Intraspinal epidermoid and dermoid cysts—tumor resection with multimodal intraoperative neurophysiological monitoring and long-term outcome

Siller, Sebastian; Egensperger, Rupert; Szelényi, Andrea; Tonn, Joerg‐Christian; Zausinger, Stefan; Schichor, Christian

doi:10.1007/s00701-020-04446-y

Cited by 7 publications

(8 citation statements)

References 24 publications

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“…Siller et al in their study had mean operative time of 200 minutes while performing resection of IDEMSCTs using IONM. 11 SSEP with typical waveform was recordable in 40.63% patients. In patients with higher deficit, amplitude was very small, where tracking of further decrease by more than 50% was difficult.…”

Section: Discussionmentioning

confidence: 90%

“…Siller et al in their study had mean operative time of 200 minutes while performing resection of IDEMSCTs using IONM. 11…”

Section: Discussionmentioning

confidence: 99%

“…15 Siller et al in their retrospective study on elderly patients (≥ 65-year age) with IDEMSCT who underwent IONM (SSEP and transcranial MEP) guided resection found 42.9% sensitivity, 98,2% specificity, 75.0% PPV, and 93.3% NPV of IONM as a composite modality. 11 van der Wal et al have cited 73% sensitivity and 78% specificity of multimodal IONM (SSEP, MEP) when used in IDEMSCT surgery. 8…”

Section: Discussionmentioning

confidence: 99%

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Diagnostic Accuracy of Somatosensory Evoked Potential and Transcranial Motor Evoked Potential in Detection of Neurological Injury in Intradural Extramedullary Spinal Cord Tumor Surgeries: A Short-Term Follow-Up Prospective Interventional Study Experience from Tertiary Care Center of India

Mishra,

Pandey,

Sharma

et al. 2024

Asian J Neurosurg

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Objectives Intraoperative neuromonitoring (IONM) is an acknowledged tool for real-time neuraxis assessment during surgery. Somatosensory evoked potential (SSEP) and transcranial motor evoked potential (MEP) are commonest deployed modalities of IONM. Role of SSEP and MEP in intradural extramedullary spinal cord tumor (IDEMSCT) surgery is not well established. The aim of this study was to evaluate sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of SSEP and transcranial MEP, in detection of intraoperative neurological injury in IDEMSCT patients as well as their postoperative limb-specific neurological improvement assessment at fixed intervals till 30 days. Materials and Methods Symptomatic patients with IDEMSCTs were selected according to the inclusion criteria of study protocol. On modified McCormick (mMC) scale, their sensory-motor deficit was assessed both preoperatively and postoperatively. Surgery was done under SSEP and MEP (transcranial) monitoring using appropriate anesthetic agents. Gross total/subtotal resection of tumor was achieved as per IONM warning alarms. Sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of SSEP and MEP were calculated considering postoperative neurological changes as “reference standard.” Patients were followed up at postoperative day (POD) 0, 1, 7, and 30 for convalescence. Statistical Analysis With appropriate tests of significance, statistical analysis was carried out. Receiver-operating characteristic curve was used to find cutoff point of mMC for SSEP being recordable in patients with higher neurological deficit along with calculation of sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of SSEP and MEP for prediction of intraoperative neurological injury. Results Study included 32 patients. Baseline mean mMC value was 2.59. Under neuromonitoring, gross total resection of IDEMSCT was achieved in 87.5% patients. SSEP was recordable in subset of patients with mMC value less than or equal to 2 with diagnostic accuracy of 100%. MEP was recordable in all patients and it had 96.88% diagnostic accuracy. Statistically significant neurological improvement was noted at POD-7 and POD-30 follow-up. Conclusion SSEP and MEP individually carry high diagnostic accuracy in detection of intraoperative neurological injuries in patients undergoing IDEMSCT surgery. MEP continues to monitor the neuraxis, even in those subsets of patients where SSEP fails to record.

