two-stage operation for resection of spinal cord astrocytomas: technical case report of three cases.
OBJECTIVE
Surgery for excision of intramedullary spinal cord tumors without increasing neurological deficit is one of the more difficult operations in spinal surgery. In particular, infiltrating astrocytomas without a clear cleavage between the tumor and normal spinal cord parenchyma are difficult to remove totally without producing additional neurological impairment. In this study, we describe a two-stage resection facilitating total resection of intramedullary tumors.


METHODS
Three cases of spinal cord astrocytomas were treated using a two-staged method.


METHODS
The first surgery included myelotomy, biopsy and duroplasty. A thin expanded polytetrafluoroethylene sheet was placed between the dorsal surface of the spinal cord and dura mater to prevent adhesions. Two or 3 weeks after surgery, a second surgery was performed to remove the now exophytic tumor.


RESULTS
Magnetic resonance imaging scans showed exophytic extrusion of the tumor in all three cases before the second operation. In each patient, we were able to carry out gross total removal of the tumors without additional neurological deficit except for transient joint position sense loss in one case. All three patients remain neurologically stable without evidence of tumor recurrence more than 3 years after surgery.


CONCLUSIONS
A two-stage operation may enhance the surgeon's ability to completely resect extensive low-grade spinal cord astrocytomas and, at the same time preserve neurological function.
Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan. kazuhida@med.hokudai.ac.jp
Kazutoshi
K
Hida
Yoshinobu
Y
Iwasaki
Toshitaka
T
Seki
Shunsuke
S
Yano
D000328:Adult; D001254:Astrocytoma / Q000601:surgery*; D002648:Child; D005260:Female; D006801:Humans; D007796:Laminectomy / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D013120:Spinal Cord Neoplasms / Q000601:surgery*; D016896:Treatment Outcome