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The first 25 slides, exactly as they appear. The full deck has 52 content slides.
Neurosurgery
Intramedullary Tumors of the Spine
Built from Feldman — Neurosurgical Operative Atlas: Neuro-Oncology
What’s inside
6 sections · 52 slides
Overview
- What this deck will teach you
What They Are
Where these tumors sit, how common they are, and the cells they arise from
- First principle: three compartments of the spine
- How rare, and how they break down
- The cast of tumor types
The Tumor Types
The histology that decides whether a tumor can be lifted out cleanly
- Astrocytomas: the infiltrative glioma
- Grading astrocytomas: a four-step ladder
- Ependymomas: the well-behaved central tumor
- Grading ependymomas
- Oligodendrogliomas and the vascular tumors
- The rare remainder: gangliogliomas to metastases
Presentation and Workup
How the tumor announces itself and how it is imaged before surgery
- How patients present: slow, vague, and varied
- Selecting patients: operate early
- Why MRI is the imaging of choice
- Reading the MRI: astrocytoma vs ependymoma
- Intramedullary cord lesion at C3-C4 on MRI
- Cervical cord ependymoma on MRI
- Imaging signatures of the other tumor types
Operative Management
General principles and the step-by-step surgical technique
- General goal: resect as much as is safe
- How the two main tumors look and behave at surgery
- Astrocytoma within the spinal cord: blurred margins
- Ependymoma within the spinal cord: a clear tumor plane
- A safety rule for the dissection plane
- Monitoring the cord's electrical function
- Setting up: positioning and anesthesia
- Exposing the cord: laminectomy and durotomy
- Transdural ultrasound to localize the tumor
- Midline durotomy over the tumor
- The critical step: the midline myelotomy
- Entering the cord through the midline raphe
- Four ways to find the true midline
- Dorsal column mapping to locate the midline
- Opening the myelotomy and starting the resection
- Pial traction sutures holding the myelotomy open
- Why the surrounding tracts dictate the dissection
- Topography of the spinal cord tracts
- Freeing the ventral tumor pole
- Special case: hemangioblastomas and cavernomas
- Finishing: hemostasis and closure
After Surgery and Takeaways
Recovery, adjuvant therapy, and the core lessons
- Postoperative management
- Three ideas to carry away
- Viva: During resection of a large intramedullary hemangioblastoma, why must you never coagulate the draining vein first?
- Conclusion
- References (1/3)
- References (2/3)
- References (3/3)
- Neurosurgical Operative Atlas: Neuro-Oncology