scholarly journals Surgical Strategy for Spinal Cord Tumors : Tumor Resection and Functional Preservation

2015 ◽  
Vol 24 (5) ◽  
pp. 301-309
Author(s):  
Toshihiro Takami ◽  
Kentaro Naito ◽  
Toru Yamagata ◽  
Kenji Ohata
Keyword(s):  
Spinal Cord ◽  
Tumor Resection ◽  
Surgical Strategy ◽  
Spinal Cord Tumors ◽  
Functional Preservation

scholarly journals Objective assessment of utility of intraoperative ultrasound in resection of central nervous system tumors: A cost-eff ective tool for intraoperative navigation in neurosurgery

2011 ◽  
Vol 02 (01) ◽  
pp. 004-011 ◽  
Author(s):  
Aliasgar Moiyadi ◽  
Prakash Shetty
Keyword(s):  
Spinal Cord ◽  
Objective Assessment ◽  
Tumor Resection ◽  
Intraoperative Ultrasound ◽  
Frameless Stereotaxy ◽  
Spinal Cord Tumors ◽  
Individual Parameter ◽  
Objective Evidence ◽  
Intraoperative Localization ◽  
Brain And Spinal Cord

ABSTRACT Background: Localization and delineation of extent of lesions is critical for safe maximal resection of brain and spinal cord tumors. Frame-based and frameless stereotaxy and intraoperative MRI are costly and not freely available especially in economically constrained nations. Intraoperative ultrasound has been around for a while but has been relegated to the background. Lack of objective evidence for its usefulness and the perceived “user unfriendliness” of US are probably responsible for this. We recount our experience with this “forgotten” tool and propose an objective assessment score of its utility in an attempt to revive this practice. Materials and Methods: Seventy seven intraoperative ultrasound (IOUS) studies were carried out in patients with brain and spinal cord tumors. Seven parameters were identifi ed to measure the “utility” of the IOUS and a “utility score” was devised (minimum 0 and maximum 7). Individual parameter and overall scores were calculated for each case. Results: IOUS was found to be useful in many ways. The median overall score was 6 (mean score 5.65). There were no scores less than 4 with the majority demonstrating usefulness in 5 or more parameters (91%). The use of the IOUS signifi cantly infl uenced the performance of the surgery in these cases without signifi cantly prolonging surgery. Conclusions: The IOUS is a very useful tool in intraoperative localization and delineation of lesions and planning various stages of tumor resection. It is easy, convenient, reliable, widely available, and above all a cost-eff ective tool. It should be increasingly used by neurosurgeons in the developing world where costlier intraoperative localization and imaging is not available freely.

Spinal cord tumors in children: long-term results of combined surgical and radiation treatment

1994 ◽  
Vol 81 (4) ◽  
pp. 507-512 ◽  
Author(s):  
Catriona O'Sullivan ◽  
R. Derek Jenkin ◽  
Mary A. Doherty ◽  
Harold J. Hoffman ◽  
Mark L. Greenberg
Keyword(s):  
Spinal Cord ◽  
Malignant Tumor ◽  
Radiation Treatment ◽  
Survival Rates ◽  
Tumor Resection ◽  
Long Term Results ◽  
Spinal Cord Tumors ◽  
Free Survival ◽  
Content Type

✓ The authors report a series of 31 children under 17 years of age with primary spinal cord tumors who underwent radiation treatment following decompression laminectomy with or without tumor resection between 1959 and 1990. The tumors consisted of 15 astrocytomas, 11 ependymomas, one mixed glioma, one ganglioglioma, and three of unknown histology. Ten- and 20-year survival rates and 10- and 20-year relapse-free survival rates for the 28 patients with known histology were 80% and 53%, and 73% and 67%, respectively. Eleven patients (35%) had no resection, 14 (45%) had a partial resection, and six (19%) had a grossly complete resection. Eight patients (26%) are dead: five due to recurrent tumor, two due to a second malignant tumor, and one due to intercurrent disease. Primary tumor relapse or progression occurred in nine patients (29%), four of whom were salvaged. A second malignant tumor developed in four patients (13%), two of whom died. Local control of the tumor was finally achieved in 26 cases (84%), despite either grossly incomplete or no resection in 25 of these cases (81%). These statistics suggest that radiation treatment without resection may achieve long-term control in children with astrocytoma or ependymoma of the spinal cord.

scholarly journals Pitfalls of the Preoperative Diagnosis and Surgical Strategy for Spinal Cord Tumors

2019 ◽  
Vol 28 (5) ◽  
pp. 278-285
Author(s):  
Kiyoshi Ito ◽  
Takuya Nakamura ◽  
Yoshinari Miyaoka ◽  
Yuki Kubota ◽  
Tetsuyoshi Horiuchi ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Preoperative Diagnosis ◽  
Surgical Strategy ◽  
Spinal Cord Tumors

scholarly journals Resection of Intramedullary Spinal Cord Tumor under Awake Anesthesia: A Novel Approach to Minimize Postoperative Motor Deficits

