scholarly journals Intramedullary Spinal Cord Metastases: Prognostic Value of MRI and Clinical Features from a 13-Year Institutional Case Series

2014 ◽  
Vol 36 (3) ◽  
pp. 587-593 ◽  
Author(s):  
F.E. Diehn ◽  
J.B. Rykken ◽  
J.T. Wald ◽  
C.P. Wood ◽  
L.J. Eckel ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Clinical Features ◽  
Prognostic Value ◽  
Case Series ◽  
Intramedullary Spinal Cord

scholarly journals Intramedullary Spinal Cord Metastases: MRI and Relevant Clinical Features from a 13-Year Institutional Case Series

2013 ◽  
Vol 34 (10) ◽  
pp. 2043-2049 ◽  
Author(s):  
J.B. Rykken ◽  
F.E. Diehn ◽  
C.H. Hunt ◽  
K.M. Schwartz ◽  
L.J. Eckel ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Clinical Features ◽  
Case Series ◽  
Intramedullary Spinal Cord

Intramedullary spinal cord cavernous malformations: clinical features and risk of hemorrhage

2003 ◽  
Vol 26 (4) ◽  
pp. 253-256 ◽  
Author(s):  
Ibrahim Erol Sandalcioglu ◽  
Helmut Wiedemayer ◽  
Thomas Gasser ◽  
Siamek Asgari ◽  
Tobias Engelhorn ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Clinical Features ◽  
Intramedullary Spinal Cord ◽  
Cavernous Malformations ◽  
Risk Of Hemorrhage

scholarly journals Clinical and pathological outcomes after resection of intramedullary spinal cord tumors: a single-institution case series

2016 ◽  
Vol 41 (2) ◽  
pp. E8 ◽  
Author(s):  
Nardin Samuel ◽  
Lindsay Tetreault ◽  
Carlo Santaguida ◽  
Anick Nater ◽  
Nizar Moayeri ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Tumor Progression ◽  
Functional Outcomes ◽  
Univariate Analysis ◽  
Case Series ◽  
Progression Free Survival ◽  
Spinal Cord Tumors ◽  
Intramedullary Spinal Cord ◽  
Free Survival ◽  
Tumor Pathology

OBJECTIVE The objective of this study was to identify clinically relevant predictors of progression-free survival and functional outcomes in patients who underwent surgery for intramedullary spinal cord tumors (ISCTs). METHODS An institutional spinal tumor registry and billing records were reviewed to identify adult patients who underwent resection of ISCTs between 1993 and 2014. Extensive data were collected from patient charts and operative notes, including demographic information, extent of resection, tumor pathology, and functional and oncological outcomes. Survival analysis was used to determine important predictors of progression-free survival. Logistic regression analysis was used to evaluate the association between an “optimal” functional outcome on the Frankel or McCormick scale at 1-year follow-up and various clinical and surgical characteristics. RESULTS The consecutive case series consisted of 63 patients (50.79% female) who underwent resection of ISCTs. The mean age of patients was 41.92 ± 14.36 years (range 17.60–75.40 years). Complete microsurgical resection, defined as no evidence of tumor on initial postoperative imaging, was achieved in 34 cases (54.84%) of the 62 patients for whom this information was available. On univariate analysis, the most significant predictor of progression-free survival was tumor histology (p = 0.0027). Patients with Grade I/II astrocytomas were more likely to have tumor progression than patients with WHO Grade II ependymomas (HR 8.03, 95% CI 2.07–31.11, p = 0.0026) and myxopapillary ependymomas (HR 8.01, 95% CI 1.44–44.34, p = 0.017). Furthermore, patients who underwent radical or subtotal resection were more likely to have tumor progression than those who underwent complete resection (HR 3.46, 95% CI 1.23–9.73, p = 0.018). Multivariate analysis revealed that tumor pathology was the only significant predictor of tumor progression. On univariate analysis, the most significant predictors of an “optimal” outcome on the Frankel scale were age (OR 0.94, 95% CI 0.89–0.98, p = 0.0062), preoperative Frankel grade (OR 4.84, 95% CI 1.33–17.63, p = 0.017), McCormick score (OR 0.22, 95% CI 0.084–0.57, p = 0.0018), and region of spinal cord (cervical vs conus: OR 0.067, 95% CI 0.012–0.38, p = 0.0023; and thoracic vs conus: OR 0.015: 95% CI 0.001–0.20, p = 0.0013). Age, tumor pathology, and region were also important predictors of 1-year McCormick scores. CONCLUSIONS Extent of tumor resection and histopathology are significant predictors of progression-free survival following resection of ISCTs. Important predictors of functional outcomes include tumor histology, region of spinal cord in which the tumor is present, age, and preoperative functional status.

