The Evolution of Intramedullary Spinal Cord Tumor Surgery

Sciubba, Daniel M.; Liang, Daniel S.; Kothbauer, Karl F.; Noggle, Joseph C.; Jallo, George I.

doi:10.1227/01.neu.0000345628.39796.40

Cited by 20 publications

(25 citation statements)

References 57 publications

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“…[3,20] To our knowledge no other intra-operative imaging technique (for example ioMRI) is used for IMCM resection. [22,24] In our series these lesions could be displayed in sufficient quality by high frequency 2D and satisfactory by real time 3D imaging (Figure 1 and 2) with regard to the surrounded healthy tissue. It was useful to show the extent of the lesion as well as the three-dimensional expansion of the lesion.…”

Section: Visualizationsupporting

confidence: 54%

“…[3,22] In this study we analyzed our experiences with ioUS and focused on six selected cavernoma cases where the lesion was not visible on the surface after opening the dura from a dorsal approach. Intra-operative imaging for exact localization is highly recommended to keep the spinal cord incision as small and as precise as possible.…”

Section: Discussionmentioning

confidence: 99%

“…Intra-operative MRI (ioMRI) for spinal intramedullary lesions has rarely been mentioned, despite its increasing use of for cranial lesions. [16,22] Recent advances in ultrasound technology, such as high frequency transducer and true real time 3D probes should be able to further improve surgical interventions. [4,15] We evaluated those two new probes in six challenging cases for localization, visualization and possible resection control.…”

Section: Discussionmentioning

confidence: 99%

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Intra-operative high frequency ultrasound improves surgery of intramedullary cavernous malformations

et al. 2011

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Intra-operative ultrasound (ioUS) is a very useful tool in surgery of spinal lesions. Here we focus on modern ioUS to analyze its use for localisation, visualisation and resection control in intramedullary cavernous malformations (IMCM). A series of 35 consecutive intradural lesions were operated in our hospital in a time period of 24 months using modern ioUS with a high frequency 7-15 MHz transducer and a true real time 3D transducer (both Phillips iU 22 ultrasound system). Six of those cases were treated with the admitting diagnosis of a deep IMCM (two cervical, four thoracic lesions). IoUS images were performed before and after the IMCM resection. Pre-operative and early postoperative MRI images were performed in all patients. In all six IMCM cases a complete removal of the lesion was achieved microsurgically resulting in an improved neurological status of all patients. High frequency ioUS emerged to be a very useful tool during surgery for localization and visualization. Excellent resection control by ultrasound was possible in three cases. Minor resolution of true real time 3D ioUS decreases the actual advantage of simultaneous reconstruction in two planes. High frequency ioUS is the best choice for intraoperative imaging in deep IMCM to localize and to visualize the lesion and to plan the perfect surgical approach. Additionally, high frequency ioUS is suitable for intra-operative resection control of the lesion in selected IMCM cases. Methods: A series of 35 consecutive intradural lesions were operated in our hospital in a time period of 24 months using modern ioUS with a high frequency 7-15 MHz transducer and a true real time 3D transducer (both Phillips iU 22 ultrasound system).Six of those cases were treated with the admitting diagnosis of a deep IMCM (two cervical, four thoracic lesions). IoUS images were performed before and after the IMCM resection. Pre-and early postoperative MRI images were performed in all patients.Results: In all six IMCM cases a complete removal of the lesion was achieved microsurgically resulting in an improved neurological status of all patients. High frequency ioUS emerged to be a very useful tool during surgery for localization and visualization. Excellent resection control by ultrasound was possible in 3 cases. Minor resolution of true real time 3D ioUS decreases the actual advantage of simultaneous reconstruction in 2 planes. Conclusion:High frequency ioUS is the best choice for intra-operative imaging in deep IMCM to localize and to visualize the lesion and to plan the perfect surgical approach.Additionally, high frequency ioUS is suitable for intra-operative resection control of the lesion in non acute IMCM cases. Resection control in acute IMCM lesions is difficult to interpret since sometimes perifocal edema and/or perifocal hemosiderin can hinder the accurate differentiation of medullary to pathological tissue.

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Section: Visualizationsupporting

confidence: 54%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Intra-operative high frequency ultrasound improves surgery of intramedullary cavernous malformations

et al. 2011

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“…21 The earliest successful resection of IMSCTs was performed in 1907 by Anton von Eiselsberg of Vienna. 36 Harvey Cushing's first surgery for the removal of a spinal cord tumor was for a cervical meningioma in November 1903. The outstanding clinical results of this surgery led Cushing to state: "The case seems in many respects the most satisfactory of any heretofore recorded.…”

Section: Discussionmentioning

confidence: 99%

“…8 The earliest successful resection was performed in 1907 by Anton von Eiselsberg of Vienna (see Zervas). 36 Surgeons of the early 20th century continued to pursue methods for successful operative treatment of these lesions, with Charles Elsberg of New York developing a 2-stage operation to minimize manipulation of the spinal cord during resection. 19 Although Harvey Cushing is known for his contributions to brain tumor surgery, his contributions to spine surgery, 7,[16][17][18]28 particularly for tumors of the spinal column, have only recently come to light.…”

mentioning

confidence: 99%

Challenges in early operative approaches to intramedullary spinal cord tumors: Harvey Cushing’s perspective

Pendleton¹,

Rincón-Torroella²,

Gokaslan³

et al. 2015

SPI

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Although Harvey Cushing was mostly known for his contributions to brain tumor surgery, he was also a pioneer in the development of spinal cord surgery. This lesser known facet of Cushing’s career can provide a fresh and unique perspective into how the founders of neurosurgery surmounted early challenges in the field. The authors bring to light and examine for the first time Cushing’s unpublished writing “Technique of Laminectomy” along with his first 3 documented intramedullary spinal cord tumor (IMSCT) cases at the Johns Hopkins Hospital. The authors draw lessons from the challenges in pathological classification, preoperative diagnosis, tumor localization, and surgical technique ofthat time. Although Cushing’s attempts at exploration and resection of IMSCT as described here were of limited success, his ability to adapt his clinical and surgical technique to the challenges of the time, as well as develop skills to successfully manipulate the spinal cord during these exploratory procedures without the patients incurring neurological damage, postoperative infection, or complications, is a testament to his determination to advance the field and his meticulous operative technique. In spite of the limitations imposed on the pioneer neurosurgeons, Harvey Cushing and his contemporaries persevered through many of the challenges and built an essential part of neurosurgery’s common story.

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Anatomical Compartment’s Representative Tumor Surgery and Video

Chung

2021

Surgery of Spinal Cord Tumors Based on Anatomy

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The Evolution of Intramedullary Spinal Cord Tumor Surgery

Cited by 20 publications

References 57 publications

Intra-operative high frequency ultrasound improves surgery of intramedullary cavernous malformations

Intra-operative high frequency ultrasound improves surgery of intramedullary cavernous malformations

Challenges in early operative approaches to intramedullary spinal cord tumors: Harvey Cushing’s perspective

Anatomical Compartment’s Representative Tumor Surgery and Video

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