scholarly journals Microsurgical Resection of Brain Stem Ependymoma: 2-Dimensional Operative Video

2019 ◽  
Vol 18 (6) ◽  
pp. E240-E241 ◽  
Author(s):  
Mirza Pojskić ◽  
Vincent Nguyen ◽  
Goran Lakičević ◽  
Kenan I Arnautović
Keyword(s):  
Spinal Cord ◽  
Medulla Oblongata ◽  
World Health ◽  
Intramedullary Tumor ◽  
Posterior Arch ◽  
Total Resection ◽  
Brainstem Lesion ◽  
Common Location ◽  
Grade Ii ◽  
Microsurgical Resection

Abstract The brainstem is a less-common location for ependymomas than the spinal cord where they are the most common adult intramedullary tumor.1-18 In this first video case report in the peer-reviewed literature, we demonstrate microsurgical resection of a medulla oblongata ependymoma.  There are several case reports of medulla oblongata ependymomas1,3,5,6,13 and a few series of spinal cord ependymomas that included cases of ependymomas of the cervicomedullary junction.9,10 The goal of surgery was to stabilize the preoperative neurological function; favorable outcome is achieved in patients with good preoperative statuses and well-defined tumor boundaries.9 Although gross total resection (GTR) provides the best overall outcome, it is most effective for classic grade II tumors, but not grade I (myxopapillary) and ependymomas, which have a lower GTR rate.14,15  A 55-yr-old patient developed 4-extremity weakness and dysphagia. Pre-/postcontrast magnetic resonance imaging (MRI) revealed centrally located brainstem lesion situated at the lower half of the medulla oblongata. Surgery, performed by the senior author, was performed in the prone position with a small suboccipital craniectomy and C1 posterior arch removal, followed by pia opening and posterior midline myelotomy. Tumor was debulked, dissected from the white matter, and resected. Histology revealed ependymoma (World Health Organization grade II). Postoperative pre-/postcontrast MRI revealed total resection. The patient's neurological deficit completely resolved postoperatively.  Written consent was obtained from the patient.

scholarly journals Microsurgical Resection of Spinal Cord Hemangioblastoma: 2-Dimensional Operative Video

2018 ◽  
Vol 15 (6) ◽  
pp. E88-E89 ◽  
Author(s):  
Mirza Pojskić ◽  
Kenan I Arnautović
Keyword(s):  
Spinal Cord ◽  
Tumor Resection ◽  
Sudden Onset ◽  
Classification Systems ◽  
World Health ◽  
Intramedullary Tumor ◽  
Intramedullary Tumors ◽  
Drainage Vein ◽  
Microsurgical Resection ◽  
Vhl Disease

Abstract This video demonstrates microsurgical resection of spinal cord hemangioblastoma. Hemangioblastomas are rare, benign, highly vascularized tumors classified as grade I according to World Health Organization classification systems. About 3% of all intramedullary tumors are hemangioblastomas.1,2 Spinal cord hemangioblastomas are either sporadic3,4 or manifestations of von Hippel-Lindau (VHL) disease in 20% to 45% of patients.5,6  A 30-year-old male presented with sudden onset urinary incontinence. Magnetic resonance imaging showed contrast enhancing intramedullary tumor with adjacent cyst in T11, and syringomyelia extending to C1. Surgical resection followed rules that apply to resection of arteriovascular malformations: coagulation of arterial feeders precedes the coagulation of the draining vein, which is preserved until the end of surgery.2,4,5,7,8  First, posterior midline myelotomy was performed and the tumor cyst was drained in order to develop a dissection plane. Following this, we continuously separated dorsal nerve roots from the tumor nodule using microsurgical technique. The key step in tumor resection is devascularization of the tumor, achievable in 2 ways.2,7,9-13 The circumferential detachment of the normal pia from the tumor pia is crucial in developing a plane of dissection. The coagulation and division of arterial feeders while preserving the drainage vein further devascularizes the tumor. Once the tumor mural nodule was detached from the spinal cord, the drainage vein was coagulated last and the tumor was removed. The patient fully recovered from his incontinence and was neurologically intact. Screening for VHL disease was negative.  Written consent was obtained directly from the patient.

