Microsurgical resection of giant T11/T12 conus cauda equina schwannoma

In this video, we highlight the anatomy involved with microsurgical resection of a giant T11/T12 conus cauda equina schwannoma. Spinal schwannoma remains the third most common intradural spinal tumor. Tumors undergoing gross total resection usually do not recur. To our knowledge, this is the first video case report of giant cauda equina schwannoma resection. A 55-year-old female presented with paraparesis and urinary retention. Lumbar spine MRI revealed a contrast-enhancing intradural extramedullary tumor at the T11/T12 level. Surgery was performed in the prone position with intraoperative neurophysiology monitoring (somatosensory and motor evoked potentials—SSEPs and MEPs). T11/T12 laminectomies were performed. After opening the dura and arachnoid, the tumor was found covered with cauda equina nerve roots. We delineated the inferior pole of the tumor, followed by opening of the capsule and debulking the tumor. Subsequently, the cranial pole was dissected from the corresponding cauda equina nerve roots. Finally, the tumor nerve origin was identified and divided after nerve stimulation confirmed the tumor arose from a sensory nerve root. The tumor was removed; histological analysis revealed a schwannoma (WHO Grade I). Postoperative MRI revealed complete resection. The patient fully recovered her neurological function. This case highlights the importance of careful microsurgical technique and gross total resection of the tumor in the view of favorable postoperative neurological recovery of the patient. Intraoperative use of ultrasound is helpful to delineate preoperatively tumor extension and confirm postoperative tumor resection

Surgical anatomy of microsurgical 3-level anterior cervical discectomy and fusion C4–C7

Anterior cervical discectomy and fusion (ACDF) is one of the most common spinal procedures, frequently used for the treatment of cervical spine degenerative diseases. It was first described in 1958. Interestingly, to our knowledge, 3-level ACDF has not been previously published as a peer-reviewed video case with a detailed description of intraoperative microsurgical anatomy. In this video, we present the case of a 33-year-old male who presented with a combination of myelopathy (hyperreflexia and long tract signs in the upper and lower extremities) and bilateral radiculopathy of the upper extremities. He had been previously treated conservatively with physical therapy and pain management for 6 months without success. We performed 3-level microsurgical ACDF from C4 to C7. All 3 levels were decompressed, and bone allografts were placed to achieve intervertebral body fusion. A titanium plate was utilized from C4 to C7 for internal fixation. The patient was discharged home on the first postoperative day. His pain, numbness and tingling resolved, as well as his myelopathy. No perioperative complications were encountered. Herein we present the surgical anatomy of our operative technique including ertain technical tips. Written consent was obtained directly from the patient. VIDEO https://vimeo.com/user128225853 VIDEO ANNOTATIONS 01:13 — opening the surgery site 02:29 — positioning of retractors 03:02 — start of 3-level discectomy 06:04 — allograft placement and fixation 08:20 — drain placement and closur

Miksopapilarni ependimom kralježnične moždine u odraslih: prikaz osobne serije i pregled literature

Myxopapillary ependymomas (MPE) of the spinal cord are slow-growing benign tumors most frequently found in adults between 30 and 50 years of age. They arise from the ependyma of the filum terminale and are located in the area of the medullary conus and cauda. The recommended treatment option is gross total resection, while patients undergoing subtotal resection usually require radiotherapy. Complete resection without capsular violation can be curative and is often accomplished by simple resection of the filum above and below the tumor mass. Nevertheless, dissemination and distant treatment failure may occur in approximately 30% of the cases. In this paper, we propose an original MPE classification, which is based upon our personal series report concerned with tumor location and its correlation with the extent of resection. We also provide literature review, discussing surgical technique, tumor recurrence rate and dissemination, and adjuvant treatment. In conclusion, our findings suggest that MPE management based on the proposed 5-type tumor classification is favorable when total surgical resection is performed in carefully selected patients. Yet, further studies on a much broader model is obligatory to confirm this.Miksopapilarni ependimomi (MPE) kralježnične moždine sporo su rastući, dobroćudni tumori najčešće zastupljeni u odraslih u dobi između 30 i 50 godina života. Nastaju iz ependima filuma terminale, a pretežito su smješteni u području medularnoga konusa i kaude. Kirurško uklanjanje tumora u cijelosti preporučena je metoda liječenja, dok u bolesnika u kojih to nije moguće učiniti u obzir dolazi subtotalna resekcija nakon koje je potrebno zračenje. Potpuno uklanjanje tumora uz očuvanje cjelovitosti tumorske kapsule postiže se jednostavnom resekcijom filuma terminale iznad i ispod tumorske mase, što može dovesti do izlječenja. Unatoč tomu, tumorska diseminacija uzduž neuralne osi može se javiti u oko 30% slučajeva. U ovom radu predlažemo originalnu klasifikaciju MPE koja prosuđuje smještaj tumora i obujam tumorske resekcije, a temeljena je na osobnoj seriji operiranih bolesnika. Također raspravljamo o kirurškoj tehnici, o mogućnostima recidiva i širenja ovakvih tumora, kao i o oblicima pomoćnog liječenja, koristeći se pregledom literature. Zaključujemo kako naši rezultati zagovaraju kirurško liječenje temeljeno na predloženoj originalnoj tumorskoj klasifikaciji, koje može biti uspješno u pažljivo odabranih bolesnika u kojih je tumor uklonjen u cijelosti. Naknadna istraživanja na znatno većem uzorku potrebna su za potvrdu naših rezultata

Extramedullary Intradural Spinal Tumors: a Review of Modern Diagnostic and Treatment Options and a Report of a Series

Extramedullary intradural spinal tumors are rare. Less than 15% of all central nervous system (CNS) tumors are spinal. Ninety percent of these patients are older than 20 years. Most of spinal tumors are extradural (50-55%) whereas 40-45% are intradural. Furthermore, 5% are intramedullary and 40% are extramedullary. Most common are Schwannomas (29%), followed by meningiomas (25%) and gliomas (22%). These tumors produce pain syndroms, a variety of neurological symptoms- motor, sensory, sphincter or a combination of thereof. All spinal levels may be involved. The diagnostics includes magnetic resonance imaging (MRI) including contrast enhancement, computerizing tomography (CT) scanning (bone windows with reconstruction) and possibly CT myelograms. Preferred treatment is the microsurgical radical resection. Perioperative mortality is very low as is serious morbidity. We herein discuss various aspects of presenting symptomatology, diagnostics, preoperative planning and tactics, surgical treatment and complications. In addition, we include our own retrospective experience with 14 patients treated over the 5.5 years time interval

Extramedullary Intradural Spinal Tumors: a Review of Modern Diagnostic and Treatment Options and a Report of a Series

Extramedullary intradural spinal tumors are rare. Less than 15% of all central nervous system (CNS) tumors are spinal. Ninety percent of these patients are older than 20 years. Most of spinal tumors are extradural (50-55%) whereas 40-45% are intradural. Furthermore, 5% are intramedullary and 40% are extramedullary. Most common are Schwannomas (29%), followed by meningiomas (25%) and gliomas (22%). These tumors produce pain syndroms, a variety of neurological symptoms- motor, sensory, sphincter or a combination of thereof. All spinal levels may be involved. The diagnostics includes magnetic resonance imaging (MRI) including contrast enhancement, computerizing tomography (CT) scanning (bone windows with reconstruction) and possibly CT myelograms. Preferred treatment is the microsurgical radical resection. Perioperative mortality is very low as is serious morbidity. We herein discuss various aspects of presenting symptomatology, diagnostics, preoperative planning and tactics, surgical treatment and complications. In addition, we include our own retrospective experience with 14 patients treated over the 5.5 years time interval

Compound osteosynthesis in the thoracic spine for treatment of vertebral metastases: technical report

Metastases to vertebrae often cause bone destruction leading to instability and neural compression. Anterior surgical approaches allow tumor resection and direct neural decompression. For patients with a short life expectancy, vertebral body replacement with methyl-methacrylate polymerized in situ can be used for load sharing in the axial plane. Screws hung from the rod into the corpectomy site are incorporated into the acrylic cement. The technique described in this article allows for immediate spinal stabilization and provides a protective environment for the neural elements. All the patients tolerated the procedure well and were able to ambulation without an orthoses

Lessons learned during covid-19 pandemic, a worldwide survey: evolution of global neurosurgical practice

Background: During the COVID-19 pandemic, a multitude of surveys have analyzed the impact virus spreading on the everyday medical practice, including neurosurgery. However, none have examined the perceptions of neurosurgeons towards the pandemic, their life changes, and the strategies they implemented to be able to deal with their patients in such a difficult time. Methods: From April 2021 to May 2021 a modified Delphi method was used to construct, pilot, and refine the questionnaire focused on the evolution of global neurosurgical practice during the pandemic. This survey was distributed among 1000 neurosurgeons; the responses were then collected and critically analyzed. Results: Outpatient department practices changed with a rapid rise in teleservices. 63.9% of respondents reported that they have changed their OT practices to emergency cases with occasional elective cases. 40.0% of respondents and 47.9% of their family members reported to have suffered from COVID-19. 56.2% of the respondents reported having felt depressed in the last 1 year. 40.9% of respondents reported having faced financial difficulties. 80.6% of the respondents found online webinars to be a good source of learning. 47.8% of respondents tried to improve their neurosurgical knowledge while 31.6% spent the extra time in research activities. Conlcusions: Progressive increase in operative waiting lists, preferential use of telemedicine, reduction in tendency to complete stoppage of physical clinic services and drop in the use of PPE kits were evident. Respondents' age had an impact on how the clinical services and operative practices have evolved. Financial concerns overshadow mental health