Background. Cervical intramedullary tumors typically present with significant morbidity. Early surgical treatment is paramount to prevent neurological deterioration. Due to the complexity of the anatomy, these lesions still present a technical challenge to the neurosurgeon. We here present the surgical management of a large intramedullary tumor with the help of microsurgical tools and intraoperative monitoring. Case information. A 55-year-old woman presented with significantly reduced strength in her upper and lower extremities and subtle deficits in epicritic and proprioceptive sensation. MRI revealed a large intramedullary tumor in her cervical spinal cord, suggestive of ependymoma. Immediate surgical intervention was indicated. We made use of microsurgical techniques, ultrasound aspiration and monitoring of somatosensory and cortical potentials to achieve a maximally safe removal of the mass. To minimize mechanical stress on the spinal cord, we aimed to debulk the tumor first before resecting it along a dissection plane. Twenty-four hours following the surgery, the patient reported a discreet improvement of upper and lower limb strength and was discharged on postoperative day five in good condition. Result. Multimodal monitoring helped us limit our extent of resection and to achieve a maximally safe near-total removal of the mass. Conclusion. Microsurgical removal of large cervical intramedullary tumors under multimodal monitoring is safe and feasible.
| Published in | World Journal of Medical Case Reports (Volume 2, Issue 4) |
| DOI | 10.11648/j.wjmcr.20210204.13 |
| Page(s) | 73-75 |
| Creative Commons |
This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited. |
| Copyright |
Copyright © The Author(s), 2021. Published by Science Publishing Group |
Spinal Surgery, Spinal Tumor, Spinal Ependymoma, Spinal Astrocytoma
| [1] | M. P. Powell, “Sir Victor Horsley at the birth of neurosurgery,” Brain, vol. 139, no. 2, pp. 631–634, Feb. 2016, doi: 10.1093/brain/awv345. |
| [2] | Tumors of the spine. Philadelphia: Saunders - Elsevier, 2008. |
| [3] | S. R. Garfin, F. J. Eismont, G. R. Bell, C. M. Bono, and J. Fischgrund, Rothman-Simeone the Spine E-Book. 2017. |
| [4] | B. M. Stein, “Intramedullary Spinal Cord Tumors,” Neurosurgery, vol. 30, no. CN_suppl_1, pp. 717–741, Jan. 1983, doi: 10.1093/neurosurgery/30.CN_suppl_1.717. |
| [5] | R. G. Ellenbogen, L. N. Sekhar, and N. D. Kitchen, Eds., Principles of neurological surgery, Fourth edition. Philadelphia, PA: Elsevier, 2018. |
| [6] | J. Brotchi, “Intrinsic Spinal Cord Tumor Resection,” Neurosurgery, vol. 50, no. 5, pp. 1059–1063, May 2002, doi: 10.1097/00006123-200205000-00021. |
| [7] | J. Brotchi, M. Bruneau, F. Lefranc, and D. Balériaux, “Surgery of intraspinal cord tumors,” Clin Neurosurg, vol. 53, pp. 209–216, 2006. |
| [8] | M. Bruneau and B. George, “The lateral approach to the V1 segment of the vertebral artery,” in Pathology and surgery around the vertebral artery, Paris: Springer Paris, 2011, pp. 125–141. doi: 10.1007/978-2-287-89787-0_12. |
| [9] | T. H. Schwartz and P. C. McCormick, “[No title found],” Journal of Neuro-Oncology, vol. 47, no. 3, pp. 211–218, 2000, doi: 10.1023/A:1006414405305. |
| [10] | L. Ferrante, L. Mastronardi, P. Celli, P. Lunardi, M. Acqui, and A. Fortuna, “Intramedullary spinal cord ependymomas? a study of 45 cases with long-term follow-up,” Acta neurochir, vol. 119, no. 1–4, pp. 74–79, Mar. 1992, doi: 10.1007/BF01541785. |
| [11] | N. Svoboda, O. Bradac, P. de Lacy, and V. Benes, “Intramedullary ependymoma: long-term outcome after surgery,” Acta Neurochir, vol. 160, no. 3, pp. 439–447, Mar. 2018, doi: 10.1007/s00701-017-3430-7. |
| [12] | M. B. Bracken et al., “A Randomized, Controlled Trial of Methylprednisolone or Naloxone in the Treatment of Acute Spinal-Cord Injury: Results of the Second National Acute Spinal Cord Injury Study,” N Engl J Med, vol. 322, no. 20, pp. 1405–1411, May 1990, doi: 10.1056/NEJM199005173222001. |
| [13] | A. D. Bhimani et al., “Preoperative steroids do not improve outcomes for intramedullary spinal tumors: a NSQIP analysis of 30-day reoperation and readmission rates,” J Spine Surg, vol. 4, no. 1, pp. 9–16, Mar. 2018, doi: 10.21037/jss.2018.03.18. |
APA Style
Manuel De Jesus Encarnacion, Rossi E. Barrientos Castillo, Durdica Lopez Vujnovic, Arturo Ayala Arcipreste, Juan Sebastian Castro, et al. (2021). Management of Cervical Intramedullary Tumors: Case Report and Review of the Literature. World Journal of Medical Case Reports, 2(4), 73-75. https://doi.org/10.11648/j.wjmcr.20210204.13
ACS Style
Manuel De Jesus Encarnacion; Rossi E. Barrientos Castillo; Durdica Lopez Vujnovic; Arturo Ayala Arcipreste; Juan Sebastian Castro, et al. Management of Cervical Intramedullary Tumors: Case Report and Review of the Literature. World J. Med. Case Rep. 2021, 2(4), 73-75. doi: 10.11648/j.wjmcr.20210204.13
