Microsurgical Resection of Giant Thoraco-Lumbo-Sacral Ependymoma With Hybrid Spinal Reconstruction Using Multilevel Laminoplasty and Up-Front Thoracolumbar Posterior Fixation: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Daniel A Donoho ◽  
Tyler Lazaro ◽  
Rita Snyder ◽  
Jaime Guerrero ◽  
David F Bauer
Keyword(s):  
Spinal Deformity ◽  
Tumor Resection ◽  
Cauda Equina ◽  
Young Patients ◽  
Thoracolumbar Junction ◽  
Spinal Tumors ◽  
Posterior Fixation ◽  
Spinal Stabilization ◽  
Spinal Reconstruction ◽  
Formidable Challenge

Abstract Extensive multifocal intradural lesions in children present a formidable challenge. This surgical video illustrates our management of a 14-yr=old boy with two intradural mass lesions on magnetic resonance imaging (MRI): one at T2-5 and the other from T12 through the sacral cul-de-sac. In a single procedure, we performed a T2-5 laminectomy and laminoplasty and T12-sacrum laminectomy for tumor resection. For reconstruction, we performed complete laminoplasty at all levels with supplementation at the thoracolumbar junction via T11-L2 posterior spinal fixation and allograft placement for fusion. In this video, we illustrate the microsurgical challenges of intradural tumor resection in both the thoracic cord and amidst the cauda equina. In young patients, prevention of postsurgical spinal deformity is of paramount concern. We discuss considerations for long-segment spinal stabilization in an adolescent and describe our decision-making to perform stabilization at the thoracolumbar junction to supplement laminoplasty while preserving function. The patient and their family consented to the procedure.  Image of the article at 0:51 is from McGirt et al, Short-term progressive spinal deformity following laminoplasty versus laminectomy for resection of intradural spinal tumors: analysis of 239 patients, Neurosurgery, 2010, 66(5), 1005-1012, by permission of the Congress of Neurological Surgeons.

scholarly journals Management of recurrent schwannoma of the cauda equina: A case report

2021 ◽  
Vol 12 ◽  
pp. 312
Author(s):  
Francisco Perez-Pinto ◽  
Juan Felipe Abaunza-Camacho ◽  
David Vergara-Garcia ◽  
Camilo Benavides ◽  
William Mauricio Riveros ◽  
...  
Keyword(s):  
Case Report ◽  
Tumor Recurrence ◽  
Tumor Resection ◽  
Cauda Equina ◽  
Spinal Tumors ◽  
Case Description ◽  
Total Excision ◽  
Clinical Recurrence ◽  
Secondary Tumor

Background: Schwannomas of the cauda equina are rare intradural primary spinal tumors. Many of these patients initially present with cauda equina syndromes, and only 2.2% demonstrate clinical recurrence. Gross total excision is the procedure of choice. Case Description: A 62-year-old female had undergone resection of a cauda equina schwannoma 5 years previously. She newly presented with cauda equina symptoms attributed to a recurrent schwannoma. Following gross total secondary tumor resection, the patient’s preoperative deficits fully resolved, and the tumor never recurred. Conclusion: Secondary gross total excision of schwannomas of the cauda equina is critical to avoid further tumor recurrence.

Vascularized Bone Grafting for Reconstruction of Oncologic Defects in the Spine: A Systematic Review and Pooled Analysis of the Literature

2018 ◽  
Vol 34 (09) ◽  
pp. 708-718 ◽  
Author(s):  
Rachel Pedreira ◽  
Charalampos Siotos ◽  
Brian Cho ◽  
Stella Seal ◽  
Deepa Bhat ◽  
...  
Keyword(s):  
Systematic Review ◽  
Complication Rate ◽  
Bone Grafting ◽  
Tumor Resection ◽  
Pooled Analysis ◽  
Spinal Tumors ◽  
Johns Hopkins Hospital ◽  
Complication Rates ◽  
Spinal Reconstruction ◽  
Vascularized Bone

Background Resection of primary spinal tumors requires reconstruction for restoration of spinal column stability. Traditionally, some combination of bone grafting and instrumentation is implemented. However, delayed healing environments are associated with pseudoarthrodesis and failure. Implementation of vascularized bone grafting (VBG) to complement hardware may present a solution. We evaluated the use of VBG in oncologic spinal reconstruction via systematic review and pooled analysis of literature. Methods We searched PubMed/MEDLINE, Embase, Cochrane, and Scopus for studies published through September 2017 according to the PRISMA guidelines and performed a pooled analysis of studies with n > 5. Additionally, we performed retrospective review of patients at the Johns Hopkins Hospital that received spinal reconstruction with VBG. Results We identified 21 eligible studies and executed a pooled analysis of 12. Analysis indicated an 89% (95% confidence interval [CI]: 0.75–1.03) rate of successful union when VBG is employed after primary tumor resection. The overall complication rate was 42% (95% CI: 0.23–0.61) and reoperation rate was 27% (95% CI: 0.12–0.41) in the pooled cohort. Wound complication rate was 18% (95% CI: 0.11–0.26). Fifteen out of 209 patients (7.2%) had instrumentation failure and mean time-to-union was 6 months. Consensus in the literature and in the patients reviewed is that introduction of VBG into irradiated or infected tissue beds proves advantageous given decreased resorption, increased load bearing, and faster consolidation. Downsides to this technique included longer operations, donor-site morbidity, and difficulty in coordinating care. Conclusions Our results demonstrate that complication rates using VBG are similar to those reported in studies using non-VBG for similar spinal reconstructions; however, fusion rates are better. Given rapid fusion and possible hardware independence, VBG may be useful in reconstructing defects in patients with longer life expectancies and/or with a history of chemoradiation and/or infection at the site of tumor resection.

Preoperative embolization and intraoperative cryocoagulation as adjuncts in resection of hypervascular lesions of the thoracolumbar spine

2002 ◽  
Vol 97 (3) ◽  
pp. 294-300 ◽  
Author(s):  
Remi Nader ◽  
Brent T. Alford ◽  
Haring J. W. Nauta ◽  
Wayne Crow ◽  
Eric Vansonnenberg ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Tumor Resection ◽  
Thoracolumbar Spine ◽  
Spinal Tumors ◽  
Preoperative Embolization ◽  
Physical Separation ◽  
Content Type ◽  
Spinal Reconstruction ◽  
Estimated Blood Loss ◽  
Fine Print

Object. The purpose of this study was twofold. First the authors evaluated preoperative embolization alone to reduce estimated blood loss (EBL) when resecting hypervascular lesions of the thoracolumbar spine. Second, they compared this experience with intraoperative cryotherapy alone or in conjunction with embolization to minimize further EBL. Methods. Twelve patients underwent 13 surgeries for hypervascular spinal tumors. In 10 cases the surgeries were augmented by preoperative embolization alone. In one patient, two different surgeries involved intraoperative cryocoagulation, and in one patient surgery involved a combination of preoperative embolization and intraoperative cryocoagulation for tumor resection. When cryocoagulation was used, its extent was controlled using intraoperative ultrasonography or by establishing physical separation of the spinal cord from the tumor. In the 10 cases in which embolization alone was conducted, intraoperative EBL in excess of 3 L occurred in five. Mean EBL was of 2.8 L per patient. In one patient, who underwent only embolization, excessive bleeding (> 8 L) required that the surgery be terminated and resulted in suboptimum tumor resection. In another three cases, intraoperative cryocoagulation was used alone (in two patients) or in combination with preoperative embolization (in one patient). In all procedures involving cryocoagulation of the lesion, adequate hemostasis was achieved with a mean EBL of only 500 ml per patient. No new neurological deficits were attributable to the use of cryocoagulation. Conclusions. Preoperative embolization alone may not always be satisfactory in reducing EBL in resection of hypervascular tumors of the thoracolumbar spine. Although experience with cryocoagulation is limited, its use, in conjunction with embolization or alone, suggests it may be helpful in limiting EBL beyond what can be achieved with embolization alone. Cryocoagulation may also assist resection by preventing spillage of tumor contents, facilitating more radical excision, and enabling spinal reconstruction. The extent of cryocoagulation could be adequately controlled using ultrasonography or by establishing physical separation between the tumor and spinal cord. Additionally, somatosensory evoked potential monitoring may provide early warning of spinal cord cooling.

Short-term Progressive Spinal Deformity Following Laminoplasty Versus Laminectomy for Resection of Intradural Spinal Tumors

Neurosurgery ◽  
2010 ◽  
Vol 66 (5) ◽  
pp. 1005-1012 ◽  
Author(s):  
Matthew J. McGirt ◽  
Giannina L. Garcés-Ambrossi ◽  
Scott L. Parker ◽  
Daniel M. Sciubba ◽  
Ali Bydon ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Spinal Deformity ◽  
Tumor Resection ◽  
Cerebrospinal Fluid Leak ◽  
Neurological Function ◽  
Spinal Tumors ◽  
Short Term ◽  
Intradural Tumor ◽  
Fluid Leak

Abstract OBJECTIVE Gross total resection of intradural spinal tumors can be achieved in the majority of cases with preservation of long-term neurological function. However, postoperative progressive spinal deformity complicates outcome in a subset of patients after surgery. We set out to determine whether the use of laminoplasty (LP) vs laminectomy (LM) has reduced the incidence of subsequent spinal deformity following intradural tumor resection at our institution. METHODS We retrospectively reviewed the records of 238 consecutive patients undergoing resection of intradural tumor at a single institution. The incidence of subsequent progressive kyphosis or scoliosis, perioperative morbidity, and neurological outcome were compared between the LP and LM cohorts. RESULTS One hundred eighty patients underwent LM and 58 underwent LP. Patients were 46 ± 19 years old with median modified McCormick score of 2. Tumors were intramedullary in 102 (43%) and extramedullary in 102 (43%). All baseline clinical, radiographic, and operative variables were similar between the LP and LM cohorts. LP was associated with a decreased mean length of hospitalization (5 vs 7 days; P = .002) and trend of decreased incisional cerebrospinal fluid leak (3% vs 9%; P = .14). Following LP vs LM, 5 (9%) vs 21 (12%) patients developed progressive deformity (P = .728) a mean of 14 months after surgery. The incidence of progressive deformity was also similar between LP vs LM in pediatric patients < 18 years of age (43% vs 36%), with preoperative scoliosis or loss of cervical/lumbar lordosis (28% vs 22%), or with intramedullary tumors (11% vs 11%). CONCLUSION LP for the resection of intradural spinal tumors was not associated with a decreased incidence of short-term progressive spinal deformity or improved neurological function. However, LP may be associated with a reduction in incisional cerebrospinal fluid leak. Longer-term follow-up is warranted to definitively assess the long-term effect of LP and the risk of deformity over time.

Malignant triton tumors of the spine

2008 ◽  
Vol 8 (6) ◽  
pp. 567-573 ◽  
Author(s):  
Greg James ◽  
Matthew Crocker ◽  
Andrew King ◽  
Istvan Bodi ◽  
Ahmed Ibrahim ◽  
...  
Keyword(s):  
Survival Data ◽  
Cauda Equina ◽  
Neurofibromatosis Type ◽  
Radical Resection ◽  
Spinal Tumors ◽  
Female Ratio ◽  
Spinal Stabilization ◽  
Peripheral Nerve Sheath Tumors ◽  
Male Female Ratio ◽  
Age Range

✓Malignant triton tumors (MTTs) are malignant peripheral nerve sheath tumors with rhabdomyosarcomatous differentiation. Malignant triton tumors affecting the spine are rare but present special challenges to the neurosurgeon. The authors report on 2 new cases of spinal MTTs, and analyze the 8 previously reported cases found via database search. The patients include a 15-year-old girl with thoracic MTT, and a 24-year-old man with lumbosacral MTT; both patients underwent radical resection with spinal stabilization. When these cases were combined with the literature results there was a male/female ratio of 6:4, and an age range of 15–67 years (median 37.5). Nine patients presented with symptoms related to the spinal cord, cauda equina, or nerve root compression. Four patients had undergone previous radiotherapy, and 2 had neurofibromatosis Type 1. Five cases of MTT were lumbosacral, 4 were thoracic, and 1 was cervical. Seven patients had intradural extension of tumor. All patients underwent some form of surgery, with 8 having total macroscopic excision. However, 6 patients required subsequent operations. In the 8 patients for which survival data was available, median time from diagnosis to death was 12 months (range 3–16). Malignant triton tumors are rare but should be included in the differential diagnosis of spinal tumors, particularly in patients who have undergone previous radiotherapy or who have neurofibromatosis. The authors suggest roles for radical surgery and multidisciplinary management.

Short versus long-segment posterior fixation in the treatment of thoracolumbar junction fractures: a comparison of outcomes

2016 ◽  
Vol 31 (1) ◽  
pp. 54-57 ◽  
Author(s):  
Mueez Waqar ◽  
Dmitri Van-Popta ◽  
Damiano Giuseppe Barone ◽  
Maneesh Bhojak ◽  
Robin Pillay ◽  
...  
Keyword(s):  
Thoracolumbar Junction ◽  
Posterior Fixation

scholarly journals The 16-item version of the SRS-instrument shows better structural validity than the 20-item version in young patients with spinal deformity

2021 ◽  
Vol 1 ◽  
pp. 100234
Author(s):  
Anne F. Mannion ◽  
Achim Elfering ◽  
Tamas F. Fekete ◽  
Ian Harding ◽  
Marco Monticone ◽  
...  
Keyword(s):  
Spinal Deformity ◽  
Young Patients ◽  
Structural Validity

Customized “Whole-Cervical-Vertebral-Body” Reconstruction After Modified Subtotal Spondylectomy of C2-C7 Spinal Tumor Via Piezoelectric Surgery

2019 ◽  
Vol 17 (6) ◽  
pp. 580-587 ◽  
Author(s):  
Shaohui He ◽  
Xinghai Yang ◽  
Jian Yang ◽  
Chen Ye ◽  
Weibo Liu ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Tumor Resection ◽  
Three Dimensional ◽  
Radical Resection ◽  
Spinal Tumor ◽  
Uneventful Recovery ◽  
Spinal Tumors ◽  
Neurological Improvement ◽  
Piezoelectric Surgery ◽  
3D Printed

Abstract BACKGROUND Radical resection is the first-line option in managing cervical primary chondrosarcoma. Favorable anterior reconstruction is challenging after multilevel total spondylectomy in the cervical spine. OBJECTIVE To illustrate the application of piezoelectric surgery and three-dimensional (3D) printing techniques in spine surgery. METHODS A 27-yr-old patient was referred to our center with complaints of nocturnal neck pain and right upper extremity weakness. A 2-stage radical tumor resection was conducted using piezoelectric surgery with pathologically tumor-free margins. A 3D-printed titanium microporous prosthesis (3D-PTMP) was designed to reconstruct the anterior column of the cervical spine between C1 and T1 for stability. RESULTS The whole intraoperative blood loss was 2300 mL over the 2 procedures. The patient had an uneventful recovery, regaining ambulatory status 3 wk after the 2 operations without ventilator support or other severe complications. By the final 14-mo follow-up, the patient had achieved marked pain relief and favorable neurological improvement; a postoperative computed tomography scan indicated a good position of the 3D-printed construct between the endplates with no sign of tumor recurrence or implant subsidence. CONCLUSION The applications of piezosurgery in total spondylectomy and in 3D-PTMP in reconstruction can be a favorable alternative for managing multilevel cervical spinal tumors. Further studies are warranted to validate this surgical strategy.

Diagnostic and therapeutic values of intraoperative electrophysiological neuromonitoring during resection of intradural extramedullary spinal tumors: a single-center retrospective cohort and meta-analysis

2019 ◽  
Vol 30 (6) ◽  
pp. 839-849 ◽  
Author(s):  
Wataru Ishida ◽  
Joshua Casaos ◽  
Arun Chandra ◽  
Adam D’Sa ◽  
Seba Ramhmdani ◽  
...  
Keyword(s):  
Evoked Potentials ◽  
Predictive Value ◽  
Meta Analysis ◽  
Tumor Resection ◽  
Diagnostic Value ◽  
Neurological Deficits ◽  
Spinal Tumors ◽  
Intradural Extramedullary ◽  
Baseline Characteristics

OBJECTIVEWith the advent of intraoperative electrophysiological neuromonitoring (IONM), surgical outcomes of various neurosurgical pathologies, such as brain tumors and spinal deformities, have improved. However, its diagnostic and therapeutic value in resecting intradural extramedullary (ID-EM) spinal tumors has not been well documented in the literature. The objective of this study was to summarize the clinical results of IONM in patients with ID-EM spinal tumors.METHODSA retrospective patient database review identified 103 patients with ID-EM spinal tumors who underwent tumor resection with IONM (motor evoked potentials, somatosensory evoked potentials, and free-running electromyography) from January 2010 to December 2015. Patients were classified as those without any new neurological deficits at the 6-month follow-up (group A; n = 86) and those with new deficits (group B; n = 17). Baseline characteristics, clinical outcomes, and IONM findings were collected and statistically analyzed. In addition, a meta-analysis in compliance with the PRISMA guidelines was performed to estimate the overall pooled diagnostic accuracy of IONM in ID-EM spinal tumor resection.RESULTSNo intergroup differences were discovered between the groups regarding baseline characteristics and operative data. In multivariate analysis, significant IONM changes (p < 0.001) and tumor location (thoracic vs others, p = 0.018) were associated with new neurological deficits at the 6-month follow-up. In predicting these changes, IONM yielded a sensitivity of 82.4% (14/17), specificity of 90.7% (78/86), positive predictive value (PPV) of 63.6% (14/22), negative predictive value (NPV) of 96.3% (78/81), and area under the curve (AUC) of 0.893. The diagnostic value slightly decreased in patients with schwannomas (AUC = 0.875) and thoracic tumors (AUC = 0.842). Among 81 patients who did not demonstrate significant IONM changes at the end of surgery, 19 patients (23.5%) exhibited temporary intraoperative exacerbation of IONM signals, which were recovered by interruption of surgical maneuvers; none of these patients developed new neurological deficits postoperatively. Including the present study, 5 articles encompassing 323 patients were eligible for this meta-analysis, and the overall pooled diagnostic value of IONM was a sensitivity of 77.9%, a specificity of 91.1%, PPV of 56.7%, and NPV of 95.7%.CONCLUSIONSIONM for the resection of ID-EM spinal tumors is a reasonable modality to predict new postoperative neurological deficits at the 6-month follow-up. Future prospective studies are warranted to further elucidate its diagnostic and therapeutic utility.

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