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Background: Although pedicle screw placement (PSP) is a well-established technique for spine surgery, the treatment of patients with primary invasive spinal tumor (PIST) has high surgical risks secondary to destroyed pedicles. Intraoperative three-dimensional fluoroscopy-based navigation (ITFN) system permits safe and accurate instrumentation of the spine with the advantage of obtaining intraoperative real-time three-dimensional images and automatic registration. The aim of this study is to evaluate the feasibility and accuracy of PSP using ITFN system for patients afflicted with PIST in the thoracic spine. Methods: Fifty-one patients diagnosed with PISTs were retrospectively analyzed, and 157 pedicles screws were implanted in 23 patients using the free-hand technique (free-hand group) and 197 pedicle screws were implanted in 28 patients using the ITFN system (ITFN group). Modified classification of Gertzbein and Robbins was used to evaluate the accuracy of PSP, and McCormick classification was applied for assessment of neurological function. Demographic data and factors affecting accuracy of screw insertion were compared using independent t-test while comparison of accuracy of screw insertion between the two groups was analyzed with Chi-square test. Results: Of 51 patients, 39 demonstrated improved neurological status and the other 12 patients reported that symptoms remained the same. In the free-hand group, 145 screws (92.4%) were Grade I, 9 screws (5.7%) were Grade II, and 3 screws (1.9%) were Grade III. In the ITFN group, 192 screws (97.4%) were Grade I, 5 screws (2.6%) were Grade II, and no Grade III screw was detected. Statistical analysis showed that the accuracies of pedicle screws in the two groups are significantly different (χ2 = 4.981, P = 0.026). Conclusions: The treatments of PISTs include total tumor resection and reconstruction of spine stability. The ITFN system provides a high accuracy of pedicle screw placement.

Background We hypothesized that the addition of dexmedetomidine in a clinically relevant dose to propofol-remifentanil anesthesia regimen does not exert an adverse effect on motor-evoked potentials (MEP) and somatosensory-evoked potentials (SSEP) in adult patients undergoing thoracic spinal cord tumor resection. Methods Seventy-one adult patients were randomized into three groups. Propofol group ( n  = 25): propofol-remifentanil regimenand the dosage was adjusted to maintain the bispectral index (BIS) between 40 and 50. DP adjusted group ( n  = 23): Dexmedetomidine (0.5 μg/kg loading dose infused over 10 min followed by a constant infusion of 0.5 μg/kg/h) was added to the propofol-remifentanil regimen and propofol was adjusted to maintain BIS between 40 and 50. DP unadjusted group ( n  = 23): Dexmedetomidine (administer as DP adjusted group) was added to the propofol-remifentanil regimen and propofol was not adjusted. All patients received MEP, SSEP and BIS monitoring. Results There were no significant changes in the amplitude and latency of MEP and SSEP among different groups ( P  > 0.05). The estimated propofol plasma concentration in DP adjusted group (2.7 ± 0.3 μg/ml) was significantly lower than in propofol group (3.1 ± 0.2 μg/ml) and DP unadjusted group (3.1 ± 0.2 μg/ml) ( P  = 0.000). BIS in DP unadjusted group (35 ± 5) was significantly lower than in propofol group (44 ± 3) ( P  = 0.000). Conclusions The addition of dexmedetomidine to propofol-remifentanil regimen does not exert an adverse effect on MEP and SSEP monitoring in adult patients undergoing thoracic spinal cord tumor resection. Trial registration The study was registered with the Chinese Clinical Trial Registry on January 31st, 2014. The reference number was ChiCTR-TRC-14004229.

Background Safe excision of spinal cord tumors depends on sufficient visualization of the tumor and surrounding structures. In patients with spinal cord tumor adjacent to a stenotic spinal canal, extensive bony decompression proximal and distal to the tumor should be considered for safer excision of the tumor. Extensive wide laminectomy is one choice for such cases, but postoperative problems such as kyphotic deformity remain a concern. Case presentation A 76-year-old man and a 60-year-old woman presented with symptomatic intradural extramedullary spinal cord tumors in the cervical spine. Both patients showed a combination of spondylotic changes in the cervical spine and stenotic condition at the level of the tumor. Both tumors were successfully resected through open-door laminoplasty with hydroxyapatite (HA) spacers, with the tumor located on the side of the laminoplasty. Histological diagnosis was schwannoma for both tumors. HA spacers completely bonded to the host bone and did not interfere with postoperative magnetic resonance imaging (MRI) of the inside of the spinal canal. Cervical spine alignment was maintained at the final follow-up of 6 years in both cases. Conclusion Laminoplasty with HA spacers enabled successful tumor extirpation, reliable MRI follow-up after surgery, and maintenance of normal cervical spine alignment. Laminoplasty with HA spacers represents a good option for the treatment of cervical spinal cord tumor in patients combined with spinal stenosis.

