors.

Intradural extramedullary (IDEM) spinal cord tumors account for approximately two-thirds of benign intraspinal neoplasms. These are amenable to gross total excision but can have variable functional outcomes, which plays a key role in assessing their impact on a patient's quality of life. Understanding the functional outcomes associated with these tumors is crucial for healthcare professionals to devise appropriate treatment plans and provide comprehensive care. In this study, we retrospectively reviewed the outcomes of 130 patients with IDEM tumors who underwent surgery in the past six years between January 2017 and December 2022 at a single institution. Patient demographics, symptoms, and tumor characteristics (anatomical and pathological) in all operated spinal IDEM tumors were analyzed. The neurological findings obtained during the preoperative stage and the postoperative follow-up were evaluated according to the Frankel grading. The back pain was assessed using the Denis pain scale (DPS). The age range, gender distribution, presentation, histopathology, and tumor characteristics were analyzed. The histopathological outcomes of the study were as follows: 56 cases of schwannoma, 37 cases of meningiomas, 16 patients of neurofibroma, six cases of epidermoid cyst, five cases each of ependymoma and dermoid cyst, three cases of arachnoid cyst, two cases of metastasis, and one case of paraganglioma. Pain was the most common symptom (38.5%), followed by weakness in limbs (31.5%), paresthesia/numbness (22.3%), and sphincter disturbance (7.7%). Complete total resection was seen in 93% of cases, with 7% undergoing subtotal excision. The complications encountered were - four cases of surgical site infection and one case each of cerebrospinal fluid leak, pseudomeningocele, and epidural hematoma. In our series, 49.3% of patients had significantly good improvement in functional outcomes as per improvement in Frankel score, and 43% of patients had good functional improvement. Significant functional improvement was noted at immediate postoperative follow-up, 2-week follow-up, and six-month follow-up periods. Reoccurrence was seen in 7 cases (5.4%). The DPS score mean values showed a significant decrease over the follow-up duration as compared to preoperative mean values. Significantly poor outcome was seen in IDEM tumours present anteriorly. The IDEM tumors are usually benign and are readily detected by contrast-enhanced magnetic resonance imaging scans. These have variable functional outcomes in different centers. Assessing this functional outcome is an essential aspect of managing IDEM spinal tumors. It was observed through our study that the ventral location of the tumor, thoracic tumors, and poor preoperative neurological status of the patient correspond with poorer postoperative functional outcomes. Furthermore, a significant decrease in the pain symptoms with improvement of Frankel score was seen postoperatively, thus this being suggestive of a significant improvement of functional outcome after surgery. This study helps to conclude that the morbidity associated with the resection of IDEM tumors is not as significant as originally thought to be.

Reliability and Predictors of Intraoperative Neuromonitoring Changes During Intramedullary Tumor Resection: A Multicenter Experience

INTRODUCTION: Intraoperative neuromonitoring (IONM) is used in real-time to alert neurosurgeons of potential neurological changes when resecting intramedullary spinal cord tumors (IMSCTs). Previous studies have reported variable reliability of IONM. METHODS: A multicenter retrospective study was performed on patients undergoing IMSCTs surgery with neuromonitoring at the three Mayo Clinic sites between 2005 to 2022. Demographics, SSEP, MEP changes and postoperative outcomes were recorded. Specificity, sensitivity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. Variables found significant on univariate analysis (p &lt; 0.05) were applied to a multivariate model to identify predictors for IONM SSEP and MEP changes. RESULTS: 135 patients underwent surgical resection for IMSCTs using IONM. The mean age at diagnosis was 45 ± 17.9 years. Laminectomy was the most frequent index operation (96.3%). A total of 8.9% of patients presented with short-term improvement, while 70.4% presented long-term improvement on their baseline McCormick Scale. Sensitivity, specificity, PPV, NPV, accounted for 86.2%, 51%, 5.2%, 99.2% for MEP; 77.8%, 48.2%, 4.4%, 98.6% for SSEP. We found predictors of IONM changes: poorly defined MEP baseline (OR 3.004, 95% CI 1.22-7.397, p = 0.017), WHO grade II tumors (OR 2.334, 95% CI 1.043-5.223, p = 0.039), cervicomedullary junction location (OR 0.103, 95% CI 0.011-0.983, p = 0.048). Only WHO grade II tumors (OR 2.85, 95% CI 1.208-6.727, p = 0.017) was a predictor for SSEP changes. CONCLUSIONS: Our study represents the largest cohort describing sensitivity, specificity, and predictive factors for intraoperative changes and postoperative outcomes of resection of IMSCTs. A poorly defined baseline and cervicomedullary tumor location were predictors of IONM MEP changes, whiIe WHO grade II tumors were a predictor for both IONM SSEP and MEP changes.

