Surgery of spinal intramedullary tumors: Optimizing surgical safety and precision

Abstract

Performing surgery for spinal intramedullary tumors remains one of the major challenges for neurosurgeons, due to their relative infrequency, unknown natural history, and surgical difficulty. However, we are sure that the safe and precise resection of spinal intramedullary tumors, particularly encapsulated benign tumors, can result in acceptable or satisfactory postoperative outcomes. In this review article, we focused our attention on 5 important subjects: ①qualitative imaging diagnosis using positron emission tomography before surgery, ②the necessity and uncertainty of intraoperative neurophysiological monitoring, ③the importance of intraoperative image‒guided surgery, ④careful selection of surgical access myelotomy, and finally ⑤dissection technique for tumors based on the tumor‒cord interface. The risk of functional deterioration after surgery should be taken into serious consideration. Functional deterioration after surgery, including neuropathic pain even long after surgery, significantly affects patient quality of life. We firmly believe that the surgical goal for spinal intramedullary tumors is the better balance between tumor control and functional preservation that can be achieved not only by the surgical technique and expertise, but also by intraoperative neurophysiological monitoring, vascular image guidance, and postoperative supportive care.