The role of intraoperative neurophysiological monitoring in intramedullary spinal cord tumor surgery

Intramedullary tumors are a class of central nervous system tumors with an incidence of 2 to 4%.As they are located very deep and frequently cause postoperative neurological complications,surgical resection is difficult.In recent years,many surgeons have performed electrophysiological monitoring to effectively reduce the occurrence of post-operative neurological complications.Modern electrophysiological monitoring technology has advanced considerably,leading to the development of many monitoring methods,such as SSEPs,MEPs,DCM,and EMG,to monitor intramedullary tumors.However,electrophysiological monitoring in tumor resection is still being studied.In this article,we discussed the different monitoring methods and their role in monitoring intramedullary tumors by reviewing previous studies.Intratumorally tumors need to be monitored for a summary of the condition of the patient.Only by using various monitoring methods flexibly and through clear communication between surgeons and neurophysiological experts can good decisions be made during surgery and positive surgical results be achieved.

Leveraging nano-engineered mesenchymal stem cells for intramedullary spinal cord tumor treatment

Intramedullary spinal cord tumor(IMSCT)is comparatively rare malignant tumor in the central nervous system and is very difficult accessible by conventional chemotherapy regimen.Currently,there are very limited researches for IMSCT treatment using nanomedicine.To fill this gap,we originally reported a targeted strategy by leveraging nano-engineered mesenchymal stem cells(MSCs)for synergistic antiIMSCT treatment.In this study,two mode drugs paclitaxel(PTX)and metformin(MET)were co-loaded in maleimide-modified poly(lactic-co-glycolicacid)(PLGA-MAL)nanoparticles,which were further conjugated onto MSCs surface via the thioether bond formed between PLGA-MAL and MSCs without affecting the migration ability of MSCs.Owing to the excellent tumor tropism and penetrability of MSCs and good biodegradability of PLGA,the designed drug delivery platform could accurately target IMSCT sites to exert long-term synergistic antitumor efficacy,exhibiting promising research value for alternative IMSCT management beyond surgery.

Three-dimensional Fluoroscopy-based Navigation for the Pedicle Screw Placement in Patients with Primary Invasive Spinal Tumors

Background：Although pedicle screw placement （PSP） is a well-established technique for spine surgery,the treatment of patients with primary invasive spinal tumor （PIST） has high surgical risks secondary to destroyed pedicles.Intraoperative three-dimensional fluoroscopy-based navigation （ITFN） system permits safe and accurate instrumentation of the spine with the advantage of obtaining intraoperative real-time three-dimensional images and automatic registration.The aim of this study is to evaluate the feasibility and accuracy of PSP using ITFN system for patients afflicted with PIST in the thoracic spine.Methods：Fifty-one patients diagnosed with PISTs were retrospectively analyzed,and 157 pedicles screws were implanted in 23 patients using the free-hand technique （free-hand group） and 197 pedicle screws were implanted in 28 patients using the ITFN system （ITFN group）.Modified classification of Gertzbein and Robbins was used to evaluate the accuracy of PSP,and McCormick classification was applied for assessment of neurological function.Demographic data and factors affecting accuracy of screw insertion were compared using independent t-test while comparison of accuracy of screw insertion between the two groups was analyzed with Chi-square test.Results：Of 51 patients,39 demonstrated improved neurological status and the other 12 patients reported that symptoms remained the same.In the free-hand group,145 screws （92.4%） were Grade Ⅰ,9 screws （5.7%） were Grade Ⅱ,and 3 screws （1.9%） were Grade Ⅲ.In the ITFN group,192 screws （97.4%） were Grade Ⅰ,5 screws （2.6%） were Grade Ⅱ,and no Grade Ⅲ screw was detected.Statistical analysis showed that the accuracies of pedicle screws in the two groups are significantly different （χ^2 =4.981,P =0.026）.Conclusions：The treatments of PISTs include total tumor resection and reconstruction of spine stability.The ITFN system provides a high accuracy of pedicle screw placement.

Primary spinal cord oligodendroglioma:a case report and review of the literature

Background:Primary spinal cord oligodendroglioma is extremely rare.In an extensive review of this disease,53 cases were reported.Furthermore,the authors summarize the characteristics of the primary spinal cord oligodendroglioma;chronological presentation,neurological imaging,treatment and the outcome obtained in the present case as well as review the literature.Case Presentation:A 46-year-old male who had progressive neck pain for a year.Magnetic resonance imaging showed an intramedullary mass from level C2 to T4.A radical resection was performed.Histology revealed oligodendroglioma.Thereafter,the patient was treated with adjuvant radiotherapy.A year later,tumor developed recurrence.The patinet died in 3 years and 6 months.Conclusions:The available data of this disease was limited.Base on 11 published papers and the present case,surgical resection is the treatment of choice although recurrence of the tumor tends to occur after partial resection with or without radiotherapy.From the literature,the management of the recurrent disease is still surgery.Moreover,Temozolomide may be an advantage in recurrent situations.

Unilateral hemilaminectomy for patients with intradural extramedullary tumors

A modified hemilaminectomy was introduced in an attempt to explore the operative techniques and the values of the limited approach to spinal cord tumors.Forty-five consecutive patients with intradural extramedullary lesions,who underwent modified hemilaminectomy,were studied retrospectively.The intraspinal tumors were removed via the limited bone window with a 3.3-cm mean length (range: 2.0–6.5 cm) and a 1.2-cm mean width (range: 0.6–1.5 cm),in which the inner parts of the medial and lateral laminae were mostly undercut for wider view.Spinal lesions were cervical in 21 cases,thoracic in 12 cases,lumbar in 10 cases,and multiple in 2 cases.Forty-three cases were completely excised via hemilaminectomy alone.Two subjects with dumbbell neurinoma underwent two-stage tumor removal via anterolateral cervical approach following hemilaminectomy.With respect to neurological status,the percentage of good Frankel scale (D+E grade) was markedly improved from 22.2% on admission to 93.3% at follow-up.At the median 26-month follow-up evaluation by magnetic resonance imaging (MRI),none of the subjects showed spinal deformity or instability.By preserving musculoligamentous attachments and posterior bony elements as much as possible,the modified approach is minimally invasive and may be routinely used to remove intradural and extramedullary tumors,especially in patients with meningiomas and neurinomas.