Maximizing surgical resection in revision surgery for an intramedullary spinal cord tumour using DTI/tractography and direct spinal cord stimulation: A technical note

Maximizing surgical resection in revision surgery for an intramedullary spinal cord tumour using DTI/tractography and direct spinal cord stimulation: A technical note

Blog Article

Background: Intramedullary spinal cord tumours are formidable lesions in spine surgery due to the high risk of postoperative deficits associated with surgical resection.Traditional MRI imaging fails to provide a 3-D rendering of the relationship between the tumour and spinal cord sensory and motor pathways; in contrast, DTI/tractography can show this relationship with the potential to reduce surgery-related morbidity.The use of intraoperative somatosensory evoked potentials (SSEP) and transcranial motor Butea Superba evoked potentials (MEP) have also been considered a standard of care to minimize neurologic complications of surgery.

However, in situations where both baseline SSEPs and MEPs are unobtainable, D-wave and direct cord stimulation can become invaluable intra-operative tools.Methods: A 6 year old child presented with new growth from an incompletely resected thoracic intramedullary dermoid tumour.Pre-operative DTI/tractography images were obtained.

During tumour resection, SSEP and MEP signals were unable to be obtained, however intraoperative monitoring of the spinal cord was undertaken with D-wave monitoring and direct cord stimulation.Results: This multimodal monitoring technique allowed identification of the corticospinal tracts intra-operatively and allowed safe tumour resection.Post-operative MRI revealed gross total resection and the patient returned to her pre-operative neurological baseline without incurring any further deficits.

Conclusions: We have presented a technical description of the clinical utility of DTI/tractography in surgical Board planning, and D-wave monitoring with direct cord stimulation as adjuncts in the resection of an intramedullary cord tumour.This is particularly useful in the scenario where TcMEP/SSEP signals cannot be obtained and in revision surgery for intramedullary spinal cord tumours.