AMA Style
Manuel De Jesus Encarnacion, Rossi E. Barrientos Castillo, Durdica Lopez Vujnovic, Arturo Ayala Arcipreste, Juan Sebastian Castro, et al. Management of Cervical Intramedullary Tumors: Case Report and Review of the Literature. World J Med Case Rep. 2021;2(4):73-75. doi: 10.11648/j.wjmcr.20210204.13
Share This Article
Twitter
Linked In
Facebook
Copy
Download@article{10.11648/j.wjmcr.20210204.13,
author = {Manuel De Jesus Encarnacion and Rossi E. Barrientos Castillo and Durdica Lopez Vujnovic and Arturo Ayala Arcipreste and Juan Sebastian Castro and Alexander Volovich and Medet Dosanov and Renat Nurmukhametov and Boris Oleinikov and Ibrahim E. Efe},
title = {Management of Cervical Intramedullary Tumors: Case Report and Review of the Literature},
journal = {World Journal of Medical Case Reports},
volume = {2},
number = {4},
pages = {73-75},
doi = {10.11648/j.wjmcr.20210204.13},
url = {https://doi.org/10.11648/j.wjmcr.20210204.13},
eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.wjmcr.20210204.13},
abstract = {Background. Cervical intramedullary tumors typically present with significant morbidity. Early surgical treatment is paramount to prevent neurological deterioration. Due to the complexity of the anatomy, these lesions still present a technical challenge to the neurosurgeon. We here present the surgical management of a large intramedullary tumor with the help of microsurgical tools and intraoperative monitoring. Case information. A 55-year-old woman presented with significantly reduced strength in her upper and lower extremities and subtle deficits in epicritic and proprioceptive sensation. MRI revealed a large intramedullary tumor in her cervical spinal cord, suggestive of ependymoma. Immediate surgical intervention was indicated. We made use of microsurgical techniques, ultrasound aspiration and monitoring of somatosensory and cortical potentials to achieve a maximally safe removal of the mass. To minimize mechanical stress on the spinal cord, we aimed to debulk the tumor first before resecting it along a dissection plane. Twenty-four hours following the surgery, the patient reported a discreet improvement of upper and lower limb strength and was discharged on postoperative day five in good condition. Result. Multimodal monitoring helped us limit our extent of resection and to achieve a maximally safe near-total removal of the mass. Conclusion. Microsurgical removal of large cervical intramedullary tumors under multimodal monitoring is safe and feasible.},
year = {2021}
}
TY - JOUR T1 - Management of Cervical Intramedullary Tumors: Case Report and Review of the Literature AU - Manuel De Jesus Encarnacion AU - Rossi E. Barrientos Castillo AU - Durdica Lopez Vujnovic AU - Arturo Ayala Arcipreste AU - Juan Sebastian Castro AU - Alexander Volovich AU - Medet Dosanov AU - Renat Nurmukhametov AU - Boris Oleinikov AU - Ibrahim E. Efe Y1 - 2021/12/29 PY - 2021 N1 - https://doi.org/10.11648/j.wjmcr.20210204.13 DO - 10.11648/j.wjmcr.20210204.13 T2 - World Journal of Medical Case Reports JF - World Journal of Medical Case Reports JO - World Journal of Medical Case Reports SP - 73 EP - 75 PB - Science Publishing Group SN - 2994-726X UR - https://doi.org/10.11648/j.wjmcr.20210204.13 AB - Background. Cervical intramedullary tumors typically present with significant morbidity. Early surgical treatment is paramount to prevent neurological deterioration. Due to the complexity of the anatomy, these lesions still present a technical challenge to the neurosurgeon. We here present the surgical management of a large intramedullary tumor with the help of microsurgical tools and intraoperative monitoring. Case information. A 55-year-old woman presented with significantly reduced strength in her upper and lower extremities and subtle deficits in epicritic and proprioceptive sensation. MRI revealed a large intramedullary tumor in her cervical spinal cord, suggestive of ependymoma. Immediate surgical intervention was indicated. We made use of microsurgical techniques, ultrasound aspiration and monitoring of somatosensory and cortical potentials to achieve a maximally safe removal of the mass. To minimize mechanical stress on the spinal cord, we aimed to debulk the tumor first before resecting it along a dissection plane. Twenty-four hours following the surgery, the patient reported a discreet improvement of upper and lower limb strength and was discharged on postoperative day five in good condition. Result. Multimodal monitoring helped us limit our extent of resection and to achieve a maximally safe near-total removal of the mass. Conclusion. Microsurgical removal of large cervical intramedullary tumors under multimodal monitoring is safe and feasible. VL - 2 IS - 4 ER -
Information
Email: