Toshihiro Takami, M.D.
Optimization in the surgery of spinal intramedullary tumors: From Benign to Malignant tumors
Department of Neurosurgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
Biography
In the surgery of spinal intramedullary tumors, it is highly desirable to achieve both middle to long-term control of the tumor and maintenance of postoperative neurological function. It goes without saying that precise surgical technique is a prerequisite for minimizing postoperative neurological complications. In order to increase the surgical accuracy, surgeons need to have (1) the accurate neurophysiological monitoring during the surgery, (2) fluorescence image guidance for vascular flow and tumor visualization, (3) optimal myelotomy for shortest access to the tumor, and (4) careful exposure and dissection of the tumor-cord interface. The final hurdle is to dissect the ventral side of tumor without significant damage of microvascular flow of spinal cord parenchyma. It is of great importance for surgeons to preserve the fine vessels that nourish the ventral spinal cord. For benign tumors, good prognosis can be expected if these are well achieved. However, in case of malignant tumors, it is extremely difficult to have the tumor control with surgery alone, and it may depend on the effectiveness of postoperative adjuvant therapy. In this presentation, surgical steps to achieve the successful removal of benign intramedullary tumors are discussed, the current status and future direction of multidisciplinary treatment for malignant intramedullary tumors is explored.