Neurosurg Focus (Suppl) 33 (1):Video 4, 2012
Laser-assisted microsurgical resection of thoracic intramedullary spinal cord ependymoma James K. Liu, M.D. Departments of Neurological Surgery and Otolaryngology-Head and Neck Surgery, Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, University of Medicine and Dentistry of New Jersey, New Jersey Medical School, Newark, New Jersey The surgical management of intramedullary spinal cord ependymomas remains a formidable challenge amongst neurosurgeons because of the potential risk of surgical morbidity. From on an oncological perspective, complete resection—if technically feasible—should be the goal of surgery, since this can result in excellent local control and progression-free survival. Advances in microsurgical techniques, intraoperative neurophysiological monitoring, and the use of lasers have contributed to our ability to achieve gross-total resection. This is also largely dependent on the presence of an identifiable surgical plane of dissection between the tumor and spinal cord, which appears to have a positive prognosis with overall neurological improvement. In this operative video manuscript, the author demonstrates an illustrative step-by-step technique for microsurgical resection of a thoracic intramedullary spinal cord ependymoma (T-3 to T-5) associated with an extensive cervicothoracic syrinx. The application of a handheld non-contact CO2 laser for performing the midline myelotomy is also highlighted. The operative technique and surgical nuances, including the surgical approach, intradural tumor removal, and closure, are illustrated in this video atlas. The video can be found here: http://youtu.be/itE2tuBFmgw. (http://thejns.org/doi/abs/10.3171/2012.V2.FOCUS12142)
Key Words • laser-assisted • intramedullary • spinal cord • ependymoma • thoracic • video
Manuscript submitted May 2, 2012. Accepted May 17, 2012. Please include this information when citing this paper: DOI: 10.3171/2012.V2.FOCUS12142. Address correspondence to: James K. Liu, M.D., Department of Neurological Surgery, University of Medicine and Dentistry of New Jersey, New Jersey Medical School, 90 Bergen Street, Suite 8100, Newark, New Jersey 07101. email: [email protected].
Neurosurg Focus / Volume 33 / July 2012
1
Laser-assisted microsurgical resection of thoracic intramedullary spinal cord ependymoma James K. Liu, M.D. Departments of Neurological Surgery and Otolaryngology-Head and Neck Surgery, Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, University of Medicine and Dentistry of New Jersey, New Jersey Medical School, Newark, New Jersey The surgical management of intramedullary spinal cord ependymomas remains a formidable challenge amongst neurosurgeons because of the potential risk of surgical morbidity. From on an oncological perspective, complete resection—if technically feasible—should be the goal of surgery, since this can result in excellent local control and progression-free survival. Advances in microsurgical techniques, intraoperative neurophysiological monitoring, and the use of lasers have contributed to our ability to achieve gross-total resection. This is also largely dependent on the presence of an identifiable surgical plane of dissection between the tumor and spinal cord, which appears to have a positive prognosis with overall neurological improvement. In this operative video manuscript, the author demonstrates an illustrative step-by-step technique for microsurgical resection of a thoracic intramedullary spinal cord ependymoma (T-3 to T-5) associated with an extensive cervicothoracic syrinx. The application of a handheld non-contact CO2 laser for performing the midline myelotomy is also highlighted. The operative technique and surgical nuances, including the surgical approach, intradural tumor removal, and closure, are illustrated in this video atlas. The video can be found here: http://youtu.be/itE2tuBFmgw. (http://thejns.org/doi/abs/10.3171/2012.V2.FOCUS12142)
Key Words • laser-assisted • intramedullary • spinal cord • ependymoma • thoracic • video
Manuscript submitted May 2, 2012. Accepted May 17, 2012. Please include this information when citing this paper: DOI: 10.3171/2012.V2.FOCUS12142. Address correspondence to: James K. Liu, M.D., Department of Neurological Surgery, University of Medicine and Dentistry of New Jersey, New Jersey Medical School, 90 Bergen Street, Suite 8100, Newark, New Jersey 07101. email: [email protected].
Neurosurg Focus / Volume 33 / July 2012
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