Revisiting Adjuvant Radiotherapy After Gross Total Resection of World Health Organization Grade II Meningioma

2017 ◽  
Vol 103 ◽  
pp. 655-663 ◽  
Author(s):  
Christopher S. Graffeo ◽  
Heather E. Leeper ◽  
Avital Perry ◽  
Joon H. Uhm ◽  
Daniel J. Lachance ◽  
...  
Keyword(s):  
World Health Organization ◽  
Adjuvant Radiotherapy ◽  
World Health ◽  
Gross Total Resection ◽  
Total Resection ◽  
Grade Ii ◽  
Health Organization

Effect of Gross Total Resection in World Health Organization Grade II Astrocytomas: SEER-Based Survival Analysis

2017 ◽  
Vol 103 ◽  
pp. 741-747 ◽  
Author(s):  
Alexander J. Schupper ◽  
Brian R. Hirshman ◽  
Kate T. Carroll ◽  
Mir Amaan Ali ◽  
Bob S. Carter ◽  
...  
Keyword(s):  
Survival Analysis ◽  
World Health Organization ◽  
World Health ◽  
Gross Total Resection ◽  
Total Resection ◽  
Grade Ii ◽  
Health Organization

scholarly journals Poor Prognostic Factors for Surgical Treatment of Spinal Intramedullary Ependymoma (World Health Organization Grade II)

2020 ◽  
Vol 14 (6) ◽  
pp. 821-828
Author(s):  
Osahiko Tsuji ◽  
Narihito Nagoshi ◽  
Ryota Ishii ◽  
Satoshi Nori ◽  
Satoshi Suzuki ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Prognostic Factors ◽  
World Health Organization ◽  
Scale Score ◽  
Multiple Logistic Regression Analysis ◽  
World Health ◽  
Total Resection ◽  
Grade Ii ◽  
Health Organization

Study Design: Single-center retrospective study.Purpose: We aimed to explore the postoperative prognostic factors for spinal intramedullary ependymoma.Overview of Literature: Ependymoma (World Health Organization grade II) is the most frequent intramedullary spinal tumor and is treated by total resection. However, postoperative deterioration of motor function occasionally occurs.Methods: Eighty patients who underwent surgical resection at Keio University and Fujita Health University in Tokyo, Japan between 2003 and 2015 with more than 2 years of follow-up were enrolled. A good surgical result was defined as an improvement in the modified McCormick Scale score by one grade or more or having the same clinical grade as was observed preoperatively. Meanwhile, a poor result was defined as a reduction in the McCormick Scale score of one grade or more or remaining in grade IV or V at final follow-up. Univariate and multivariate logistic regression analyses of the following factors were performed in the two groups: sex, age, preoperative Visual Analog Scale (VAS), tumor location, the extent of tumor resection, hemosiderin caps, cavity length, and tumor length on magnetic resonance imaging.Results: At final follow-up, 15 patients were included in the poor results group and 65 in the good results group. In the univariate analysis, the factors related to poor results were as follows: higher age, preoperative McCormick Scale score severity, higher preoperative VAS, thoracic location, hemosiderin capped, and non-gross total resection (GTR). A multiple logistic regression analysis was conducted and showed that age, worse preoperative McCormick Scale score, and non-GTR were significant factors for poor prognosis.Conclusions: The independent risk factors for motor deterioration after ependymoma resection were age, worse preoperative McCormick Scale score, and non-GTR. Early surgery for patients with even mild neurological disorders could facilitate functional outcomes. These results may contribute to determining the optimal timing of surgery for spinal intramedullary ependymoma.

scholarly journals Microsurgical resection of a large cavernous malformation of the medulla oblongata

2019 ◽  
Vol 1 (1) ◽  
pp. V25
Author(s):  
Sima Sayyahmelli ◽  
Mustafa K. Başkaya
Keyword(s):  
Surgical Resection ◽  
Medulla Oblongata ◽  
Cavernous Malformation ◽  
Foramen Magnum ◽  
Total Resection ◽  
Postoperative Course ◽  
Suboccipital Craniotomy ◽  
Postoperative Mri ◽  
Microsurgical Resection

In this surgical video, we present a 57-year-old man with neck pain, dizziness, and imbalance. MRI showed a heterogeneously enhancing mass lesion within the posterior medulla at the level of the foramen magnum. Because the patient was symptomatic from this cavernous malformation, the decision was made to proceed with surgical resection. The patient underwent a midline suboccipital craniotomy with C1 laminectomy for surgical resection of the cavernous malformation in the medulla oblongata, with concurrent monitoring of motor and somatosensory evoked potentials.The surgery and postoperative course were uneventful. The postoperative MRI showed gross-total resection of the mass with histopathology indicating a cavernous malformation. The patient continues to do well without recurrence at 7 years of follow-up. In this video, we demonstrate important microsurgical steps for the resection of this challenging and rare vascular malformation.The video can be found here: https://youtu.be/gbGleLowzxo.