2017 ◽  
Vol 3 (1) ◽  
pp. 28-34
Author(s):  
Ahsan Ali Khan ◽  
Lukui Chen ◽  
Xiaoyuan Guo ◽  
Hong Wang ◽  
Guojian Wu ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Evoked Potential ◽  
Spinal Cord Tumor ◽  
Tumor Resection ◽  
Motor Deficits ◽  
Spinal Cord Tumors ◽  
Intramedullary Spinal Cord ◽  
Intramedullary Spinal Cord Tumor ◽  
Advantages And Disadvantages ◽  
Sensory Evoked

Objective To observe advantages and disadvantages of the resection of intramedullary spinal cord tumor under awake anesthesia. Methods Two patients with intramedullary spinal cord tumor underwent resection under awake anesthesia and followed up post-operatibely for any motor deficits. Results Patients who underwent tumor resection under awake (AAA) anesthesia combined with intraoperative NPM had no motor deficits postoperatively. More accurate and nondelayed responses were observed in the awake cycle of anesthesia and helped guide surgery, thus avoiding injuries to the spinal cord. Conclusion Intramedullary spinal cord tumors are not common, but only gross total resection (GTR) can provide complete remission of symptoms and progression-free survival. However, GTR sometimes results in motor function deficits postoperatively, particularly when the cervical cord is involved, and especially if surgery is done under general anesthesia with intraoperative neurophysiological monitoring (NPM) alone, because of delayed sensory evoked potential and motor evoked potential responses. We present two cases that underwent GTR of cervical intramedullary spinal cord tumors under an asleep-awake-asleep (AAA) cycle of anesthesia, combined with intraoperative NPM in which no postoperative motor deficits were observed on 6-months follow up.

scholarly journals Cervical spine deformity associated with resection of spinal cord tumors

2006 ◽  
Vol 20 (2) ◽  
pp. 1-7 ◽  
Author(s):  
Daniel R. Fassett ◽  
Randy Clark ◽  
Douglas L. Brockmeyer ◽  
Meic H. Schmidt
Keyword(s):  
Spinal Cord ◽  
Cervical Spine ◽  
Sagittal Plane ◽  
Cervical Spinal Cord ◽  
Tumor Resection ◽  
Spine Deformity ◽  
Spinal Cord Tumors ◽  
Intramedullary Spinal Cord ◽  
Spine Deformities ◽  
Anterior Posterior

✓ Postoperative sagittal-plane cervical spine deformities are a concern when laminectomy is performed for tumor resection in the spinal cord. These deformities appear to occur more commonly after resection of intramedullary spinal cord lesions, compared with laminectomy for stenosis caused by degenerative spinal conditions. Postlaminectomy deformities are most common in pediatric patients with an immature skeletal system, but are also more common in young adults (< 25 years of age) in comparison with older adults. The extent of laminectomy and facetectomy, number of laminae removed, location of laminectomy, preoperative loss of lordosis, and postoperative radiation therapy in the spine have all been reported to influence the risk of postlaminectomy spinal deformities. When these occur, patients should be monitored closely with serial imaging studies, because a significant percentage will have progressive deformities. These can range from focal kyphosis to more complicated swan-neck deformities. General indications for surgical intervention include progressive deformity, axial pain in the area, and neurological symptoms attributable to the deformity. Surgical options include anterior, posterior, and combined anterior–posterior procedures. The authors have reviewed the literature on postlaminectomy kyphosis as it relates to resection of cervical spinal cord tumors, and they summarize some general factors to consider when treating these patients.

Intrinsic Spinal Cord Tumor Resection

Neurosurgery ◽  
2002 ◽  
Vol 50 (5) ◽  
pp. 1059-1063 ◽  
Author(s):  
Jacques Brotchi
Keyword(s):  
Spinal Cord ◽  
Standard Treatment ◽  
Case Reports ◽  
Spinal Cord Tumor ◽  
Tumor Resection ◽  
Vascular Tumors ◽  
Spinal Cord Tumors ◽  
The Past ◽  
Midline Approach

Abstract SPINAL CORD TUMORS are more frequently detected than in the past, because of progress in neuroradiology. Many neurosurgeons must now decide how to treat such lesions. The recent neurosurgical literature contains many case reports, few series, and different strategies. This article describes the surgical method I have developed in a period of 15 years, with Georges Fischer in Lyon, on the basis of experience with more than 260 patients and 300 operations. The standard treatment is complete resection whenever possible, but we must learn when and where to stop to preserve the quality of life. I have several useful strategies, which are explained in this report. For gliomas (ependymomas and astrocytomas), I favor a midline approach; for most vascular tumors (such as hemangioblastomas and cavernomas), however, I prefer to proceed from the point at which the lesion is observed through the microscope and to dissect the lesion in one piece. Meticulous nonbleeding surgery and experience are the keys to success.

