Our Summary

This research paper studies a rare type of benign (non-cancerous) tumor called intraspinal epidermoid/dermoid cysts. These tumors occur when skin cells are abnormally located in the spinal canal. The study is unique in that it looks at the long-term outcomes after these tumors are removed using a particular type of surgery called microsurgical resection with multimodal intraoperative neurophysiological monitoring (IONM).

The research involved 12 patients who had this surgery between 1998 and 2019. The study looked at their medical data, the details of their surgery, and their health after the operation. The patients included both adults and children, with the majority presenting symptoms like muscle weakness, unsteady movement, and vegetative disorders. Most of the tumors were located in the lower part of the spine and were outside the spinal cord but within the spinal canal.

During the surgery, the surgeons used IONM, a technique that monitors the patient’s nerve function to ensure that the surgery doesn’t damage any important nerves. They found that this technique was effective and even helped them make changes during the surgery in three cases to avoid potential complications.

The study found that none of the patients had worsened neurologically after the surgery, and most of the tumors were completely removed. The patients’ pain levels and neurological function improved in the long term (average follow-up of nearly 5 years).

In conclusion, using IONM during the surgical removal of these rare spinal tumors is a feasible approach in both adults and children, and it leads to good clinical and surgical outcomes.

FAQs

  1. What is the most common comorbidity associated with intraspinal epidermoid/dermoid tumors?
  2. What are the most frequent symptoms at diagnosis for intraspinal epidermoid/dermoid tumors?
  3. What is the success rate of IONM-aided resection for intraspinal epidermoid/dermoid tumors?

Doctor’s Tip

One helpful tip a doctor might tell a patient about tumor resection is to ensure they follow their postoperative care instructions carefully, including any recommendations for physical therapy or rehabilitation. This can help optimize their recovery and improve long-term outcomes after surgery.

Suitable For

Patients who are typically recommended tumor resection for intraspinal epidermoid/dermoid cysts include those with symptomatic tumor manifestation, such as spastic pareses, ataxia, and vegetative disorders. Patients with spinal dysraphism as a comorbidity may also be recommended for tumor resection. In this case series, tumors were most often located in the lumbosacral region and were intradural-extramedullary. The use of multimodal intraoperative neurophysiological monitoring (IONM) during microsurgical resection of these tumors was shown to be feasible and resulted in a gross total resection rate of 92%. Patients who underwent tumor resection with IONM showed improved pain situation, McCormick grade, and mJOA Score at long-term follow-up. Overall, IONM-aided resection of intraspinal epidermoid/dermoid tumors is feasible and can lead to a satisfying clinical and surgical outcome.

Timeline

  • Before tumor resection: Patients may experience symptoms such as spastic pareses, ataxia, and vegetative disorders. Imaging studies are done to locate the tumor, and surgical planning is conducted. Intraoperative neurophysiological monitoring (IONM) is performed to ensure the safety of the surgery.

  • During tumor resection: The patient undergoes microsurgical resection with multimodal IONM, which includes EMG, SSEPs, and TcMEPs monitoring. Intraoperative corrective actions may be taken if there are any transient IONM deterioration. The goal is to achieve a gross total resection of the tumor without causing any postoperative neurological deterioration.

  • After tumor resection: Patients have a follow-up period to monitor their long-term outcomes. Pain situation, McCormick grade, and mJOA Score are assessed to evaluate improvements in neurological status. The study showed that IONM-aided resection of intraspinal epidermoid/dermoid tumors is feasible and results in a satisfying clinical and surgical outcome.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with tumor resection surgery for intraspinal epidermoid/dermoid cysts?
  2. How will intraoperative neurophysiological monitoring (IONM) be used during the surgery?
  3. What is the expected recovery time and rehabilitation process after the tumor resection surgery?
  4. Will I need any additional treatments or therapies after the surgery?
  5. What is the likelihood of the tumor recurring after the surgery?
  6. Are there any specific lifestyle changes or precautions I should take after the surgery to prevent complications?
  7. What are the long-term outcomes and prognosis for patients who undergo tumor resection for intraspinal epidermoid/dermoid cysts?
  8. How often should I follow up with you after the surgery for monitoring and evaluation of my condition?
  9. Are there any specific warning signs or symptoms I should watch out for after the surgery that may indicate a complication or recurrence of the tumor?
  10. Are there any alternative treatment options available for intraspinal epidermoid/dermoid cysts that I should consider before proceeding with surgery?

Reference

Authors: Siller S, Egensperger R, Szelenyi A, Tonn JC, Zausinger S, Schichor C. Journal: Acta Neurochir (Wien). 2020 Nov;162(11):2895-2903. doi: 10.1007/s00701-020-04446-y. Epub 2020 Jun 10. PMID: 32524245