scholarly journals Microsurgical Resection of Low-Grade Spinal Cord Astrocytoma: 2-Dimensional Operative Video

2018 ◽  
Vol 17 (3) ◽  
pp. E107-E108
Author(s):  
Mirza Pojskić ◽  
Kenan I Arnautović
Keyword(s):  
Spinal Cord ◽  
Motor Evoked Potentials ◽  
Prognostic Significance ◽  
Neurological Function ◽  
Intramedullary Tumor ◽  
Low Grade ◽  
Thoracic Spinal Cord ◽  
Thoracic Spinal ◽  
Microsurgical Resection ◽  
Spinal Cord Astrocytoma

Abstract This video demonstrates microsurgical resection of low-grade (Grade I) thoracic spinal cord astrocytoma. Astrocytomas are the most common pediatric intramedullary tumors and occur secondary to ependymomas in adults.1,2 The treatment goal should be radical gross total resection while preserving neurological function with intraoperative neuromonitoring.2-4 To our knowledge, this is the first video report on microsurgical resection of low-grade spinal cord astrocytoma.  A 58-yr-old female presented with gait disturbances has been featured in this video. A spinal MRI revealed T1/T2 hyperintense intramedullary tumor at T4, suggesting spinal cord astrocytoma versus ependymoma. Dura was opened in the midline and tacked to the surrounding muscle tissue with tacking sutures. The arachnoid was opened separately with microscissors, keeping it intact for closure at the end of surgery. Liga clips were applied to hold the arachnoid to the dura. Myelotomy was done in the midline,5 opening the posterior median sulcus over the length of the tumor and extending proximally and distally a few millimeters beyond the tumor.3,5 The tumor reduction was achieved by coagulation or debulking. Once sufficient debulking was achieved, dissection of the tumor margins toward surrounding cord was performed. Preoperative recording of motor-evoked potentials (MEPs) compared with continuous intraoperative MEPs were essential for preserving the neurological function and quality of life. The intraoperative finding of a clear tumor plane of resection carries positive prognostic significance and reduces the risk of complications.2,3,6  A pathohistological diagnosis showed a low-grade (Grade I) spinal cord astrocytoma (pilocytic). Follow-up MRI showed no sign of tumor or recurrence. The patient recovered fully and was neurologically intact. Written consent was obtained directly from the patient.

Influence of cross-linked hyaluronic acid hydrogels on neurite outgrowth and recovery from spinal cord injury

2007 ◽  
Vol 6 (2) ◽  
pp. 133-140 ◽  
Author(s):  
Eric M. Horn ◽  
Michael Beaumont ◽  
Xiao Zheng Shu ◽  
Adrian Harvey ◽  
Glenn D. Prestwich ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Hyaluronic Acid ◽  
Neurite Outgrowth ◽  
Motor Evoked Potentials ◽  
Neurite Growth ◽  
Thoracic Spinal Cord ◽  
Bioactive Materials ◽  
Thoracic Spinal ◽  
Cord Injury

Object Therapies that use bioactive materials as replacement extracellular matrices may hold the potential to mitigate the inhibition of regeneration observed after central nervous system trauma. Hyaluronic acid (HA), a nonsulfated glycosaminoglycan ubiquitous in all tissues, was investigated as a potential neural tissue engineering matrix. Methods Chick dorsal root ganglia were cultured in 3D hydrogel matrices composed of cross-linked thiol-modified HA or fibrin. Samples were cultured and images were acquired at 48-, 60-, and 192-hour time points. Images of all samples were analyzed at 48 hours of incubation to quantify the extent of neurite growth. Cultures in cross-linked thiolated HA exhibited more than a 50% increase in neurite length compared with fibrin samples. Furthermore, cross-linked thiolated HA supported neurites for the entire duration of the culture period, whereas fibrin cultures exhibited collapsed and degenerating extensions beyond 60 hours. Two concentrations of the thiolated HA (0.5 and 1%) were then placed at the site of a complete thoracic spinal cord transection in rats. The ability of the polymer to promote regeneration was tested using motor evoked potentials, retrograde axonal labeling, and behavioral assessments. There were no differences in any of the parameters between rats treated with the polymer and controls. Conclusions The use of a cross-linked HA scaffold promoted robust neurite outgrowth. Although there was no benefit from the polymer in a rodent spinal cord injury model, the findings in this study represent an early step in the development of semisynthetic extracellular matrice scaffolds for the treatment of neuronal injury.

scholarly journals Role of Multimodality Intraoperative Neurophysiological Monitoring during Embolisation of a Spinal Cord Arteriovenous Malformation

2000 ◽  
Vol 6 (3) ◽  
pp. 223-234 ◽  
Author(s):  
F. Sala ◽  
Y. Niimi ◽  
A. Berenstein ◽  
V. Deletis
Keyword(s):  
Spinal Cord ◽  
Mr Imaging ◽  
General Anesthesia ◽  
Endovascular Procedures ◽  
Motor Evoked Potentials ◽  
Neurological Deficits ◽  
Neurophysiological Monitoring ◽  
Thoracic Spinal Cord ◽  
Lower Extremity Weakness ◽  
Thoracic Spinal

