2092 Management of Spinal Intramedullary Tumors: Microsurgical Techniques, Pitfalls and Results, Based on My Personal Experience of Over 350 Cases

INTRODUCTION: The management of spinal intramedullary tumors has evolved significantly with the advent of microsurgical techniques. Traditional approaches such as laminectomy, dural decompression, and radiotherapy are no longer the primary modalities. Current evidence supports the feasibility of gross total resection with favorable outcomes. METHODS: This retrospective study includes 350 cases of spinal intramedullary tumors operated on over the past ten years. Pre-operative and post-operative-MRI were utilized for diagnosis and evaluation. The surgical approach typically involves a laminotomy followed by laminoplasty to preserve spinal architecture. A midline myelotomy was performed under high magnification for tumor resection. Factors affecting surgical outcomes, such as tumor location, number of segments involved, and chronicity of symptoms, were analyzed. RESULTS: Gross total resection was achieved in a significant number of cases. The cervical and cervicomedullary regions demonstrated higher resectability whereas the dorsal and conus regions tend to be less favorable. The number of segments involved did not significantly impact the degree of resection or clinical outcomes. Chronic symptoms were associated with poorer outcomes. None of the patients experienced posterior column dysfunction following midline myelotomy. Post-operative MRI often revealed a thinned spinal cord, which, if managed meticulously, maintained functional integrity. CONCLUSIONS: Microsurgical techniques have markedly improved the management of spinal intramedullary tumors, allowing for gross total resection with minimal complications. The study confirms that even a thinned spinal cord can maintain function with meticulous surgical handling. Tumor location and symptom chronicity are critical factors influencing surgical outcomes. Continued advancements in microsurgical approaches are expected to further enhance patient recovery and long-term prognosis.