gms | German Medical Science

58. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

26. bis 29.04.2007, Leipzig

Intraoperative MRI for the resection of an intramedullary tumor of the cervical spinal cord

Intraoperative MRT zur Resektionskontrolle eines zervikalen, intramedullären Tumors

Meeting Abstract

  • corresponding author A. Nabavi - Neurochirurgische Universitätsklinik, Universitätsklinikum Schleswig-Holstein, Campus Kiel
  • L. Dörner - Neurochirurgische Universitätsklinik, Universitätsklinikum Schleswig-Holstein, Campus Kiel
  • C. Straßner - Neurochirurgische Universitätsklinik, Universitätsklinikum Schleswig-Holstein, Campus Kiel
  • S. Ulmer - Neurochirurgische Universitätsklinik, Universitätsklinikum Schleswig-Holstein, Campus Kiel
  • C. Bahr - Neurochirurgische Universitätsklinik, Universitätsklinikum Schleswig-Holstein, Campus Kiel
  • K. Haman - Neurochirurgische Universitätsklinik, Universitätsklinikum Schleswig-Holstein, Campus Kiel
  • H. M. Mehdorn - Neurochirurgische Universitätsklinik, Universitätsklinikum Schleswig-Holstein, Campus Kiel

Deutsche Gesellschaft für Neurochirurgie. 58. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC). Leipzig, 26.-29.04.2007. Düsseldorf: German Medical Science GMS Publishing House; 2007. DocP 033

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dgnc2007/07dgnc288.shtml

Veröffentlicht: 11. April 2007

© 2007 Nabavi et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective: Intraoperative MRI has been employed for cranial surgeries in numerous centres. As to our knowledge, there is no report on using this technology during microsurgical removal of an intramedullary spinal lesion. We illustrate the capabilities of intraoperative MRI in the microsurgical resection of spinal cord tumors.

Methods: A 35-year-old patient presented with progressive gait disturbance. Diagnostic work-up revealed an intramedullary lesion at C6 and hyperintense, non-contrast enhancing extensions with bulging of the spinal cord up to C3 and as low, as T3. The patient consented to our strategy, to remove the contrast enhancing lesion, while taking a conservative stance on its extensions. For spinal cord lesions, we routinely employ intraoperative electrophysiological monitoring. In presurgical tests we obtained inconclusive results, casting doubt on the potential efficacy in this particular patient. We operated the patient in our integrated MRI-OR suit, with intraoperative MRI scans, to locate the tumour prior to skin opening, before dural incision and for resection control. The patient head was rigidly fixed in a carbon fibre Mayfield clamp. A flexible coil was placed underneath the patient, while the corresponding coil was placed on the patient's back for scanning and removed for surgery. A laminoplasty was done. Scan time was around 90 min.

Results: The patient has recovered well. Being able to walk with little assistance, he experiences pronounced undulating sensory deficits. The enhancing lesion, histologically an ependymoma, was totally removed. In regards to image quality, T1, T2 and post-contrast studies yielded data, which was comparable to pre- and post-operative imaging.

Conclusions: Albeit an elaborate technique, we could use intraoperative MRI, to target and define the lesion, as well as to confirm its total resection. Intraoperative MRI has the capacity to yield imaging, which provides clear delineation of intramedullary spinal cord lesions.