Tumores Intramedulares. Experiencia reciente / intramedullary tumors. recent experience

Introducción: Los tumores intramedulares (TIM) constituyen una patología infrecuente siendo pasibles de resección radical con alto riesgo de deterioro neurológico definitivo. Objetivos: Evaluar factores determinantes de la evolución tales como la técnica quirúrgica empleada, la utilidad del monitoreo neurofisiológico y la evolución de los casos tratados recientemente en nuestro Servicio. Material y Métodos: Revisamos retrospectivamente las Historias Clínicas de pacientes diagnosticados como tumores espinales entre diciembre de 2011 y diciembre 2018. Se consigna el examen neurológico pre y post operatorio, extensión tumoral, descripción de la técnica quirúrgica y los registros obtenidos durante el monitoreo neurofisiológico. Se reflejó la evolución en la Escala de McCormick inmediata, a 6 y 12 meses. Las IRM de ingreso y posoperatoria fueron comparadas para determinar el grado de resección. Se registraron los procedimientos de estabilización ortopédica, así como el tratamiento oncológico complementario. Resultados: Sobre un total de 51 Tumores espinales registrados en el período estudiado, 13 de ellos fueron diagnosticados como TIM. 7 Femeninas, 6 Masculinos. Edad media: 8 años (8 meses a 14 años). Seguimiento de 6 meses a 5 años. Sintomatología: Trastorno de la marcha: 5, Dolor: 5, Escoliosis: 4, Trastornos vesicales: 3, Tortícolis: 2.Características en neuroimágenes: Sólido 8, Sólido/quístico 5, Siringomielia asociada: 5 Técnica quirúrgica: Laminoplastía: 12 pacientes. Laminectomía: 1. Monitoreo intraoperatorio: Atenuación de la onda menor 50%: 5, atenuación mayor 50%: 6.Resección Total: 7, Subtotal/Parcial: 4, Biopsia: 2. Reoperación: una paciente portadora de Ependimoma con residuo en cara anterior medular.Resultado postoperatorio al año: Empeorado: 3. Sin cambios: 5. Mejoría: 5. No se registraron fallecimientos relacionados con el procedimiento.Quimioterapia adyuvante: 2. El déficit funcional mediato mejoró o se mantuvo estable en 12 casos. Se obtuvo recuperación a los 6 meses en 11 pacientes. Un paciente que adicionalmente sufrió un empiema a la semana no recuperó la paraplejía al año de la cirugía. Otro paciente falleció en el curso de la quimioterapia en los dos meses posoperatorios. Conclusiones: El empeoramiento en la función neurológica es esperable en el posoperatorio inmediato. La mayoría de los pacientes exhiben recuperación en los meses siguientes. La resección radical es factible y permite curación o favorece el tratamiento oncológico a largo plazo acorde a la biología tumoral.

Introduction: Intramedullary tumors constitute an infrequent pathology, being capable of radical resection with a high risk of definitive neurological deterioration. Objectives: Evaluate outcome determinants such as the surgical technique used, the usefulness of neurophysiological monitoring and the evolution of the cases recently treated in our Hospital. Material and Methods: We retrospectively reviewed the clinical records of patients diagnosed as spinal tumors between December 2011 and December 2018. The pre and post-operative neurological examination, tumor extension, description of the surgical technique and the information obtained during neurophysiological monitoring are recorded. The evolution was analyzed by the McCormick Scale, at 6 and 12 months. Admission and postoperative MRIs were compared to determine the degree of resection. Orthopedic stabilization procedures as well as complementary oncological treatment were studied. Results: Follow up: 6 months to 5 years. 7 Female, 6 Male. Average age: 8 years (8 months to 14 years) Symptoms: Gait disturbance: 5, Pain: 5, Scoliosis: 4, Bladder Disturbance: 3, Tortícolis: 2.MRI: Solid 8, Solid/ cystic 5, associated Syrinx: 5Surgery: Laminoplasty: 11. Laminectomy: 2. Surgery monitoring : flattened wave less to 50%: 5, up to 50%: 6.Gross total removal: 7, Subtotal/Partial: 4, Biopsy: 2. New exploration: a patient with anterior spinal cord remained Ependymoma.Surgical results: Worsened : 3. Unchanged: 5. Improvement: 5Chemotherapy : 2. Improvement of functional deficit was seen in 11 cases between 6-12 months. There were no deaths due the surgery. Conclusions: Worsening of neurological function is usual immediately to intramedullary surgery. Mostly of patients will have a recovery. Radical resection of this tumors is feasible and in some cases curative, in other cases provide better chemotherapy opportunities.

