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Intradural, Intramedullary Tumor

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Spinal Tumor Surgery
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Abstract

Intramedullary spinal cord tumors (IMSCTs) are rare lesions and represent 2–4% of all central nervous system neoplasms. Primary glial tumors, ependymomas, and astrocytomas, as well as hemangioblastomas, represent well over 90% of IMSCTs. For these low-grade lesions, an attempt at gross total resection has been shown to impact progression-free survival as well as overall survival. Intraoperative neuromonitoring has emerged as an important adjunct for surgical resection and can help guide the extent of resection by providing real-time feedback that impacts the extent of resection. Gross total resection can be safely achieved in cases where there is an identifiable plane between the tumor and normal spinal cord. Higher grade lesions often do not have clear planes, and there is limited utility in aggressive surgical resection. Functional outcomes are determined by the patient’s preoperative status as most patients will maintain their preoperative function, with only a few showing some improvement. Technological advances have pushed surgical techniques for IMSCT resection and have improved our ability to more aggressively treat these lesions.

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References

  1. Constantini S, Miller DC, Allen JC, Rorke LB, Freed D, Epstein FJ. Radical excision of intramedullary spinal cord tumors: surgical morbidity and long-term follow-up evaluation in 164 children and young adults. J Neurosurg. 2000;93(2 Suppl):183–93.

    CAS  PubMed  Google Scholar 

  2. Sciubba DM, Liang D, Kothbauer KF, Noggle JC, Jallo GI. The evolution of intramedullary spinal cord tumor surgery. Neurosurgery. 2009;65(6 Suppl):84–91. discussion 91-2.

    PubMed  Google Scholar 

  3. Boström A, von Lehe M, Hartmann W, Pietsch T, Feuss M, Boström JP, Schramm J, Simon M. Surgery for spinal cord ependymomas: outcome and prognostic factors. Neurosurgery. 2011;68(2):302–8.

    Article  Google Scholar 

  4. Parsa AT, Lee J, Parney IF, Weinstein P, McCormick PC, Ames C. Spinal cord and intradural-extraparenchymal spinal tumors: current best care practices and strategies. J Neuro-Oncol. 2004;69(1–3):291–318.

    Article  Google Scholar 

  5. Yang I, Parsa AT. Intramedullary spinal cord tumors. In: Gupta N, Banerjee A, Haas-Kogan D, editors. Pediatric CNS tumors. Berlin, Heidelberg: Springer; 2010. p. 187–204.

    Google Scholar 

  6. Lee M, Rezai AR, Freed D, Epstein FJ. Intramedullary spinal cord tumors in neurofibromatosis. Neurosurgery. 1996;38(1):32–7.

    Article  CAS  Google Scholar 

  7. Kucia EJ, Bambakidis NC, Chang SW, Spetzler RF. Surgical technique and outcomes in the treatment of spinal cord ependymomas, part 1: intramedullary ependymomas. Neurosurgery. 2011;68(1 Suppl operative):57–63.

    PubMed  Google Scholar 

  8. Ardeshiri A, Chen B, Hütter BO, Oezkan N, Wanke I, Sure U, Sandalcioglu IE. Intramedullary spinal cord astrocytomas: the influence of localization and tumor extension on resectability and functional outcome. Acta Neurochir. 2013;155(7):1203–7.

    Article  Google Scholar 

  9. Liu A, Sankey EW, Bettegowda C, Burger PC, Jallo GI, Groves ML. Poor prognosis despite aggressive treatment in adults with intramedullary spinal cord glioblastoma. J Clin Neurosci. 2015;22(10):1628–31. https://doi.org/10.1016/j.jocn.2015.05.008. Epub 2015 Jun 30.

    Article  PubMed  Google Scholar 

  10. Waxman SG. Correlative neuroanatomy. 23rd ed. Stamford: Appleton & Lange; 1996. p. 45–68.

    Google Scholar 

  11. Hanbali F, Fourney DR, Marmor E, et al. Spinal cord ependymoma: radical surgical resection and outcome. Neurosurgery. 2002;51(5):1162–72.

    Article  Google Scholar 

  12. Vaccaro AR, Albert TJ. Spine surgery: tricks of the trade. 2nd ed. New York: Thieme; 2008.

    Google Scholar 

  13. de Jonge T, Slullitel H, Dubousset J, Miladi L, Wicart P, Illes T. Late-onset spinal deformities in children treated by laminectomy and radiation therapy for malignant tumours. Eur Spine J. 2005;14:765–71.

    Article  Google Scholar 

  14. Papagelopoulos PJ, Peterson HA, Ebersold MJ, Emmanuel PR, Choudhury SN, Quast LM. Spinal column deformity and instability after lumbar or thoracolumbar laminectomy for intraspinal tumors in children and young adults. Spine (Phila Pa 1976). 1997;22:442–51.

    Article  CAS  Google Scholar 

  15. Hersh DS, Iyer RR, Garzon-Muvdi T, Liu A, Jallo GI, Groves ML. Instrumented fusion for spinal deformity after laminectomy or laminoplasty for resection of intramedullary spinal cord tumors in pediatric patients. Neurosurg Focus. 2017;43(4):E12. https://doi.org/10.3171/2017.7.FOCUS17329.

