Anterior approach to cervical intramedullary pilocytic astrocytoma

2008 ◽  
Vol 9 (3) ◽  
pp. 253-257 ◽  
Author(s):  
Alfred T. Ogden ◽  
Neil A. Feldstein ◽  
Paul C. McCormick
Keyword(s):  
Pilocytic Astrocytoma ◽  
Anterior Approach ◽  
Intramedullary Tumor ◽  
Total Resection ◽  
Intramedullary Tumors ◽  
Sensory Deficits ◽  
Spinal Lesions ◽  
Intradural Extramedullary ◽  
Considerable Experience

Although there has been considerable experience with anterior approaches to ventral intradural, extramedullary, and pial-based spinal lesions, there is no information in the literature regarding the safety and feasibility of the resection of an intramedullary tumor via an anterior approach. The authors report on the gross-total resection of an intramedullary cervical pilocytic astrocytoma via a C-7 corpectomy and anterior myelotomy. The surgery proceeded without complication, and postoperatively the patient maintained the preoperative deficit of mild unilateral hand weakness but had no sensory deficits. Follow-up MR imaging at 6 months showed gross-total macroscopic resection. Selected intramedullary tumors can be safely removed via an anterior approach. This approach avoids the typical sensory dysfunction associated with posterior midline myelotomy.

scholarly journals Giant cystic intradural extramedullary pilocytic astrocytoma of Cauda equina

2013 ◽  
Vol 04 (04) ◽  
pp. 453-456 ◽  
Author(s):  
Amandeep Kumar ◽  
Bhawani S. Sharma ◽  
Shashank S. Kale ◽  
Ajay Garg ◽  
M. C. Sharma
Keyword(s):  
Differential Diagnosis ◽  
Pilocytic Astrocytoma ◽  
Cauda Equina ◽  
Intramedullary Tumors ◽  
First Report ◽  
Intradural Extramedullary

ABSTRACTAstrocytomas of Conus‑Cauda equina region are rare. Astrocytomas, which are intramedullary tumors, may rarely have an extramedullary component. However, primary intradural extramedullary astrocytomas are extremely rare, with very few cases reported in the literature. We describe a giant extramedullary pilocytic astrocytoma of Cauda equina in a 20‑year‑old male. To the best of our knowledge, this is the first report of such a case in the available literature. This case highlights the fact that astrocytomas can be primarily extramedullary and emphasizes the need to consider pilocytic astrocytoma in the differential diagnosis of cystic Cauda equina tumors.

scholarly journals Cervical meningioma resection including the inner dura through an open-door laminoplasty using hydroxyapatite spacers: A case report

2020 ◽  
Vol 11 ◽  
pp. 317
Author(s):  
Naohisa Miyakoshi ◽  
Michio Hongo ◽  
Yuji Kasukawa ◽  
Yoshinori Ishikawa ◽  
Daisuke Kudo ◽  
...  
Keyword(s):  
Tumor Resection ◽  
Complete Resection ◽  
Csf Leak ◽  
Open Door ◽  
Spinal Cord Tumors ◽  
Total Resection ◽  
Watertight Closure ◽  
Intradural Extramedullary ◽  
The Ideal

Background: The ideal surgery for spinal cord tumors is complete resection to prevent recurrence. However, it should be accomplished safely/effectively without risking increased morbidity. Here, we report a cervical meningioma that was totally resected, including the inner dura, through a laminoplasty performed with hydroxyapatite (HA) spacers. Case Description: A 61-year-old Asian male presented with a symptomatic intradural extramedullary C4-C6 cervical meningioma. At surgery, this required resection of the inner dural layer through an open-door laminoplasty. Preservation of the outer dural layer facilitated a watertight closure and the avoidance of a postoperative cerebrospinal fluid (CSF) fistula. Notably, the laminoplasty utilized HA spacers which were magnetic resonance (MR) compatible allowing for future follow-up studies to evaluate for tumor recurrence. At 5-year follow-up, the tumor had not recurred, the patient was asymptomatic, and alignment was maintained. Conclusion: Gross total resection of an intradural extramedullary C4-C6 cervical meningioma was performed with removal of just the inner dural layer. Preservation of the outer dural layer allowed for a watertight closure and the avoidance of a postoperative CSF leak. Further, laminoplasty using HA spacers allowed for successful tumor resection, adequate fusion/stabilization, while not interfering with future MR studies (e.g., HA MR compatible).

