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Intramedullary Tumor Surgery When, Why, and How

Intramedullary Tumor Surgery When, Why, and How. Eric M. Massicotte, MD, MSc, FRCSC Associate Professor University of Toronto. Thursday May 22 nd , 2014. Today’s Objectives. To understand different types of tumor To understand the function of the Spinal Cord

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Intramedullary Tumor Surgery When, Why, and How

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  1. Intramedullary Tumor Surgery When, Why, and How Eric M. Massicotte, MD, MSc, FRCSC Associate Professor University of Toronto Thursday May 22nd, 2014

  2. Today’s Objectives • To understand different types of tumor • To understand the function of the Spinal Cord • To understand who might benefit from surgery for Intramedullary tumors

  3. Disclosure  Depuy-Synthes, Medtronic, Baxter, Stryker, Zimmer for Educational grant  AOSPINE North America Education Committee

  4. Internet Definitions – Not the whole story Cancer: the disease caused by an uncontrolled division of abnormal cells in a part of the body. a malignant growth or tumor resulting from the division of abnormal cells. plural noun: cancerssynonyms: malignant growth, cancerous growth, tumor, malignancy Metastatic Cancer: Definitions of Metastatic cancer on the Web: Metastasis (Greek: displacement, μετά=next + στάσις=placement, plural: metastases), or Metastatic disease, sometimes abbreviated mets ...cancer that has spread from the place in which it started to other parts of the body.Cancer that migrates from a primary site to a secondary site(s).

  5. Internet Definitions – Not the whole story "A neoplasm is an abnormal mass of tissue, the growth of which exceeds and is uncoordinated with that of the normal tissues, and persists in the same excessive manner after cessation of the stimulus which evoked the change.” • Neoplasia vs. tumor • Tumor (Latin for swelling, one of the cardinal signs of inflammation) originally meant any form of swelling, neoplastic or not. Current English, however, both medical and non-medical, uses tumor as a synonym of neoplasm.[7]

  6. Types of Tumor • Classification of tumors based on tissue of origin • Grouping of tumors based on location

  7. Types of Tumor – Based on tissue of origin Bone-forming tumor: • Benign: Osteoma, osteoid osteoma • Malignant: Osteosarcoma, Cartilage-forming tumor • Benign: Chondroma, osteochondroma • Malignant: Chondrosarcoma, chondroblastoma Giant-cell tumor (Osteoblastoma) Marrow Tumor • Ewing’s sarcoma • Malignant lymphoma • Myeloma Vascular tumors • Benign: hemagioma, lymphangioma, glomus tumor • Malignant: angiosarcoma Other connective tissue tumor • Benign: Lipoma, desmoplastic fibroma • Malignant; Fibrosarcoma, liposarcoma, leiomyosarcoma Others • Chordoma, neurofibroma

  8. Types of Tumor – Based on location Extradural: • Metastatic lung, breast, prostate • Myeloma, lymphoma, leukemia • Primary vertebral tumors

  9. Types of Tumor – Based on location Intradural Extramedullary • Meningioma • Schwannoma • Nerve sheath tumour • Vascular malformation • Teratoma • Dermoid

  10. Types of Tumor – Based on location Intramedullary • Astrocutomas • Ependymomas • Oligodendroglioma • Teratoma • Hemangioma

  11. Types of Tumor – Examples Schwannoma ependymoma

  12. Function of the Spinal Cord Communication • Connecting your brain with the rest of your body

  13. Function of the Spinal Cord • Understanding the level of the tumor becomes very important • Pain, is much harder to use as localizer.

  14. Function of the Spinal Cord – Specific Pathway Dorsal Column/Medial Lemniscus: discriminative touch, joint position, vibration

  15. Surgery – Comprehensive consent conversation • Why? • How? • What can go wrong? • Alternatives

  16. Surgery – A case study 36 year-old mother of two boys presents with: • twomonth history of progressive numbness and clumsiness in her hands. • Difficulty with walking in the dark and on uneven surfaces. • Physical exam reveal mild weakness in her hands, abnormal reflexes and unsteady gait.

  17. Surgery Knife cutting the dura

  18. Surgery Intra-operative Ultrasound Free edge of dura

  19. Surgery Blood vessels on the surface of the spinal cord

  20. Surgery Instruments are in the spinal cord to reach the tumor

  21. Surgery The difference between tumor and spinal cord is typically obvious in ependymoma

  22. Surgery

  23. Surgery Pre-Operative Status: • Post-Operative Status: • Hands stronger. • Weakness in hands • Difficulty walking

  24. Surgery 30 year-old lady with no symptoms

  25. Today’s Objectives • To understand different types of tumor • Using location • To understand the function of the Spinal Cord • Connection between your brain and body • To understand who might benefit from surgery for Intramedullary tumors • Make a definitive diagnosis • Remove tumor • Prevent further loss of Function

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