Predictors of Ambulatory Function after Surgical Resection of Intramedullary Spinal Cord Tumors

Neurosurgery ◽  
2007 ◽  
Vol 61 (1) ◽  
pp. 99-106 ◽  
Author(s):  
Graeme F. Woodworth ◽  
Kaisorn L. Chaichana ◽  
Matthew J. McGirt ◽  
Daniel M. Sciubba ◽  
George I. Jallo ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Radiation Therapy ◽  
Relative Risk ◽  
Confidence Interval ◽  
Functional Status ◽  
Tumor Resection ◽  
Preoperative Radiation ◽  
Spinal Cord Tumors ◽  
Intramedullary Spinal Cord

Abstract BACKGROUND Contemporary treatment of intramedullary spinal cord tumors (IMSCTs) involves radical or subtotal tumor resection with adjuvant radiation and/or chemotherapy, depending on the tumor's histological type and grade as well as the extent of resection. Despite advances in surgical therapy, this approach continues to have significant morbidity. Although previous research is limited, identifying reliable predictors of functional status after tumor resection would be clinically useful for perioperative modification strategies. METHODS All patients who underwent surgery for IMSCTs at an academic tertiary care institution between 1995 and 2004 were retrospectively reviewed, and predictors of postoperative neurological functional status were assessed by multivariate logistical regression analysis. Neurological status was gauged by the ability to walk without assistance at the time of the last follow-up visit. RESULTS Seventy-eight IMSCT resections were performed during the study period. Preoperative (on the day of or the day before surgery) serum glucose greater than 170 mg/dl (relative risk, 0.03; 95% confidence interval, 0.00–0.27; P = 0.001) and preoperative radiation therapy (relative risk, 0.02; 95% confidence interval, 0.00–0.39, P = 0.012) were independently associated with poor functional status postoperatively. The ability to walk unassisted before surgery (relative risk, 17.1; 95% confidence interval, 1.89–154.5, P = 0.012), on other hand, was the only positive predictor of the ability to walk unassisted at the time of the last follow-up visit. CONCLUSION This study suggests that early surgical intervention after the onset of symptoms for patients with IMSCT may help preserve ambulatory function. Deferral of preoperative radiation therapy for less radiosensitive tumors and strict perioperative glucose control may also help maximize a patient's subsequent ambulatory status.

The Evolution of Intramedullary Spinal Cord Tumor Surgery

2009 ◽  
Vol 65 (suppl_6) ◽  
pp. ons84-ons92 ◽  
Author(s):  
Daniel M. Sciubba ◽  
Daniel Liang ◽  
Karl F. Kothbauer ◽  
Joseph C. Noggle ◽  
George I. Jallo
Keyword(s):  
Spinal Cord ◽  
New Technologies ◽  
Spinal Cord Tumor ◽  
Tumor Resection ◽  
Surgical Techniques ◽  
Surrounding Tissue ◽  
Tumor Surgery ◽  
Spinal Cord Tumors ◽  
Intramedullary Spinal Cord ◽  
Intramedullary Spinal Cord Tumor

Abstract Objective: Resections of intramedullary spinal cord tumors were attempted as early as 1890. More than a century after these primitive efforts, profound advancements in imaging, instrumentation, and operative techniques have greatly improved the modern surgeon’s ability to treat such lesions successfully, often with curative results. Methods: We review the history of intramedullary spinal cord tumor surgery, as well as the evolution and advancement of technologies and surgical techniques that have defined the procedure over the past 100 years. Results: Surgery to remove intramedullary spinal cord tumors has evolved to include sophisticated imaging equipment to pinpoint tumor location, laser scalpel systems to provide precise incisions with minimal damage to surrounding tissue, and physiological monitoring to detect and prevent intraoperative motor deficits. Conclusion: Modern surgical devices and techniques have developed dramatically with the availability of new technologies. As a result, continual advancements have been achieved in intramedullary spinal cord tumor surgery, thus increasing the safety and effectiveness of tumor resection, and progressively improving the overall outcomes in patients undergoing such procedures.

ATYPICAL PRESENTATION OF SPINAL CORD TUMORS IN CHILDREN

2006 ◽  
Vol 37 (S 1) ◽  
Author(s):  
C Waisburg ◽  
J Hukin ◽  
F Durity ◽  
E Roland ◽  
A Hill
Keyword(s):  
Spinal Cord ◽  
Atypical Presentation ◽  
Spinal Cord Tumors
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