C2-C5 intramedullary tumor.
- Intramedullary tumors like Astrocytomas, Ependymomas and Hemangioblastomas arise within the substance of the spinal cord
- The goal of surgery is to completely remove the tumor while preserving a maximum of neurological function.
History. C2-C5 intramedullary tumor.
- 32 year old male
- Moderate Neck pain
- No H/O, trauma
Examination.
- Conscious, Following commands
- Vitals Stable.
- Chest, P/A – NAD.
- Higher mental functions – Normal.
- Cranial Nerves – Normal.
- Motor system.
- Tone -normal.
- Power – 5/5 all four limbs.
- DTRs- Brisk LL>UL.
- sensory– preserved all modalities posterior column except left upper limbs sensation↓
- Cerebellar sign – Absent.
MRI spine.
Procedure.C2-C5 intramedullary tumor.
- C2-C5 laminoplasty.
- Excision of tumor↓ IONM
- Under GA.
Intraoperative photograph Base line MEPs.
Intraoperative photograph Base line SSEPs.
Base line D wave and continued.
Dropped MEPs during decompression of lesion but D wave was intact through out the procedure.
Note- If you see the signals of motor in MEP maximum dropped from upper extremities rather than lower limbs as per homunculus of cord cervical region is more medially than thoracic, lumbar, sacral.
Post Dura closed ↓↓.
Post operative video clip.
Bend of knees.
After few months. all power 5/5.
Take home message.
Excision of Intramedullary spinal tumors is safe under intraoperative neurophysiological monitoring and indication of D wave is very much along with other modality {multi-modality, like MEP,SSEP,D wave, posterior column mapping , marginal stimulation for motor.}.
Related to this article.
https://neurointraoperative.com/wp-admin/post.php?post=1816&action=edit