Spinal Tumor Excision

Intramedullary Tumor Excision

Intramedullary tumors originate within the spinal cord itself. Common types include ependymomas and astrocytomas. The excision of these tumors involves:

• Microsurgical Techniques: The use of a high-powered microscope allows for precise removal of the tumor while minimizing damage to the surrounding healthy spinal cord tissue.
• Neurophysiological Monitoring: Continuous monitoring of nerve function during surgery helps prevent neurological deficits.
• Benefits include:
  • Symptom Relief: Alleviation of symptoms such as pain, weakness, and sensory deficits.
  • Improved Function: Potential for improved neurological function and enhanced quality of life.
  • Tumor Control: Effective in controlling tumor growth and preventing further neurological deterioration.

Extramedullary-Intradural Tumor Excision

These tumors are located outside the spinal cord but within the dura mater, the protective covering of the spinal cord. Examples include meningiomas and schwannomas. Techniques include:

• Laminectomy: Removal of a portion of the vertebra to access and excise the tumor.
• Minimally Invasive Surgery: Using small incisions and endoscopic techniques to reduce recovery time and postoperative pain.
• Benefits include:
  • Less Invasive: Often involves less invasive techniques, leading to shorter recovery times.
  • Effective Removal: High success rate in completely removing benign tumors, resulting in symptom resolution.
  • Low Recurrence: Low risk of tumor recurrence with complete resection.

Extradural Tumor Excision

Extradural tumors are located outside the dura mater and often involve the vertebral bones. These can be benign, metastatic, or primary malignant bone tumors like chordoma. Procedures include:

• En Bloc Spondylectomy: Removal of the tumor in one piece, which is often necessary for malignant tumors to reduce the risk of recurrence. This can be done as a a full or partial spondylectomy, i.e. removal of the tumor-containing vertebral segment
  • Benefits include complete removal of the tumor, reduction in recurrence risk, spinal stability, and pain relief.
  • Risks include infection, bleeding, nerve injury, or hardware failure given that these procedures are quite extensive
• Intralesional resection: removal of most of the tumor visible to the eye by scraping it out, but not likely capturing 100% of the cells
  • Benefits include less invasive surgery, and the ability to combine surgery with radiation to “clean up” any residual tumor cells
  • Risks include higher chance of tumor coming back

Dr. Colman will determine precise access to the tumor based on careful evaluation of diagnostic imaging prior to surgery. A thorough discussion of the goals and expected outcomes of surgery is important to have prior to the procedure date. A multidisciplinary panel will likely review your case and ensure proper diagnosis; surgery, radiation, and systemic medications are offered. In addition to tumor removal and eradication, Dr. Colman will also carefully discuss the reconstruction to be used after tumor removal, typically with spacers, screws, rods, and/or bone graft.

Recovery from spinal tumor resection varies based on the tumor’s location, the extent of the surgery, and the patient’s overall health. Initially, patients spend a few days in the hospital in bed where they are closely monitored for complications such as infection or neurological deficits. Activities that involve stretching or straining the spine will be prohibited. Patients may need to wear a brace to aid stability. Pain management is a priority, with medications administered to control discomfort. Depending on the extent of neurological damage, physical therapy may help restore mobility and strength.