The application value and improved warning criterion of D-wave monitoring in intramedullary spinal cord tumor surgery

BACKGROUND CONTEXTThe primary treatment method for intramedullary spinal cord tumor (IMSCT) is surgical resection, but this procedure carries a significant risk of neurological damage. Intraoperative neurophysiological monitoring (IONM) has become a necessary adjunctive tool for IMSCT resection. PURPOSEThe current study aimed to explore the application value of D-wave monitoring in IMSCT surgery, and tried to investigate a tailored criterion for its early warning. STUDY DESIGNA retrospective clinical study. PATIENT SAMPLEA retrospective analysis was conducted based on the data of patients who underwent IMSCT surgeries performed by the same neurosurgical team at our hospital. IONM was applied in all surgeries. According to inclusion and exclusion criteria, ultimately 90 patients were enrolled in the study. OUTCOME MEASURESThe McCormick Scale (MMS) was applied to assess the functional outcome through outpatient visits or telephone follow-up at one month and six months postoperatively. Patients with an MMS grade over II one month after surgery were considered to have newly developed postoperative motor dysfunction (PMD). If the MMS grade could be restored to I or II six months after surgery, it was defined as a short-term PMD. Otherwise, it was defined as a long-term PMD. METHODSThe predictive value of different IONM modalities, including somatosensory evoked potential (SEP), muscle motor evoked potential (MEP), and D-wave for PMD, was assessed with sensitivity, specificity, positive predictive value, negative predictive value, and subsequent logistic regression analysis. At last, the cut-off value of the D-wave amplitude reduction ratio for predicting PMD was obtained through the receiver operating characteristic (ROC) curve analysis. RESULTSSEP showed the worst performance in predicting short-term and long-term PMD. Significant MEP changes were indicated as an independent predictive factor for short-term PMD (OR 5.062, 95% CI 1.947–13.166, p=.001), while D-wave changes were demonstrated as an independent predictor for long-term PMD (OR 339.433, 95% CI 11.337–10770.311, p=.001). The optimum cut-off value of the D-wave amplitude reduction ratio for predicting long-term PMD was 42.18%, with a sensitivity of 100% and a specificity of 93.8% (AUC=0.981, p<.001). CONCLUSIONSD-wave monitoring showed extremely high specificity in predicting PMD compared to SEP and MEP monitoring. Moreover, the authors suggested that a D-wave amplitude reduction of over 40% during IMSCT surgery generally indicates long-term PMD for patients.

Evaluation of surgically treated primary spinal cord tumors in a single Indian institution: A case series study of 178 patients.

Primary spinal cord tumors are rare tumors that are usually heterogeneous having variable histopathological subtypes. Rapidly, growing space-occupying lesions in the spinal canal cause severe loss of function. This study aimed to analyze all adult patients diagnosed with primary spinal cord tumors and to describe their location, symptoms, histopathological types, surgical outcome, complications, recurrence in a single institution, and prognostic factors. The study was a retrospective study of 178 patients with spinal tumor who underwent surgical intervention at the department of neurosurgery at a tertiary care institute from 2014 to 2021. Patient demographic characteristics, symptoms, radiological features, spinal level of tumor, spinal compartment, preoperative and postoperative McCormick grade, and complications were recorded, and a comparison of outcomes after surgical intervention was done. In our study, 97 patients were males and the rest of the 81 patients were females. The mean age at the time of surgery was 43.5 years. The thoracic region of the spinal canal was the most involved with 67 (37.64%) cases, whereas intradural extramedullary was the most common (65.73%). Schwannoma was the most common histopathological subtype (46.06%). Total excision was achieved in 154 cases. A total of 37 patients were in Grades 4 and 5 of modified McCormick's grade preoperatively. However, postoperatively, there were only 17 patients in this group. Two patients with cervical intramedullary tumor expired in the postoperative period. Early surgical intervention with sound microneurosurgical skills gives good outcomes independent of the type and location of tumor. Better outcomes are seen in extradural tumors, early surgical intervention, tumors better amenable to total resection, and in patients with better preoperative neurological status.