Management and prognosis of symptomatic patients with intramedullary spinal cord cavernoma

2011 ◽  
Vol 15 (4) ◽  
pp. 447-456 ◽  
Author(s):  
Jian-tao Liang ◽  
Yu-hai Bao ◽  
Hong-qi Zhang ◽  
Li-rong Huo ◽  
Zhen-yu Wang ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Case Series ◽  
Symptom Duration ◽  
Incomplete Resection ◽  
Spinal Angiography ◽  
Intramedullary Spinal Cord ◽  
Long Term Follow Up ◽  
Group 5

Object The authors conducted a study to assess the clinical pattern, radiological features, therapeutic strategies, and long-term outcomes in patients with intramedullary spinal cord cavernomas (ISCCs) based on a large case series. Methods This retrospective study identified 96 patients (60 males, 36 females) surgically (81 cases) or conservatively (15 cases) treated for ISCCs between May 1993 and November 2007. Each diagnosis was based on MR imaging and spinal angiography evidence. For all surgically treated patients, the diagnosis was verified pathologically. The neurological outcomes pre- and postoperatively, as well as long-term follow-up, were assessed using the Aminoff-Logue Disability Scale. Results The mean age at the onset of symptoms was 34.5 years (range 9–80 years). Of the lesions, 68 (71%) were located in the thoracic spine, 25 (26%) in the cervical spine, and only 3 (3%) in the lumbar spine. The median symptom duration was 19.7 months. The clinical behavior of the lesion was a slow progression in 73 cases and an acute decline in 23 cases. Long-term follow-up data (mean 45.8 months, range 10–183 months) were available for 75 patients (64 surgical cases and 11 conservative cases). In the surgical group, a complete resection was achieved in 60 patients, and incomplete resection was detected in 4 patients after operation. At the end of the follow-up period in the operative group, 23 patients (36%) improved, 35 (55%) remained unchanged, and 6 (9%) worsened. In the nonoperative group, 5 patients improved, 6 patients remained unchanged, and none worsened. Conclusions For differential diagnosis, spinal angiography was necessary in some cases. For most symptomatic lesions, complete microsurgical resection of the symptomatic ISCC is safe and prevents rebleeding and further neurological deterioration. However, in patients whose lesions were small and located ventrally in the spinal cord, one can also opt for a rigorous follow-up, considering the high surgical risk.

scholarly journals Combined Use of Diffusion Tractography and Advanced Intraoperative Imaging for Resection of Cervical Intramedullary Spinal Cord Neoplasms: A Case Series and Technical Note

2019 ◽  
Vol 17 (5) ◽  
pp. 525-530 ◽  
Author(s):  
Carolina Gesteira Benjamin ◽  
Anthony Frempong-Boadu ◽  
Michael Hoch ◽  
Mary Bruno ◽  
Timothy Shepherd ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Diffusion Tensor ◽  
Intraoperative Imaging ◽  
Case Series ◽  
Technical Note ◽  
Surface Registration ◽  
Integrated Navigation ◽  
Total Resection ◽  
Intramedullary Spinal Cord ◽  
Spinal Cord Neoplasms

Abstract BACKGROUND Intramedullary spinal cord neoplasms (ISCN) pose significant management challenges. Advances in magnetic resonance imaging (MRI) (such as diffusion tensor imaging, DTI) have been utilized to determine the infiltrative nature and resectability of ISCN. However, this has not been applied to intraoperative decision making. OBJECTIVE To present a case series of 2 patients with ISCN, the first to combine use of DTI, pre- and intraoperative 3-dimensional (3D) virtual reality imaging, and microscope integrated navigation with heads-up display. METHODS Two patients who underwent surgery for ISCN were included. DTI images were obtained and 3D images were created using Surgical Theater (Surgical Theater SRP, Version 7.4.0, Cleveland, Ohio). Fiducials were used to achieve accurate surface registration to C4. Navigation confirmed the levels of laminectomy necessary. The microscope was integrated with Brainlab (Brainlab AG Version 3.0.5, Feldkirchen, Germany) and the tumor projected in the heads-up display. Surgical Theater was integrated with Brainlab to allow for real time evaluation of the 3D tractography. RESULTS Case 1: All tracts were pushed away from the tumor, suggesting it was not infiltrative. Surgical Theater and Brainlab assisted in confirming midline despite the abnormal swelling of the cord so the myelotomy could be performed. The heads-up display outline demonstrated excellent correlation to the tumor. Gross total resection was achieved. Diagnosis of ependymoma was confirmed. Case 2: Some tracts were going through the tumor itself, suggesting an infiltrative process. Surgical Theater and Brainlab again allowed for confirmation of the midline raphe. Near total resection of the enhancing portion was achieved. Diagnosis of glioblastoma was confirmed. CONCLUSION This is a proof of concept application where multi-modal imaging technology was utilized for safest maximal ISCN resection.

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