5-Aminolevulinic Acid Fluorescence-Guided Resection of Intramedullary Ependymoma: Report of 9 Cases

2012 ◽  
Vol 72 (2) ◽  
pp. ons159-ons168 ◽  
Author(s):  
Tomoo Inoue ◽  
Toshiki Endo ◽  
Kenichi Nagamatsu ◽  
Mika Watanabe ◽  
Teiji Tominaga
Keyword(s):  
Spinal Cord ◽  
Aminolevulinic Acid ◽  
Tumor Resection ◽  
Extent Of Resection ◽  
Labeling Index ◽  
World Health ◽  
Histopathological Diagnosis ◽  
Glioma Surgery ◽  
Ki 67 ◽  
Grade Ii

Abstract BACKGROUND: Resection guided by 5-aminolevulinic acid (5-ALA) fluorescence has proved to be useful in intracranial glioma surgery. However, the effects of 5-ALA on spinal cord tumors remain unknown. OBJECTIVE: To evaluate the usefulness of 5-ALA fluorescence-guided resection of intramedullary ependymoma for achieving maximum tumor resection. METHODS: This study included 10 patients who underwent surgical resection of an intramedullary ependymoma. Nine patients were orally administered 5-ALA (20 mg/kg) 2 hours before the induction of anesthesia. 5-ALA fluorescence was visualized with an operating microscope. Tumors were removed in a standardized manner with electro-physiological monitoring. The extent of resection was evaluated on the basis of intra-operative findings and postoperative magnetic resonance imaging. Histopathological diagnosis was established according to World Health Organization 2007 criteria. Cell proliferation was assessed by Ki-67 labeling index. RESULTS: 5-ALA fluorescence was positive in 7 patients (6 grade II and 1 grade III) and negative in 2 patients (grade II). Intraoperative findings were dichotomized: Tumors covered by the cyst were easily separated from the normal parenchyma, whereas tumors without the cyst appeared to be continuous to the spinal cord. In these cases, 5-ALA fluorescence was especially valuable in delineating the ventral and cranial and caudal margins. Ki-67 labeling index was significantly higher in 5-ALA-positive cases compared with 5-ALA-negative cases. All patients improved neurologically or stabilized after surgery. CONCLUSION: 5-ALA fluorescence was useful for detecting tumor margins during surgery for intramedullary ependymoma. When combined with electrophysiological monitoring, fluorescence-guided resection could help to achieve maximum tumor resection safely.

scholarly journals Driver Genetic Mutations in Spinal Cord Gliomas Direct the Degree of Functional Impairment in Tumor-Associated Spinal Cord Injury

Cells ◽  
2021 ◽  
Vol 10 (10) ◽  
pp. 2525
Author(s):  
Yoshitaka Nagashima ◽  
Yusuke Nishimura ◽  
Fumiharu Ohka ◽  
Kaoru Eguchi ◽  
Kosuke Aoki ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Functional Impairment ◽  
The Body ◽  
World Health ◽  
Genetic Mutations ◽  
Idh Mutations ◽  
Cord Injury ◽  
Grade Ii ◽  
Grade Iii

Genetic analysis in glioma has been developed recently. Spinal cord glioma is less common than intracranial glioma. Thus, the clinical significance of genetic mutations in spinal cord gliomas remains unclear. Furthermore, because the spinal cord is an important communication channel between the brain and the rest of the body, increased attention should be paid to its functional prognosis. In this study, we investigated the functional prognosis and driver genetic mutations in eight patients with spinal cord gliomas (World Health Organization grade I, three cases; grade II, two cases; grade III/IV, three cases). IDH mutations were detected in all grade II cases and H3F3A mutations were detected in all grade III/IV cases. The functional status of grade I and II gliomas remained unchanged or improved 1 year after surgery, whereas grade III/IV gliomas remained unchanged or deteriorated. Spinal glioma progenitor cells with H3F3A mutations were associated with accelerated tumor-associated spinal cord injury, which led to functional impairment. Conversely, the presence of IDH mutations, which are rarely reported in spinal gliomas, indicated a relatively favorable functional prognosis.

scholarly journals Microsurgical Resection of Medulla Oblongata Hemangioblastoma: 2-Dimensional Operative Video

2018 ◽  
Vol 15 (5) ◽  
pp. E64-E65 ◽  
Author(s):  
Mirza Pojskić ◽  
Kenan I Arnautović
Keyword(s):  
Medulla Oblongata ◽  
Posterior Arch ◽  
Tumor Nodule ◽  
Posterior Aspect ◽  
Von Hippel Lindau ◽  
Postoperative Mri ◽  
Suboccipital Craniectomy ◽  
Microsurgical Resection ◽  
Magnetic Resonance Imaging Mri ◽  
The Right