This review article endeavors to provide an update on the current concepts pertaining to the presentation, investigation, and management of sacral metastases. A review of the English language literature from 1995 to 2015 was undertaken. PubMed electronic database, SCOPUS, EMBASE, Medline OVID, and Cochrane database were searched to identify relevant studies using the terms \"sacral metastases\" and \"metastatic sacral tumours.\" Sacral metastasis can present in a variety of ways. Pain in the sacral region can be associated with neurology and mechanical instability. Multidisciplinary involvement is crucial to thoroughly work up the patient. This involves a variety of imaging modalities. Radiotherapy is often used as the first-line treatment. Surgical intervention is based on tumor location, infiltration of surrounding structures, expected outcomes based on primary malignancy, and pelvic stability. Adjuvant cryosurgery and radiosurgery have demonstrated promising results. This is a challenging entity to appropriately diagnose and treat. An appreciation of the disease stage, the clinical burden, and the implications for the individual patient are necessary to deliver patient-centered care.

Objective Our aim is to assess the surgical management of intramedullary spinal cord tumours (IMSCTs) and evaluate factors associated with surgical outcomes in our hospitals. Patient and methods Between June 2013 and June 2016, a retrospective study was conducted on 16 consecutive cases of IMSCTs. All patients provided their signed consent, and MRI was performed. The patients were surgically treated and were evaluated pre- and post-operatively by the modified McCormick scale (MMS). Appropriate statistical analysis was conducted. Results The mean patient age was 50.4 years, and the median follow-up was 15 months. The most common histological origin was ependymoma ( n  = 9, 56.25%). A cervical tumour was detected in eight patients, and a dorsal tumour was detected in seven. Post-operatively, the score was clinically but not statistically improved in seven cervical (87.5%) and four dorsal (57.1%) tumours ( p  = 0.334). Ten patients underwent total resection. Post-operative MMS scores showed improvement in all cases of total resection ( n  = 10, 100%). This improvement was clinically and statistically significant on last follow-up ( p  = 0.008). Fewer than four segments were involved in 9 cases, and more than four segments were involved in 7 cases. Post-operatively, all 9 patients (100%) with fewer than four involved segments improved, while only three patients (42.9%) with more than 4 involved segments improved ( p  = 0.019). Low-grade tumours such as ependymomas were correlated with good surgical outcomes, while high-grade tumours such as astrocytomas were correlated with poor surgical outcomes ( p  = 0.022). Conclusions Total tumour resection coupled with good preoperative clinical condition for tumours localised in the cervical or conus region predicts good neurological outcomes. Tumour localisation in the dorsal region with multi-segmental extension and high-grade tumour pathology predicts poor neurological outcomes.

Central neurocytomas (CNs) are rare benign tumors located in the central nervous system with a good prognosis. These tumors are predominantly located in the lateral ventricle near the foramen of Monro or in the third ventricle. Similar tumors that are located outside the ventricle are also called extraventricular neurocytomas, and have an even lower morbidity. Until now, several tumors have been identified in the thalamus, cerebellum, pons, medulla oblongata and spinal cord. In total, 24 cases of neurocytomas located in the spinal cord have been reported in English journals. The present study reported a patient with an intramedullary central neurocytoma of the thoracic spinal cord, diagnosed from clinical features, imaging findings, pathology and immunohistochemistry. The present case report also outlined the prognosis of the patient and reviewed the literature currently available on CNs located in the spinal cord.

