Intramedullary Tumor Surgery When, Why, and How
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Transcript of Intramedullary Tumor Surgery When, Why, and How
Intramedullary Tumor Surgery When, Why, and How
Eric M. Massicotte, MD, MSc, FRCSCAssociate ProfessorUniversity of Toronto
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Thursday May 22nd, 2014
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
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Disclosure
Depuy-Synthes, Medtronic, Baxter, Stryker, Zimmer for Educational grant
AOSPINE North America Education Committee
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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).
Internet Definitions – Not the whole story4
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]
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Types of Tumor
1. Classification of tumors based on tissue of origin
2. Grouping of tumors based on location
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Bone-forming tumor:‣ Benign: Osteoma, osteoid osteoma‣ Malignant: Osteosarcoma, Cartilage-forming tumor‣ Benign: Chondroma, osteochondroma‣ Malignant: Chondrosarcoma, chondroblastomaGiant-cell tumor (Osteoblastoma)Marrow Tumor‣ Ewing’s sarcoma‣ Malignant lymphoma‣ MyelomaVascular tumors‣ Benign: hemagioma, lymphangioma, glomus tumor‣ Malignant: angiosarcomaOther connective tissue tumor‣ Benign: Lipoma, desmoplastic fibroma‣ Malignant; Fibrosarcoma, liposarcoma, leiomyosarcomaOthers‣ Chordoma, neurofibroma
Types of Tumor – Based on tissue of origin
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Extradural:
‣ Metastatic lung, breast, prostate‣ Myeloma, lymphoma, leukemia‣ Primary vertebral tumors
Types of Tumor – Based on location
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Types of Tumor – Based on location
Intradural Extramedullary
‣ Meningioma ‣ Schwannoma‣ Nerve sheath tumour‣ Vascular malformation‣ Teratoma‣ Dermoid
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Types of Tumor – Based on location
Intramedullary
‣ Astrocutomas‣ Ependymomas‣ Oligodendroglioma‣ Teratoma‣ Hemangioma
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Types of Tumor – Examples
Schwannoma
ependymoma
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Function of the Spinal Cord
Communication– Connecting your brain
with the rest of your body
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• Understanding the level of the tumor becomes very important
• Pain, is much harder to use as localizer.
Function of the Spinal Cord13
Dorsal Column/Medial Lemniscus:
• discriminative touch,• joint position, • vibration
Function of the Spinal Cord – Specific Pathway14
Surgery – Comprehensive consent conversation
Why?How?What can go wrong?Alternatives
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Surgery – A case study
36 year-old mother of two boys presents with:• two month 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.
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SurgeryKnife cutting the dura
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Surgery
Intra-operative Ultrasound
Free edge of dura
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Surgery
Blood vessels on the surface of the spinal cord
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Surgery
Instruments are in the spinal cord to reach the tumor
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Surgery
The difference between tumor and spinal cord is typically obvious in ependymoma
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Surgery22
Surgery
Post-Operative Status:• Hands stronger.
Pre-Operative Status:• Weakness in
hands• Difficulty
walking
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30 year-old lady with no symptoms
Surgery24
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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