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Section: Discussionmentioning

confidence: 90%

“…Siller et al in their study had mean operative time of 200 minutes while performing resection of IDEMSCTs using IONM. 11…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Diagnostic Accuracy of Somatosensory Evoked Potential and Transcranial Motor Evoked Potential in Detection of Neurological Injury in Intradural Extramedullary Spinal Cord Tumor Surgeries: A Short-Term Follow-Up Prospective Interventional Study Experience from Tertiary Care Center of India

Mishra,

Pandey,

Sharma

et al. 2024

Asian J Neurosurg

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“…Prompt diagnosis and surgery followed by aggressive rehabilitation forms the core for ensuring good outcomes to patients of this rare lesion. 15…”

Section: Discussionmentioning

confidence: 99%

Pediatric spinal dermoids - the silent legacy of dysraphism: Diagnosis, management and prognosis – a case series with review of literature

Bysani¹,

Ganapathy²,

Adesh³

et al. 2021

JNSK

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Paediatric spinal dermoids are a subtype of cutaneous inclusion tumours of the spine consisting of ectodermal derivatives. They are relatively rare conditions with associated with the stigmata of spinal dysraphism with possible devastating consequences. We present a case series, in which we study the clinical, radiological and surgical aspects and follow up of the tumour in the last one year. All patients presented with either para or tetraplegia with or without sensory involvement. Contrast MRI was done in all cases, of which 3 were intradural extramedullary lesions and one was intramedullary lesion. The age ranged from 1 year to 4 years. 2 cases were associated with tethering of cord, 2 cases with dermal sinus and another with dandy walker malformation. One case had infected discharging sinus with dermoid. Gross total excision of tumour was done in all cases with Neuro monitoring. All had good post operative outcome without worsening of deficits. All patients received rehabilitation. Follow up study ranged from 3 months to 11 months. No residual tumour noted in follow up MRI.

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“…Although the primary treatment in dermoids and epidermoids is surgery, radical resection is cautioned due to the concern for neurological injury caused by the tumor capsule adherence to the spinal cord and nerve roots [ 42 , 44 ]. In a recent study, Siller et al reported a higher rate of GTR along with reduced postoperative neurological decline using intraoperative neurophysiological monitoring [ 45 ].…”

Section: Extramedullary Tumorsmentioning

confidence: 99%

Characterization and Treatment of Spinal Tumors

2022

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The prevalence of spinal tumors is rare in comparison to brain tumors which encompass most central nervous system tumors. Tumors of the spine can be divided into primary and metastatic tumors with the latter being the most common presentation. Primary tumors are subdivided based on their location on the spinal column and in the spinal cord into intramedullary, intradural extramedullary, and primary bone tumors. Back pain is a common presentation in spine cancer patients; however, other radicular pain may be present. Magnetic resonance imaging (MRI) is the imaging modality of choice for intradural extramedullary and intramedullary tumors. Plain radiographs are used in the initial diagnosis of primary bone tumors while Computed tomography (CT) and MRI may often be necessary for further characterization. Complete surgical resection is the treatment of choice for spinal tumors and may be curative for well circumscribed lesions. However, intralesional resection along with adjuvant radiation and chemotherapy can be indicated for patients that would experience increased morbidity from damage to nearby neurological structures caused by resection with wide margins. Even with the current treatment options, the prognosis for aggressive spinal cancer remains poor. Advances in novel treatments including molecular targeting, immunotherapy and stem cell therapy provide the potential for greater control of malignant and metastatic tumors of the spine.

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Intraspinal epidermoid and dermoid cysts—tumor resection with multimodal intraoperative neurophysiological monitoring and long-term outcome

Cited by 7 publications

References 24 publications

Diagnostic Accuracy of Somatosensory Evoked Potential and Transcranial Motor Evoked Potential in Detection of Neurological Injury in Intradural Extramedullary Spinal Cord Tumor Surgeries: A Short-Term Follow-Up Prospective Interventional Study Experience from Tertiary Care Center of India

Diagnostic Accuracy of Somatosensory Evoked Potential and Transcranial Motor Evoked Potential in Detection of Neurological Injury in Intradural Extramedullary Spinal Cord Tumor Surgeries: A Short-Term Follow-Up Prospective Interventional Study Experience from Tertiary Care Center of India

Pediatric spinal dermoids - the silent legacy of dysraphism: Diagnosis, management and prognosis – a case series with review of literature

Characterization and Treatment of Spinal Tumors

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