Abstract BACKGROUND Despite major advances in radiation and systemic treatments, surgery remains a critical step in the multidisciplinary treatment of metastatic spinal cord tumors. OBJECTIVE To describe the indications, rationale, and technique of “hybrid therapy” (separation surgery and concomitant spine stereotactic radiosurgery [SRS]) along with practical nuances. METHODS Separation surgery describes a posterolateral approach for circumferential epidural decompression and stabilization. The goal is to decompress the spinal cord, stabilize the spine, and create adequate separation between the neural elements and the tumor for SRS to achieve durable tumor control. RESULTS A transpedicular route to achieve ventrolateral access and limited resection of the tumorous vertebral body is carried out. In the setting of high-grade cord compression, caution must be taken when performing the tumor decompression. “Separation” of the ventral epidural tumor component anteriorly creates space for concomitant SRS while a simple laminectomy would not adequately achieve this goal. Dissection of the posterior longitudinal ligament allows maximal ventral decompression. Gross total tumor resection is not crucial for durable tumor control using the “hybrid therapy” model. Thus, attempts at ventral tumor resection may unnecessarily increase operative morbidity. Cement augmentation of the construct or vertebral body may improve construct stability. CT myelogram is the preferred exam for postoperative SRS planning. Radiosurgical planning constitutes a multidisciplinary effort and guidelines for contouring in the postoperative setting have recently become available. CONCLUSION Separation surgery is an effective, well-tolerated, and reproducible surgery. It provides safe margins for concomitant SRS. Combined, this “Hybrid Therapy” allows durable local control, maintenance of spinal stability, and palliation of symptoms, while minimizing operative morbidity.

Primary spinal cord tumors constitute 2% to 4% of all central nervous system neoplasms and are characterized based on their location as intramedullary, intradural extramedullary, and extradural. A contemporary literature review of primary intradural spinal cord tumors was performed. Among intramedullary tumors, ependymomas are more common and often can be surgically resected. However, astrocytomas infiltrate the spinal cord and complete resection is rare. Intradural extramedullary tumors include schwannomas, neurofibromas, and meningiomas and are usually amenable to surgical resection. Radiotherapy is reserved for malignant variants and recurrent gliomas, whereas chemotherapy is administered for recurrent primary spinal cord tumors without surgical or radiotherapy options. Early recognition of the signs and symptoms related to primary spinal cord tumors facilitates timely discovery, treatment, potentially minimizes neurologic morbidity, and may improve outcome. Treatment consists of surgical resection, and predictors of outcome include preoperative functional status, histologic grade of tumor, and extent of surgical resection.

PurposesIntradural spinal teratomas are very rare in adults and may cause severe neurological deficits. Tumors often tightly attached to the spinal cord, making complete resection difficult. The purpose of this study was to evaluate the impact of surgical resection extent on neurologic outcomes in these patients.MethodsA retrospective study of IST patients who underwent microsurgery in our center was performed. Age, sex, symptoms, duration of symptoms, tumors size, neurologic status, extent of resection, and surgical outcome were reviewed for each patient. The Kruskal-Wallis test and multivariate logistic regression were used to assess affecting factors on neurological outcomes.ResultsA total of 26 adult patients underwent microsurgical management were studied. The mean age at surgery was 41.3 years (range 23–66 years). The mean follow-up was 109.5 months (range 17–216 months). Gross total resection (GTR) was achieved in 12 (46.2%) cases and subtotal resection (STR) in 14 (53.8%) cases. 6 patients (23.1%) had recurrence, and the mean time to recurrence (TTR) was 86.0 months (range 3–168 months) after the first surgery. No recurrence was found after the second surgery during follow-up. All tumors were pathologically confirmed as mature teratomas. In analysis of neurological outcomes, patients with shorter symptom duration (p = 0.035) and lower MMcS grade (p = 0.025) had better postoperative neurological outcomes. The neurological prognosis of STR patients was better than that of GTR patients (p = 0.041). Multivariate logistic regression confirmed that the extent of resection differences remained significant (p = 0.017).ConclusionsSurgical resection is optimal therapeutical management of IST and can obtain a good prognosis. STR appeared to be superior to GTR in terms of neurological improvement. Considering the characteristics of slow growth and long TTR of IST, STR may be a feasible option for highly adherent tumors.

Abstract Prior to their provisional WHO classification as a distinct entity in 2016, diffuse leptomeningeal glioneuronal tumors (DLGNT) were often regarded as diffuse leptomeningeal presentations of oligodendrogliomas or extraventricular neurocytomas. Their classification as a distinct entity partly relies on their pattern of growth, but DLGNTs without radiological leptomeningeal involvement have been described. In a patient with a DLGNT of the spinal cord without evidence of leptomeningeal involvement, we review in depth the clinical course and the histologic and molecular features of the neoplasm, in the context of other reported cases without diffuse leptomeningeal involvement. Our findings highlight the advantages of molecular analysis in making accurate diagnoses on small spinal tissue samples and underline the need for more long-term clinical follow-up of these rare neoplasms to inform treatment decisions.