The decision whether or not to embolise during endovascular procedures for arteriovenous malformations (AVMs) of the spinal cord under general anesthesia, relies primarily on neurophysiological results of provocative tests with Lidocaine and short-acting barbiturates. Because of the complex haemodynamics of spinal AVMs, when either sensory (CSEPs) or muscle motor evoked potentials (mMEPs) are used independently, they can mislead the interpretation of provocative tests. This report illustrates the specific but complementary role played by provocative tests using CSEPs and mMEPs during embolisation of a low thoracic spinal cord AVM. We present the case of a 46 year old male with six year history of right lower extremity weakness. At that time, Magnetic Resonance (MR) imaging of the spine disclosed an intramedullary AVM at T11. He remained neurologically stable up to seven months before admission, when he developed sudden onset of low back pain, followed by progressive paraparesis, numbness in lower extremities, urinary retention and fecal incontinence. A new MR imaging study indicated venous thrombosis of the AVM. A two-stage embolisation was performed. During the first procedure, after provocative tests did not affect either CSEPs or mMEPs, an embolisation was performed through a sulco-commisure feeder from the anterior spinal artery (ASA) at T9. Conversely, provocative tests with Lidocaine performed from a right posterior spinal artery (PSA) feeder to the AVM nidus resulted in a significant (>50%) decrease of CSEPs, while mMEPs remained unchanged. The repeatedly positive tests warranted further investigation of the vascular anatomy which disclosed a normal right PSA distal to the nidus; the distal normal PSA was protected with coils. A repeated Lidocaine test was negative and the posterior feeder was embolised with no subsequent changes in CSEPs or mMEPs. After the procedure, the patient experienced only a mild transitory increase in right leg numbness, but no additional motor deficits. Five days later, the embolisation through the ASA feeder at T9 was completed on the basis of negative provocative tests. No additional neurological deficits were observed. Favoring either CSEPs or MEPs during endovascular procedures in the spinal cord is not justified by a solid scientific background. This case report illustrates that monitoring both CSEPs and mMEPs combined with provocative tests allows the safest and most effective embolisation of spinal cord AVMs under general anesthesia.

Surgical Management of a Patient With Thoracic Spinal Cord Herniation

Neurosurgery ◽  
2015 ◽  
Vol 77 (3) ◽  
pp. E492-E499 ◽  
Author(s):  
Eduardo Martinez-del-Campo ◽  
Karam Moon ◽  
Samuel Kalb ◽  
Hector Soriano-Baron ◽  
Nicholas Theodore
Keyword(s):  
Spinal Cord ◽  
Subarachnoid Space ◽  
Motor Evoked Potentials ◽  
Foot Drop ◽  
Dural Defect ◽  
Thoracic Spinal Cord ◽  
Lower Extremity Weakness ◽  
Computed Tomographic Myelography ◽  
Thoracic Spinal ◽  
Spinal Cord Herniation

Abstract BACKGROUND AND IMPORTANCE: Thoracic spinal cord herniation (TSCH) is rare and likely underdiagnosed. It is characterized by ventral herniation of the spinal cord through a dural defect, effacement of the anterior subarachnoid space, and increased posterior subarachnoid space. We present here a case of TSCH diagnosed and surgically treated at Barrow Neurological Institute, along with supplemental intraoperative video. CLINICAL PRESENTATION: A 61-year-old man with a history of progressive myelopathy causing left lower-extremity weakness with associated numbness, impaired gait, foot drop, incontinence, and sexual impotence was referred without any previous treatment. Computed tomographic myelography and magnetic resonance imaging of the thoracic spine showed ventral spinal cord herniation at T3-T4. Neurological monitoring was recorded preoperatively and intraoperatively. The patient underwent left-sided posterolateral exploration via T3-T4 laminectomies and costotransversectomy for intradural cord release/detethering of the spinal cord with additional superior and inferior extension and repair of the dural defect. Arthrodesis was not considered necessary. After cord release, motor evoked potentials showed immediate improvement from baseline. Dural duplication was considered the cause of TSCH in this case. Total reduction of herniation was evident in postoperative images. The postoperative course was uneventful, and at the last follow-up, the patient had regained ambulation and sphincter control. CONCLUSION: Anterior displacement of the thoracic spinal cord should elicit consideration of herniation to prevent misdiagnosis and inadequate surgery. Surgical cord release and enlargement of the dural defect are safe and associated with good clinical outcomes.

scholarly journals Bipolar transesophageal thoracic spinal cord stimulation: A novel clinically relevant method for motor-evoked potentials

2020 ◽  
Vol 4 ◽  
pp. 28-35
Author(s):  
Ken Yamanaka ◽  
Kazumasa Tsuda ◽  
Daisuke Takahashi ◽  
Naoki Washiyama ◽  
Katsushi Yamashita ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Evoked Potentials ◽  
Spinal Cord Stimulation ◽  
Motor Evoked Potentials ◽  
Thoracic Spinal Cord ◽  
Thoracic Spinal

scholarly journals Microsurgical resection of intramedullary spinal cord hemangioblastoma