1077 Operative Management and Outcomes in Spinal Hemangioblastoma: A Multi-institutional Case Series of 59 Patients

INTRODUCTION: Hemangioblastoma is a rare benign neoplasm that accounts for 2-5% of all spinal cord tumors and is associated with von-Hippel Landau (VHL) disease in about 25-30% of patients. Symptomatic spinal hemangioblastomas are typically managed with en bloc microsurgical resection, but the infrequent nature of these lesions has limited the detailed characterization of reported management and surgical outcomes in the literature. METHODS: We retrospectively reviewed all patients with pathology-proven spinal hemangioblastoma. We collected information about demographics, preoperative symptoms and imaging, intraoperative characteristics, and postoperative course. We analyzed what variables influence postoperative changes in motor scores and McCormick scores. RESULTS: We included 59 patients (35 sporadic, 24 VHL). The average age of diagnosis was 48.7 (± 16.1) for sporadic tumors and 35.1 (± 12.6) for those associated with VHL (p = 0.001). Most tumors were cervical (46.6%) or thoracic (34.5%) and both intradural (93.2%) and intramedullary (71.2%). Most patients (69.5%) had multiple spinal tumors. The average lesion volume was 0.98 (± 1.1) cm3. The average symptom duration before surgery was 24.7 (± 73.2) months. Adjuvant therapies included radiation (6.8%) and chemotherapy (1.7%). At 1 month postoperatively, 4.4% had motor loss in any muscle group and 31.1% had motor gain, while 18.6% had a decreased McCormick score and 28.8% had an improved score at 1 month. While 72.9% of patients had numbness/paresthesia preoperatively, only 59.3% did at 1 month. Duration of pre-operative symptoms and time from diagnosis to surgery were not found to influence outcomes. CONCLUSIONS: Overall, surgical planning should be guided by symptom management. In this population, duration of preoperative symptoms and timing of surgery did not influence post-operative functional outcomes.

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.

A STUDY OF THE INCIDENCE AND FACTORS ASSOCIATED WITH GLIOBLASTOMA MULTIFORME IN THE REPUBLIC OF SRPSKA

&amp;lt;p&amp;gt;&amp;lt;strong&amp;gt;Introduction.&amp;lt;/strong&amp;gt; Glioblastoma multiforme (GBM) is a highly aggressive brain or spinal cord tumor, representing the most lethal form of brain tumors with a five-year mortality rate exceeding 90%. It constitutes ap proximately 60% of all primary brain tumors in adults and has an annual incidence of 2&amp;amp;ndash;3 new cases per 100,000 population. Although it pre dominantly affects adult patients, it can occur at any age. The aim of this study is to determine the incidence rate and factors (age, sex and out come) associated with GBM in Republic of Srpska over a five-year period.&amp;lt;/p&amp;gt; &amp;lt;p&amp;gt;&amp;lt;strong&amp;gt; Methods. &amp;lt;/strong&amp;gt;This retrospective observational cross-sectional study includ ed a total of 97 male and female patients of all age groups from the terri tory of Republic of Srpska, who were pathohistologically diagnosed with GBM between January 1st, 2014 and December 31st, 2018. Data obtained from the National Registry for Malignant Neoplasms in Republic of Srps ka, managed by the Public Health Institute and the Republic Institute of Statistics, were analyzed using Microsoft Excel. &amp;lt;strong&amp;gt;Results. &amp;lt;/strong&amp;gt;During the investigated period, GBM accounted for 15.13% of all reported brain tumors in Republic of Srpska with incidence rate of 8.45 per 100,000 population. The occurrence of this tumor was slightly higher in males, with a ratio of 1.2:1.0 compared to females. No cases were reported in patients under the age of 18. Among the reported cas es, 65 persons (67.01%) were between 18 and 65, with incidence rate of 5.66 per 100,000 population, while 32 persons (32.99%) were over 65, with incidence rate of 2,78 per 100,000 population. Out of all patients diagnosed with GBM, 80 patients (82.47%) experienced a fatal outcome, while 17 patients (17.53%) survived.&amp;lt;/p&amp;gt; &amp;lt;p&amp;gt;&amp;lt;strong&amp;gt; Conclusion.&amp;lt;/strong&amp;gt; GBM exhibits a high incidence compared to other brain neoplasms within Republic of Srpska, and it is characterized by an ex tremely high mortality rate, primarily affecting adult, working-age pop ulation (18&amp;amp;ndash;65 years).&amp;lt;/p&amp;gt; &amp;lt;p&amp;gt;&amp;amp;nbsp;&amp;lt;/p&amp;gt;