Abstract This video demonstrates the microsurgical resection of brainstem hemangioblastoma. The patient is a 32-yr-old woman with Von Hippel Lindau syndrome who presented with quadriparesis and inability to swallow. Magnetic resonance imaging (MRI) of the neuroaxis revealed a brainstem cystic lesion with contrast-enhancing tumor nodule right along the posterior aspect of the lower part of medulla oblongata. The surgery was performed in the prone position with suboccipital craniectomy and partial C1 posterior arch removal. The aim of the surgery was to remove the tumor nodule.1-12 The tumor was separated from the right dorsal nerve roots, and then progressively dissected with coagulation of arterial feeders and draining vein and division of the pia circumferentially. Postoperative MRI revealed complete resection. The patient completely recovered from her quadriparesis and difficulty swallowing.

scholarly journals Treatment of pediatric Grade II spinal ependymomas: a population-based study

2015 ◽  
Vol 15 (3) ◽  
pp. 243-249 ◽  
Author(s):  
Yimo Lin ◽  
Andrew Jea ◽  
Stephanie C. Melkonian ◽  
Sandi Lam
Keyword(s):  
Spinal Cord ◽  
Overall Survival ◽  
Radiation Therapy ◽  
Pediatric Patients ◽  
Treatment Patterns ◽  
Gross Total Resection ◽  
Subtotal Resection ◽  
Total Resection ◽  
Spinal Ependymoma ◽  
Grade Ii

OBJECT Grade II spinal cord ependymomas occurring in pediatric patients are exceptionally rare neoplasms. In this paper the authors use a national cancer database to determine patient demographics, treatment patterns, and associated outcomes of this cohort. METHODS The Surveillance Epidemiology and End Results (SEER) database was used to analyze subjects younger than 18 years with histologically confirmed diagnoses of Grade II spinal cord ependymoma from the years 1973 to 2008. Descriptive data on the demographic characteristics of this cohort and the associated treatment patterns are shown. The Kaplan-Meier method was used to estimate overall survival at 1, 2, 5, and 10 years. RESULTS This cohort comprised 64 pediatric subjects with Grade II spinal ependymoma. The median age was 13 years, nearly half of the patients were male, and most were white (84%). The median follow-up was 9.2 years. Overall survival at 5 and 10 years was 86% and 83%, respectively. Gross-total resection was achieved in 57% of subjects, and radiation therapy was administered to 36%. Radiation therapy was administered to 78% of subjects after subtotal resection but only to 19% of patients after gross-total resection; this difference was significant (p < 0.001). In a multivariate regression model analyzing sex, age at diagnosis, year of diagnosis, radiotherapy, and extent of resection, female sex was found to be an independent predictor of decreased mortality (HR 0.15 [95% CI 0.02–0.94], p = 0.04). CONCLUSIONS These data show long-term outcomes for pediatric patients with Grade II spinal ependymoma. Radiotherapy was more likely to be administered in cases of subtotal resection than in cases of gross-total resection. Female sex is associated with decreased mortality, while other demographic or treatment modalities are not.

scholarly journals Spinal Cord Ependymomas With MYCN Amplification Show Aggressive Clinical Behavior

2019 ◽  
Vol 78 (9) ◽  
pp. 791-797 ◽  
Author(s):  
Amy A Swanson ◽  
Aditya Raghunathan ◽  
Robert B Jenkins ◽  
Martina Messing-Jünger ◽  
Torsten Pietsch ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Adolescent And Young Adult ◽  
World Health ◽  
Gross Total Resection ◽  
Mycn Amplification ◽  
Chromosomal Microarray Analysis ◽  
Adjuvant Radiation ◽  
Low Grade ◽  
Adult Women ◽  
Total Resection

Abstract Adult spinal cord ependymomas are typically low grade and have a relatively favorable clinical course following gross total resection. We report 4 cases of anaplastic spinal cord ependymoma with MYCN amplification, an exceptionally rare finding. All cases occurred in the spinal cord of adolescent and young adult women and had morphological and immunohistochemical features of anaplastic ependymomas (World Health Organization grade III). Chromosomal microarray analysis demonstrated amplification of 2p24 (including MYCN) in all cases. One patient died 6 months after surgery. Another patient recently had removal of metastatic nodules in the thoracic region, following gross total resection and adjuvant radiation therapy of a lumbar ependymoma 1 year previously. One patient responded well after chemotherapy but died after multiple relapses 82 months after diagnosis. We found MYCN amplification reported in 2 other ependymomas, both anaplastic and arising in the spinal cord of adult females (Brain Pathol 2001;11:133–43). One patient had multiple recurrences in the spinal cord and an intracranial metastasis. Although MYCN amplification is rare in ependymomas, the current and previously reported cases suggest that this is associated with higher-grade histology, spinal location, and often unfavorable prognosis. The clinical significance and therapeutic implications of MYCN amplification in ependymomas require further evaluation.

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