Neurosurgical focus: Video最新文献

A 58-year-old male was admitted to the authors' department due to cervicothoracic pain and disequilibrium. Physical examination evidenced sensory and motor deficits in the lower limbs. MRI evidenced an expansive intramedullary lesion compatible with ependymoma. The nuances of this surgical access and the management of intradural tumors are discussed.

This video demonstrates a gross-total resection of a multisegmental intradural extramedullary tumor using only multisegmental hemilaminectomy. The patient is a 21-year-old woman presenting with only backache. MRI of the lumbar spine demonstrates a large multisegmental heterogeneously enhancing intradural extramedullary tumor extending down from the eleventh dorsal vertebrae down to the fifth lumbar vertebrae. The surgical video demonstrates the technique of multisegmental hemilaminectomy and microsurgical resection of the tumor without posterior spinal instrumentation. Postoperatively, the patient had no neurological deficit and was discharged on postoperative day 5. Three-month postoperative MRI shows no residual disease or spinal deformity.

This video presents the case of a 44-year-old male with a 2-year history of pain in the left upper extremity that had worsened over the course of the last 6 months with associated weakened grip strength and had extended into his right arm. T2-weighted sagittal and axial MRI demonstrated an expansive nonenhancing solid intramedullary lesion extending from C5 to T1. The patient underwent a C5-T1 laminectomy and laminoplasty with near-complete resection of the intradural intramedullary subependymoma. At 3 months' follow-up, he reported doing well and had experienced significant improvement in motor strength with ongoing therapies.

The video demonstrates an operative approach to a recurrent cervical anaplastic ependymoma. MYCN-amplified anaplastic ependymomas are locally aggressive, recurrent, and have a high risk of iatrogenic injury. In this case, the patient presented with local, aggressive tumor expansion, arachnoid adhesions, and pial invasion ventral to the spinal cord. Subcapsular decompression minimized cord retraction from a dorsal approach. Removal of the tumor capsule was guided by bipolar stimulation paired with neuromonitoring. Local gross-total resection was achieved, and the patient had a postoperative improvement in his neurological deficits and myelopathy.

A 60-year-old male with renal cell carcinoma (RCC) presented with back pain, weakness, and bowel and bladder urgency. MRI demonstrated a cauda equina tumor at L2. Following L1-3 laminectomies, intraoperative ultrasound localized the tumor. After dural opening, a vascular tumor was adherent to the cauda equina. Intraoperative nerve stimulation helped to identify the nerve rootlets. Tumor was removed in a piecemeal fashion. Tumor dissection caused periodic spasms in L1-3 distributions. A neuromonitoring checklist was used to recover motor evoked potential signals with elevated mean arterial pressures. Hemostasis was challenging with the vascular tumor. Intraoperative ultrasound confirmed tumor debulking. Pathology confirmed metastatic RCC.

Spinal cord ependymomas comprise 25% of all intramedullary tumors and are typically treated with resection. A man in his mid-60s presented with imbalance and sensory deficits in both lower extremities, and a spinal thoracic intramedullary ependymoma spanning the levels T2 and T3 was diagnosed. After a laminectomy was performed, the tumor was microsurgically resected, and the patient demonstrated no neurological deficits on postoperative examination. Subsequent MRI showed complete resection of the tumor. This video showcases a thoracic intramedullary ependymoma resected using careful microdissection into the median raphe as a safe entry zone to preserve neurological function.

The surgical management of ventral upper cervical meningiomas poses significant challenges due to their deep location and limited accessibility. These tumors have the potential to compress or involve nearby neurovascular structures, leading to various neurological complications including inferior cranial nerve palsy, motor deficits, and sensory disturbances such as hypoesthesia, paresthesia, and impaired coordination. To address this issue, surgical intervention through an anterolateral or far lateral approach has been recognized as the optimal treatment strategy. In this video, the authors present a detailed demonstration of the operative technique using an anterolateral upper cervical approach to safely resect a ventrally located C1-2 meningioma.

Epidermoid cysts are rare, benign neoplasms that account for less than 1% of all intraspinal tumors. The most common localization is in the lumbar area, and one-third of the tumors are intramedullary. In this video, the authors present removal of a thoracic intramedullary epidermoid tumor in a 6-year-old boy, carrier of a 22q11 gene duplication and affected by psychomotor retardation. He presented a 1-year history of progressive gait impairment. No history of lumbar puncture or trauma was reported. The procedure was performed under neurophysiological monitoring, and it was uneventful with complete recovery of neurological function. Technical nuances are illustrated.

Large ventrally located spinal meningiomas are typically resected via a posterolateral or lateral approach. Optimal outcomes are associated with good preoperative functional status (i.e., modified McCormick grade < 4), while recurrence rates may be predicted by degree and quality of resection (i.e., low Simpson grade). This video describes the operative techniques for resection of a large ventral C2 intradural extramedullary meningioma in a 71-year-old male presenting with hemibody sensory loss and abnormal gait. A paramedian approach was performed, allowing for adequate exposure and gross-total resection. The patient was discharged on postoperative day 2 and showed near-complete resolution of sensory deficits.

This video depicts the resection of three separate intradural extramedullary spinal tumors performed under the same anesthetic. Neuromonitoring was used to identify motor nerve roots, and laminoplasty was performed at the thoracolumbar junction to preserve alignment and minimize the risk of postoperative CSF leak.