2014 ◽  
Vol 37 (v2supplement) ◽  
pp. Video10 ◽  
Author(s):  
Paul C. McCormick
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Tumors ◽  
Pia Mater ◽  
Thoracic Spinal Cord ◽  
Intramedullary Spinal Cord ◽  
Glial Tumors ◽  
Tumor Margin ◽  
Thoracic Spinal ◽  
Microsurgical Techniques ◽  
Microsurgical Resection

Spinal cord hemangioblastomas account for about 10% of spinal cord tumors. They usually arise from the dorsolateral pia mater and are characterized by their significant vascularity. The principles and techniques of safe resection are different than those employed for the more commonly occurring intramedullary glial tumors (e.g. ependymoma, astrocytoma) and consist of circumferential detachment of the tumor margin from the surrounding normal pia. This video demonstrates the microsurgical techniques of resection of a thoracic spinal cord hemangioblastoma.The video can be found here: http://youtu.be/yT5KLi4VyAo.

scholarly journals Aggressive FUS-Mutant Motor Neuron Disease Without Profound Spinal Cord Pathology

2020 ◽  
Vol 79 (4) ◽  
pp. 365-369 ◽  
Author(s):  
Yan Chen Wongworawat ◽  
Yin Allison Liu ◽  
Ravi Raghavan ◽  
Charles L White ◽  
Robin Dietz ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Motor Neuron ◽  
Motor Neuron Disease ◽  
Motor Neurons ◽  
Cell Loss ◽  
Anterior Horn ◽  
Low Grade ◽  
Thoracic Spinal Cord ◽  
Cytoplasmic Inclusions ◽  
Thoracic Spinal

Abstract A 29-year-old man presented with rapidly progressive severe neck weakness, asymmetrical bilateral upper extremity weakness, bulbar dysfunction, profound muscle wasting, and weight loss. Within 1 year, his speech became unintelligible, he became gastrostomy- and tracheostomy/ventilator-dependent, and wheelchair bound. Electrophysiology suggested motor neuron disease. Whole exome sequencing revealed a heterozygous pathogenic variant in the fused in sarcoma gene (FUS), c.1574C>T,p. R525L, consistent with autosomal dominant amyotrophic lateral sclerosis. Autopsy revealed extensive denervation atrophy of skeletal musculature. Surprisingly, there was only minimal patchy depletion of motor neurons within the cervico-thoracic spinal cord anterior horn cells, and the tracts were largely preserved. TDP-43 inclusions were absent. Abnormal expression of FUS mutation product (cytoplasmic inclusions) was demonstrated by immunohistochemistry within anterior horn motor neurons. The most prominent finding was a disparity between profound neck weakness and relatively low-grade anterior horn cell loss or tract degeneration in the cervico-thoracic cord.

Resection of Ventral Thoracic Calcified Meningiomas Through a Transpedicular Approach: 2-Dimensional Operative Video

2020 ◽  
Author(s):  
Michael A Galgano ◽  
Haydn Hoffman
Keyword(s):  
Spinal Cord ◽  
Posterior Instrumentation ◽  
Video Recording ◽  
Tumor Resection ◽  
Thoracic Spinal Cord ◽  
Lower Extremity Weakness ◽  
Transpedicular Approach ◽  
Institutional Review ◽  
Thoracic Spinal ◽  
Microsurgical Resection

Abstract The surgical resection of ventrally located thoracic lesions carries additional complexity because of the constraints of the mediastinum and pleural cavity as well as the intolerance of the spinal cord to manipulation. The creation of a ventrolateral operative corridor through a transpedicular, transarticular route is effective for accessing the ventral thoracic spinal cord. This operative video demonstrates the surgical management of a 67-yr-old female who presented with progressive gait ataxia and bilateral lower extremity weakness and was found to have noncontiguous calcified ventral thoracic meningiomas at T6 and T10. The surgical plan consisted of T4-11 posterior instrumentation, T5-6 and T9-10 laminectomies with unilateral facetectomies and pediculectomies at both segments, and microsurgical resection of both tumors. Postoperatively, the patient's gait and paraparesis improved. Although instrumentation is infrequently utilized when managing intradural pathology, it permitted aggressive bone removal in order to create an unobstructed ventrolateral corridor to the tumor. This allowed us to perform generous durotomies spanning the length of each lesion and obviated the need for spinal cord manipulation during tumor resection. The patient provided informed consent for the surgery and video recording, and institutional review board approval was determined to be unnecessary.

Spontaneous Herniation of the Thoracic Spinal Cord: A Case Report

2001 ◽  
Vol 45 (4) ◽  
pp. 353 ◽  
Author(s):  
Sung Chan Jin ◽  
Seoung Ro Lee ◽  
Dong Woo Park ◽  
Kyung Bin Joo
Keyword(s):  
Spinal Cord ◽  
Case Report ◽  
Thoracic Spinal Cord ◽  
Thoracic Spinal ◽  
Spontaneous Herniation
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