    Article  PubMed  Google Scholar 

  16. Parker SL, Kretzer RM, Recinos PF, Molina CA, Wolinsky JP, Jallo GI, Recinos VR. Ultrasonic BoneScalpel for osteoplastic laminoplasty in the resection of intradural spinal pathology: case series and technical note. Neurosurgery. 2013;73(1 Suppl Operative):ons61–6. https://doi.org/10.1227/NEU.0b013e318283c98b.

    Article  PubMed  Google Scholar 

  17. Takami T, Yamagata T, Naito K, Arima H, Ohata K. Intraoperative assessment of spinal vascular ow in the surgery of spinal intramedullary tumors using indocyanine green videoangiography. Surg Neurol Int. 2013;4:135.

    Article  Google Scholar 

  18. Mende KC, Krätzig T, Mohme M, Westphal M, Eicker SO. Keyhole approaches to intradural pathologies. Neurosurg Focus. 2017;43(2):E5.

    Article  Google Scholar 

  19. Jallo GI, Kothbauer KF, Epstein FJ. Intrinsic spinal cord tumor resection. Neurosurgery. 2001;49(5):1124–8.

    CAS  PubMed  Google Scholar 

  20. Woodworth GF, Chaichana KL, McGirt MJ, Sciubba DM, Jallo GI, Gokaslan Z, et al. Predictors of ambulatory function after surgical resection of intramedullary spinal cord tumors. Neurosurgery. 2007;61(1):99–105.

    Article  Google Scholar 

  21. Sala F, Palandri G, Basso E, Lanteri P, Deletis V, Faccioli F, et al. Motor evoked potential moni- toring improves outcome after surgery for intramedullary spinal cord tumors: a historical control study. Neurosurgery. 2006;58:1129–43. [discussion: 1129-1143].

    Article  Google Scholar 

  22. Jin SH, Chung CK, Kim CH, Choi YD, Kwak G, Kim BE. Multimodal intraoperative monitoring during intramedullary spinal cord tumor surgery. Acta Neurochir. 2015;157:2149–55.

    Article  Google Scholar 

  23. Muramoto A, Imagama S, Ito Z, Ando K, Tauchi R, Matsumoto T, et al. The cutoff amplitude of transcranial motor evoked potentials for transient postoperative motor deficits in intra- medullary spinal cord tumor surgery. Spine. 2014;39:E1086–94.

    Article  Google Scholar 

  24. Kothbauer KF, Deletis V, Epstein FJ. Motor- evoked potential monitoring for intramedullary spinal cord tumor surgery: correlation of clinical and neurophysiological data in a series of 100 consecutive procedures. Neurosurg Focus. 1998;4:e1.

    CAS  PubMed  Google Scholar 

  25. Eroes CA, Zausinger S, Kreth FW, Goldbrunner R, Tonn JC. Intramedullary low grade astrocytoma and ependymoma. Surgical results and predicting factors for clinical outcome. Acta Neurochir. 2010;152:611–8.

    Article  Google Scholar 

  26. Garcés-Ambrossi GL, McGirt MJ, Mehta VA, Sciubba DM, Witham TF, Bydon A, et al. Factors associated with progression-free survival and long-term neurological outcome after resection of intramedullary spinal cord tumors: analysis of 101 consecutive cases. Clinical article. J Neurosurg Spine. 2009;11:591–9.

    Article  Google Scholar 

  27. Cristante L, Herrmann HD. Surgical management of intramedullary spinal cord tumors: functional outcome and sources of morbidity. Neurosurgery. 1994;35(1):69–74. discussion 74-6.

    Article  CAS  Google Scholar 

  28. Albert TJ, Vacarro A. Postlaminectomy kyphosis. Spine (Phila Pa 1976). 1998;23:2738–45.

    Article  CAS  Google Scholar 

  29. McGirt MJ, Chaichana KL, Atiba A, Bydon A, Witham TF, Yao KC, Jallo GI. Incidence of spinal deformity after resection of intramedullary spinal cord tumors in children who underwent laminectomy compared with laminoplasty. J Neurosurg Pediatr. 2008;1:57–62.

    Article  Google Scholar 

  30. Klekamp J. Treatment of intramedullary tumors: analysis of surgical morbidity and long-term results. J Neurosurg Spine. 2013;19(1):12–26. https://doi.org/10.3171/2013.3.SPINE121063.

    Article  PubMed  Google Scholar 

  31. Fischer G, Brotchi J. Intramedullary spinal cord tumors. Stuttgart: Thieme; 1996.

    Google Scholar 

  32. McGirt MJ, Chaichana KL, Atiba A, Attenello F, Yao KC, Jallo GI. Resection of intramedullary spinal cord tumors in children: assessment of long-term motor and sensory de cits. J Neurosurg Pediatr. 2008;1:63–7.

    Article  Google Scholar 

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Correspondence to Mari L. Groves .

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Groves, M.L., Jallo, G. (2019). Intradural, Intramedullary Tumor. In: Sciubba, D. (eds) Spinal Tumor Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-98422-3_27

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  • DOI: https://doi.org/10.1007/978-3-319-98422-3_27

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  • Online ISBN: 978-3-319-98422-3

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