Surgical Strategy for Resection of Intramedullary Tumors

Abstract

Main Information and Objectives: General surgical concepts in the treatment of intramedullary tumors are demonstrated with clear characterization of the main surgical steps and illustrative images. Laminoplasty as surgical approach followed by durotomy and midline myelotomy, establishment of the tumor-cord interface during intraoperative monitoring, avoiding coagulation during intramedullary preparation, pial sutures to close the myelotomy, and watertight dural closure represent the main steps during resection of intramedullary pathologies. Differentiation between resectable and non-resectable tumors must be performed in order to reduce risks for neurological deficits based on history of the patient, preoperative imaging, intraoperative presentation, and instantaneous section if intraoperative presentation is unclear.

Conclusions: Improvement of microsurgical techniques combined with high-quality preoperative imaging and versatile intraoperative monitoring concepts has significantly improved surgical results in the treatment of resectable intramedullary tumors. For non-resectable intramedullary tumors, surgical biopsy remains an important aspect to verify the diagnosis and to initiate alternative treatment strategies besides surgical resection. Therefore, surgical intervention remains indicated for the vast majority of oncologic intramedullary lesions.