Outcome Features Analysis in Intramedullary Tumors of the Cervicomedullary Junction: A Surgical Series

2021 ◽  
Author(s):  
Leonardo Tariciotti ◽  
Giacoma Maria Floriana Brunetto ◽  
Alessandro Landi ◽  
Fabrizio Gregori ◽  
Francesca Santoro ◽  
...  
Keyword(s):  
Low Grade ◽  
Lower Grade ◽  
Functional Evaluation ◽  
High Grade ◽  
Total Resection ◽  
Intramedullary Tumors ◽  
Macroscopic Appearance ◽  
Cervicomedullary Junction ◽  
The Impact

Abstract Object The aim of this study is to investigate the impact of surgery for different cervicomedullary lesions on symptomatic pattern expression and postoperative outcome. We focused on specific outcome features of the early and late postoperative assessments. The former relies on surgery-related transient and permanent morbidity and feasibility of radicality in eloquent areas, whereas the latter on long-term course in lower grade tumors and benign tumorlike lesions (cavernomas, etc.). Material and Methods We retrospectively analyzed 28 cases of intramedullary tumors of the cervicomedullary junction surgically treated at our institution between 1990 and 2018. All cases were stratified for gender, histology, macroscopic appearance, location, surgical approach, and presence of a plane of dissection (POD). Mean follow-up was 5.6 years and it was performed via periodic magnetic resonance imaging (MRI) and functional assessments (Karnofsky Performance Scale [KPS] and modified McCormick [MC] grading system). Results In all, 78.5% were low-grade tumors (or benign lesions) and 21.5% were high-grade tumors. Sixty-one percent underwent median suboccipital approach, 18% a posterolateral approach, and 21% a posterior cervical approach. Gross total resection was achieved in 54% of cases, near-total resection (>90%) in 14%, and subtotal resection (50–90%) in 32% of cases. Early postoperative morbidity was 25%, but late functional evaluation in 79% of the patients showed KPS > 70 and MC grade I; only 21% of cases showed KPS < 70 and MC grades II and III at late follow-up. Mean overall survival was 7 years in low-grade tumors or cavernomas and 11.7 months in high-grade tumors. Progression-free survival at the end of follow-up was 71% (evaluated mainly on low-grade tumors). Conclusions The surgical goal should be to achieve maximal cytoreduction and minimal postoperative neurologic damage. Functional outcome is influenced by the presence of a POD, radicality, histology, preoperative status, and employment of advanced neuroimaging planning and intraoperative monitoring.

scholarly journals Intramedullary tumors in children: analysis of 24 operated cases

2010 ◽  
Vol 68 (3) ◽  
pp. 396-399 ◽  
Author(s):  
Ricardo de Amoreira Gepp ◽  
Jose Mauro Cardoso Couto ◽  
Maria Dorvalina da Silva ◽  
Régis Tavares da Silva ◽  
Eidmar Augusto Neri
Keyword(s):  
Medical Records ◽  
Function Method ◽  
Clinical Characteristics ◽  
Neurological Function ◽  
Common Type ◽  
Male Gender ◽  
Total Resection ◽  
Intramedullary Tumors ◽  
Significant Difference

Intramedullary tumors are rare. The authors reviewed 24 cases operated between 1996 and 2006. The study assessed the clinical characteristics and surgical results based upon the neurological function. METHOD: Medical records of patients with intramedullary astrocytoma and ependymoma were reviewed. The minimal follow up time was 6 months and, at the end of this period, a comparative analysis of the neurological function was performed based using the McCormick scale score. RESULTS: Most patients had astrocytoma (75%). Male gender was more prevalent (58.3%). The most common type of tumor was graded as I or II, and in three cases these were malignant. The total resection of the tumor was achieved in 20.8% of the cases. The statistical analysis did not show a statistically significant difference between preoperative and postoperative grades at McCormick scale. CONCLUSION: The authors concluded that microsurgery to intramedullary tumors did not significantly alter the neurological function after six months.

Predicting sagittal deformity after surgery for intramedullary tumors

2014 ◽  
Vol 21 (3) ◽  
pp. 342-347 ◽  
Author(s):  
Steven Knafo ◽  
Charles Court ◽  
Fabrice Parker
Keyword(s):  
Spinal Deformity ◽  
Univariate Analysis ◽  
Intramedullary Tumor ◽  
Statistical Tool ◽  
Intramedullary Tumors ◽  
The Mean ◽  
The Difference ◽  
Sagittal Deformity ◽  
Time Point

Object Spinal deformity after surgery for intramedullary tumors is a potentially serious complication that may require subsequent fusion. The aim of this study was to determine whether there were risk factors that could be used to predict postoperative sagittal deformity. Methods The authors conducted a retrospective study of patients harboring an intramedullary tumor who had undergone surgery at a single center between 1985 and 2011. The main outcome of interest was the difference, at the last follow-up, between post- and preoperative measures of the Cobb angle formed by the superior and inferior limits of the laminectomy (ΔCobb). Results Sixty-three patients were eligible for inclusion in the study. The mean sagittal deformity, measured as described above, was 15.9° (range 0°–77°) at a mean follow-up of 85.4 months (range 4–240 months). Univariate analysis showed increased sagittal deformity in patients 30 years old or younger (21.9° vs 13.7°, p = 0.04), undergoing a laminectomy involving 4 or more levels (19.3° vs 12.1°, p = 0.04), and undergoing a laminectomy that included a spinal junction (20.8° vs 12.4°, p = 0.02). Multivariate analysis showed that only age (p = 0.01) and the number of spinal levels involved in the laminectomy (p = 0.014) were significant and independent predictors of postoperative sagittal deformity. The linear regression equation drawn from this model allows one to quantitatively predict sagittal deformity for any follow-up time point after surgery. Conclusions Authors of this study developed a statistical tool that could be used to plan surgery and follow-up as regards the risk of sagittal spinal deformity in patients undergoing surgery for intramedullary tumors.

scholarly journals Keyhole approaches to intradural pathologies

2017 ◽  
Vol 43 (2) ◽  
pp. E5 ◽  
Author(s):  
Klaus C. Mende ◽  
Theresa Krätzig ◽  
Malte Mohme ◽  
Manfred Westphal ◽  
Sven O. Eicker
Keyword(s):  
Complete Resection ◽  
Spinal Tumors ◽  
Spinal Instability ◽  
Open Approach ◽  
Intramedullary Tumors ◽  
Interlaminar Approach ◽  
Intradural Extramedullary ◽  
The Mean ◽  
Mini Open

OBJECTIVESpinal tumors account for 2%–4% of all tumors of the central nervous system and can be intramedullary, intradural extramedullary, or extradural. In the past, wide approaches were used to obtain safe access to these tumors, as complete resection is the goal in treating most tumor entities. To reduce surgical complications due to large skin incisions and destabilizing laminectomies, minimally invasive approaches were established. In this study, the authors share their experience with mini-open approaches to intradural tumor pathologies.METHODSThe authors retrospectively reviewed cases involving patients with intramedullary and intradural extramedullary lesions treated between 2009 and 2016. They present their surgical mini-open approach to the spinal cord as well as unique characteristics, key steps, and postsurgical complications for specific tumor subgroups (meningioma, neuroma, and intramedullary tumors).RESULTSA total of 245 intradural tumors were surgically treated during the study period. Of these lesions, 151 were intradural extramedullary meningiomas (n = 79) or neuromas (n = 72). Nine (12.5%) of the neuromas were dumbbell neuromas. Ninety-four tumors were intramedullary. The mean age of the patients was 51.4 years, and 53.9% were female. The mean duration of follow-up was 46.0 months.All meningiomas and neuromas could be resected using a mini-open keyhole approach, but only 5.3% of the intramedullary lesions could be accessed using this technique. Of the 94 patients with intramedullary tumors, 76.6% required a laminotomy, 7.4% required a hemilaminectomy, and 10.6% required a 2-level laminectomy. Only 2 of the patients with intramedullary tumors needed stabilization for progressive cervical kyphosis during follow-up. None of the other patients developed spinal instability after undergoing surgery via the mini-open (keyhole/interlaminar) approach. There were significantly more surgery-associated complications in the large exposure group than in the patients treated with the mini-open approach (19.1% vs 9.6%, p < 0.01).CONCLUSIONSIntradural extramedullary and in selected cases intramedullary pathologies may safely be resected using a mini-open interlaminar approach. Avoiding laminectomy, laminotomy, and even hemilaminectomy preserves spinal stability and significantly reduces comorbidities, while still allowing for complete resection of these tumors.

scholarly journals Intramedullary spindle cell hemangioma: case report

2016 ◽  
Vol 25 (3) ◽  
pp. 379-382
Author(s):  
Rani Nasser ◽  
Kimberly Ashayeri ◽  
Alan D. Legatt ◽  
John K. Houten
Keyword(s):  
Spinal Cord ◽  
Spindle Cell ◽  
Biological Behavior ◽  
Rare Tumor ◽  
Loss Of Function ◽  
Total Resection ◽  
Intramedullary Spinal Cord ◽  
Intradural Extramedullary ◽  
Spindle Cell Hemangioma

The authors describe the case of a 48-year-old man found to have the first reported intramedullary spinal cord spindle cell hemangioma. Previous research indicates that spindle cell hemangiomas are rarely found in the spine. Only 3 previous cases exist, all in the intradural, extramedullary space. In the present case, gross-total resection of the tumor was possible with no loss of function from baseline. This report presents the successful resection of the first reported intramedullary spindle cell hemangioma and reports 4-month follow-up, demonstrating the biological behavior of this rare tumor.

scholarly journals Resection of a Lumbar Intradural Extramedullary Schwannoma: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Michael J Strong ◽  
Timothy J Yee ◽  
Siri Sahib S Khalsa ◽  
Yamaan S Saadeh ◽  
Whitney E Muhlestein ◽  
...  
Keyword(s):  
Spinal Nerve ◽  
Gross Total Resection ◽  
Preoperative Imaging ◽  
Benign Tumors ◽  
Total Resection ◽  
Intradural Tumor ◽  
Key Points ◽  
Intraoperative Fluoroscopy ◽  
Patient Consent ◽  
Intradural Extramedullary

Abstract Schwannomas are typically benign tumors that arise from the sheaths of nerves in the peripheral nervous system. In the spine, schwannomas usually arise from spinal nerve roots and are therefore extramedullary in nature. Surgical resection-achieving a gross total resection, is the main treatment modality and is typically curative for patients with sporadic tumors. In this video, we present the case of a 38-yr-old male with worsening left leg radiculopathy, found to have a lumbar schwannoma. Preoperative imaging demonstrated that the tumor was at the level of L4-L5. A laminectomy at this level was performed with gross total resection of the tumor. The key points of the video include use of intraoperative fluoroscopy to confirm surgical level and help plan surgical exposure, use of ultrasound for intradural tumor localization, and advocating for maximum safe resection using neurostimulation. The patient tolerated the surgery well without any complications. He was discharged home with no additional therapy needed. Appropriate patient consent was obtained.

scholarly journals Endoscopically controlled surgery with open hemilaminectomy for the treatment of intradural extramedullary tumors: an operative technique and short-term outcomes of 20 consecutive cases

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Xiaorong Yan ◽  
Huiqing Wang ◽  
Cai Li ◽  
Yuanxiang Lin ◽  
Lin Lin ◽  
...  
Keyword(s):  
Surgical Technique ◽  
Spinal Deformity ◽  
Tumor Recurrence ◽  
Clinical Symptoms ◽  
Short Term ◽  
Before And After ◽  
Intradural Extramedullary ◽  
Controlled Surgery

Abstract Background To present a surgical technique for the treatment of intradural extramedullary (IDEM) tumors by using endoscopically controlled surgery with open hemilaminectomy technique. Methods In this study, 20 patients with 22 IDEM tumors were enrolled. An endoscopically controlled surgery with open hemilaminectomy was employed to remove the tumors. Data related to clinical symptoms and medical images before and after surgery were collected for perioperative evaluation and follow-up analysis. Results All the tumors in 20 patients were well removed. The clinical symptoms were significantly reduced in all the patients as well. The short-term follow-up data showed that there was no tumor recurrence or spinal deformity. Conclusion The endoscopically controlled surgery with open hemilaminectomy technique provided favorable exposure and satisfactory resection to the IDEM tumors. It may be an effective surgical method for treating IDEM tumors. Larger samples and longer follow-up data are needed to verify its long-term effectiveness.

Concurrent Thoracic Spinal Intradural Extramedullary Epidermoid and Neurenteric Cyst in a Spinal Dysraphism Child

2021 ◽  
pp. 1-7
Author(s):  
Rajeev Sharma ◽  
Swati Mahajan ◽  
Minakshi Bhardwaj ◽  
Laxmi Naraian Gupta ◽  
Deepak Gupta
Keyword(s):  
Surgical Planning ◽  
English Literature ◽  
Spinal Dysraphism ◽  
Neurenteric Cyst ◽  
Germ Layers ◽  
Case Presentation ◽  
Spinal Lesions ◽  
Congenital Origin ◽  
Thoracic Spinal ◽  
Intradural Extramedullary

<b><i>Introduction:</i></b> Intraspinal epidermoid cysts are congenital or acquired in origin; whereas intraspinal neurenteric cysts (NECs) are of congenital origin. Their individual association with spinal dysraphism and vertebral segmentation anomalies is very well known. <b><i>Case presentation:</i></b> We hereby report a case of concurrent intradural extramedullary epidermoid and NEC at adjacent vertebral levels in a spinal dysraphism child, not reported in English Literature till now. <b><i>Conclusion:</i></b> Multiple spinal lesions related to any/all of the 3 germ layers can coexist at same or adjacent vertebral levels in the same patient and surgical planning shown to be done accordingly.

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