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Management of Cervical Intramedullary Tumors: Case Report and Review of the Literature

Received: 24 November 2021     Accepted: 14 December 2021     Published: 29 December 2021
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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.

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

Keywords

Spinal Surgery, Spinal Tumor, Spinal Ependymoma, Spinal Astrocytoma

References
[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.
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    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

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    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

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    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

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  • @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}
    }
    

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  • 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
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    AU  - Medet Dosanov
    AU  - Renat Nurmukhametov
    AU  - Boris Oleinikov
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    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
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    EP  - 75
    PB  - Science Publishing Group
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    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
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Author Information
  • Department of Neurosurgery, Russian People's Friendship University, Moscow, Russia

  • Department of Neurosurgery, Russian People's Friendship University, Moscow, Russia

  • Department of Neurosurgery, Hospital Juárez de México, Mexico City, Mexico

  • Department of Neurosurgery, Hospital Juárez de México, Mexico City, Mexico

  • Division of Spine Surgery, Central Clinical Hospital of the Russian Academy of Sciences, Moscow, Russia

  • Division of Spine Surgery, Central Clinical Hospital of the Russian Academy of Sciences, Moscow, Russia

  • Division of Spine Surgery, Central Clinical Hospital of the Russian Academy of Sciences, Moscow, Russia

  • Department of Neurosurgery, Russian People's Friendship University, Moscow, Russia

  • Department of Neurosurgery, Russian People's Friendship University, Moscow, Russia

  • Department of Neurosurgery, Charité – University Medicine Berlin, Berlin, Germany

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