Long Term Outcome of Non-Dysraphic Intramedullary Spinal Cord Lipomas in Adults: Case Series and Review

STUDY DESIGN: It is a case series involving clinical presentation, radiological findings, surgical technique and long term outcome of Non-dysraphic intramedullary spinal cord lipomas in adults along with the review of the literature. PURPOSE: The purpose of the study is to find out from our series as well as from literature what determines the long term outcome and how it can be improved in patients diagnosed to have intramedullary spinal cord lipomas. OVERVIEW OF LITERATURE: Non-dysraphic spinal intramedullary lipomas in adults are extremely rare. Majority of cases occur in children and in cervico-dorsal regions. Only eight cases of dorso-lumbar spinal lipomas without spinal dysraphism in adults have been reported in the English literature till 2013. METHODS: Here we report our experience with three such cases in the dorsolumbar region and discuss the surgical technique and the long term outcome of such cases. RESULTS: Review of literature and from our own cases we conclude that long term outcome after surgery is determined by the preoperative neurological status. CONCLUSIONS: Earlier surgical intervention with preserved neurological status results in better outcome. Radical subtotal excision without producing iatrogenic postoperative neurological deficit should be the goal of the surgery and it stabilizes the disease process in the long run. When early clinico-radiological signs of recurrence develop, such patient's to be reoperated immediately to prevent them from developing a fixed neurological deficit.

Microsurgical strategies in patients with intramedullary tumors in the cervical spinal cord and their efficacy evaluation / 中华神经医学杂志

Objective To discuss the microsurgical strategies in patients with intramedullary tumors in the cervical spinal cord and their efficacy evaluation. Methods The clinical manifestations, imaging features, diagnoses of 11 patients with intramedullary tumors in the cervical spinal cord were analyzed retrospectively: the tumors on these patients were resected by microneurosurgery in our hospital during Jan 2006 and Dec 2008; the tumor resection degree was measured and the preoperative or postoperative nerve function was evaluated. Results Of the 11 patients with intramedullary tumors, total resection and subtotal resection were achieved in 8 and 3, respectively. Postoperative nerve functions were alleviated in 7, unchanged in 3 and aggravated in 1. No patient died. Conclusion Appropriate operative strategies and practiced microsurgical technique are the foundation of improving the clinical curative effect of the intramedullary tumors in the cervical spinal cord.

Magnetic resonance imaging-based diagnosis of intramedullary spinal cord metastases / 中华神经医学杂志

Objective To investigate the features of intramedullary spinal cord metastases (ISCM) in magnetic resonance imaging (MRI) in relation to their pathological basis. Methods The MRI appearance in 15 clinically and pathologically established ISCM were reviewed retrospectively. Spin-echo sequence T1 weighted images and turbo-spin-echo sequence T2 weighted images were acquired from all the patients with intravenous injection of Gd-DTPA. Results All the 15 ISCM were displayed on MRI as solitary lesions. The lesions were located in the cervical spinal cord in 3 cases, in the thoracic spinal cord in 5 cases, and in the medullary cone in 7 cases. The ISCM displayed isointensity on T1-weighted images and hyperintensity on T2-weighted images, all showing marked enhancement with clear borders after intravenous Gd-DTPA injection. Conclusion ISCM presents with some characteristic findings in MRI and a definite diagnosis can be obtained by combining the investigation of the clinical history.