TY - JOUR
T1 - Intraoperative Computed Tomography Navigation-Assisted Resection of Symptomatic Intramedullary Spinal Cord Cavernoma
T2 - A Technical Note and Case Report
AU - Moldovan, Krisztina
AU - Konakondla, Sanjay
AU - Barber, Sean
AU - Nakhla, Jonathan
AU - Fridley, Jared S.
AU - Telfeian, Albert E.
AU - Gokaslan, Ziya L.
AU - Oyelese, Adetokunbo A.
PY - 2019/9/1
Y1 - 2019/9/1
N2 - Background: Intramedullary spinal cord cavernous malformations (ISCCMs) are a rare entity. Most commonly, ISCCMs present with neurologic decline from lesion hemorrhage, which can be catastrophic and irreversible irrespective of surgical intervention. Given the challenging anatomic location of these lesions in highly critical neurologic areas, precise surgical localization and visualization is necessary to limit collateral damage during resection particularly for deep ISCCMs that do not present to a pial surface. Case Description: We present a case of a 54-year-old man who presented with incomplete paraplegia after hemorrhage of a deep ISCCM at T11. Surgical resection was undertaken using intraoperative computed tomography (CT) navigation assistance autofused with high-resolution preoperative magnetic resonance imaging for precise intramedullary lesion targeting and localization for myelotomy. Complete resection was demonstrated on postoperative imaging. At a 6-week follow-up appointment, the patient endorsed return of his bladder function and was noted to have some return of motor function to his left foot with 3 of 5 dorsiflexion. At 4 months, he had improved to 3 of 5 proximal, 4 of 5 distal on the left and 2 of 5 proximal, and 3 of 5 distal on the right. Conclusions: The approach represents a novel application of intraoperative CT navigation assistance in the resection of deep ISCCMs.
AB - Background: Intramedullary spinal cord cavernous malformations (ISCCMs) are a rare entity. Most commonly, ISCCMs present with neurologic decline from lesion hemorrhage, which can be catastrophic and irreversible irrespective of surgical intervention. Given the challenging anatomic location of these lesions in highly critical neurologic areas, precise surgical localization and visualization is necessary to limit collateral damage during resection particularly for deep ISCCMs that do not present to a pial surface. Case Description: We present a case of a 54-year-old man who presented with incomplete paraplegia after hemorrhage of a deep ISCCM at T11. Surgical resection was undertaken using intraoperative computed tomography (CT) navigation assistance autofused with high-resolution preoperative magnetic resonance imaging for precise intramedullary lesion targeting and localization for myelotomy. Complete resection was demonstrated on postoperative imaging. At a 6-week follow-up appointment, the patient endorsed return of his bladder function and was noted to have some return of motor function to his left foot with 3 of 5 dorsiflexion. At 4 months, he had improved to 3 of 5 proximal, 4 of 5 distal on the left and 2 of 5 proximal, and 3 of 5 distal on the right. Conclusions: The approach represents a novel application of intraoperative CT navigation assistance in the resection of deep ISCCMs.
KW - AIRO intraoperative CT
KW - Image guidance intramedullary cavernoma
KW - MRI-CT fusion
KW - Spinal navigation
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U2 - 10.1016/j.wneu.2019.06.101
DO - 10.1016/j.wneu.2019.06.101
M3 - Article
C2 - 31229746
AN - SCOPUS:85068595957
VL - 129
SP - 311
EP - 317
JO - World neurosurgery
JF - World neurosurgery
SN - 1878-8750
ER -