Dorsal column mapping for intramedullary spinal cord tumor resection decreases dorsal column dysfunction.
METHODS
Retrospective cohort study and technical report.


OBJECTIVE
To demonstrate, through our institutional series of intramedullary spinal tumor resection, the potential avoidance of dorsal column dysfunction after using dorsal column mapping.


BACKGROUND
Surgical resection of intramedullary spinal cord tumors carries significant associated postoperative morbidity. Much of this morbidity is because of dorsal column dysfunction from the dorsal myelotomy. The inconsistency and distortion of anatomic landmarks for a midline myelotomy has posed a significant challenge for spine surgeons. Dorsal column mapping is a relative new technique that may decrease the morbidity associated with operative resection of intramedullary masses.


METHODS
A cohort of patients operated upon at our institution for intramedullary lesions were retrospectively reviewed. Neurologic examination changes were assessed through clinic notes and chart review. A total of 91 intramedullary tumors were assessed, with 80 patients without dorsal column mapping and 11 patients with dorsal column mapping.


RESULTS
In our cohort of 91 patients with intramedullary tumors undergoing resection over the past decade, postoperative dorsal column dysfunction was observed in 45%. Dorsal column mapping decreased the frequency of new postoperative posterior column dysfunction. Patients with dorsal column mapping had a statistically significant decrease rate of new postoperative posterior column dysfunction of 9% compared with 50% for without mapping (P=0.01). Tumor histology was not found to correlate with worsening posterior column dysfunction in patients undergoing tumor resection.


CONCLUSIONS
With our surgical cohort as an internal control, we found a decreased rate of postoperative posterior column dysfunction when using intraoperative dorsal column mapping. Our findings show the ability of this evolving technology to provide useful intraoperative information to localize the physiological midline and decrease the rate of posterior column dysfunction after intramedullary spinal cord tumor resection.
Division of Neurosurgery, Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA. ankit.mehta@duke.edu
Ankit Indravadan
AI
Mehta
Cindy A
CA
Mohrhaus
Aatif M
AM
Husain
Isaac O
IO
Karikari
Betsy
B
Hughes
Tiffany
T
Hodges
Oren
O
Gottfried
Carlos A
CA
Bagley
D015331:Cohort Studies; D004566:Electrodes; D005260:Female; D006801:Humans; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D009460:Neurologic Examination; D012189:Retrospective Studies; D013116:Spinal Cord / Q000503:physiopathology* / Q000601:surgery; D013120:Spinal Cord Neoplasms / Q000601:surgery*; D016896:Treatment Outcome