Abstract:

Glioblastoma multiforme (GBM) is the most frequent primary central nervous system (CNS) tumor. Despite the best treatment and advances in therapy, prognosis remains poor. One of the mainstays of therapy in GBM is surgical excision. Several studies have confirmed that the extent of resection (EOR) positively influences overall survival (OS) in patients with high-grade gliomas (HGGs). A literature search was performed using PubMed to assess the useful neurosurgical tools to achieve the best neurosurgical performance. In order to achieve the major extent of resection, preserving neurological function, many tools are now available, especially neuronavigation, intraoperative fluorescence, intraoperative ultrasound, and neuromonitoring. In addition to the maximal excision of tumor, the neurosurgeon can use photodynamic therapy (PTD) and local drug delivery (LDD) to improve the local control and bridge conventional radio and chemotherapy. EOR improves OS in patients with HGGs. There are technological possibilities for achieving a complete resection preserving neurological function, and it is not acceptable to perform only biopsy of these lesions.

Authors:

Roberto Altieri, MD, Resident in Neurosurgery, Section of Neurosurgery, Department of Neuroscience, University of Turin, Turin, Italy, Marco Maria Fontanella, MD, Professor of Neurosurgery, Department of Neurosurgery, Spedali Civili di Brescia, Brescia, Italy, Giannantonio Spena, MD, Francesco Zenga, MD, Specialist in Neurosurgery, Fabio Cofano, MD, Resident in Neurosurgery, Alessandro Agnoletti, MD, Resident in Neurosurgery, Emanuela Crobeddu, MD, Resident in Neurosurgery, Riccardo Fornaro, MD, Specialist in Neurosurgery, Alessandro Ducati, MD, Professor of Neurosurgery, Diego Garbossa, MD, Specialist in Neurosurgery

For Direct IP Access please click this link

Abstract:

Spinal cord injury (SCI) during revision surgery for persistent multilevel cervical myelopathy (MCM) after an initial anterior procedure is rare. However, the pathophysiology of MCM, even prior to surgery, is a risk-factor for neurological deterioration due to the development of a “sick cord”, which reflects pathological changes in the spinal cord that lower the threshold for injury. We report a case of persistent MCM despite a three-level ACDF and corpectomy who developed an incomplete C6 tetraplegia during revision cervical laminectomy and posterior instrumentation. Intraoperative neuromonitoring signal-changes occurred in the absence of mechanical trauma. Postoperative MRI of the cervical spine demonstrated increased T2 hyperintensity and cord expansion at C3 and C4 compared to the pre-laminectomy MRI. The patient has not made improvements in her neurological status at 13 months postoperatively. The pathophysiology of MCM is discussed in addition to perioperative imaging, neuromonitoring, and use of steroids.

Authors:

Justin A. Iorio, MD, Fellow in Spinal Surgery, Hospital for Special Surgery Department of Orthopaedic Surgery, New York, NY , Andre M. Jakoi, MD, Fellow in Spinal Surgery, University of Southern California Department of Orthopaedic Surgery, Los Angeles, CA, Franklin T. Wetzel, MD, Vice-Chairperson and Professor, Temple University Department of Orthopaedic Surgery, Philadelphia, PA

For Direct IP Access please click this link