12/28/2015 1 Spinal Tumor Management Rully Hanafi Dahlan. Farid Yudoyono. Sevline Estethia Ompusunggu SPINE RESEARCH LABORATORY TM . SPINE CARE TM Division of Neurospine, Peripheral Nerve and Pain Department of Neurosurgery. Hasan Sadikin Hospital. School of Medicine Padjadjaran University . Bandung City INDONESIA SPINE CASES IN OUR DEPARTMENT 2009‐2014 419 PATIENTS SURGERY 139 PATIENTS NON SURGERY 108 PATIENTS TUMOR 99 PATIENTS TRAUMA 35 PATIENTS CONGENITAL 46 PATIENTS INFECTION 19 PATIENTS VASCULAR 112 PATIENTS DEGENERATIF INTRODUCTION • 15 % of Primary CNS Tumors • Most primary are benign, most present by compression rather than invasion • Broadly organized into 3 Categories depending on the spine compartment invaded by the tumor • MRI is the best modality Extradural Intradural Extramedullary Intramedullary Anatomy
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CASE 4• ♀/36 yo• Weakness all extremities• D/ SOL intramedullary at spinal cord level vertebra C2‐C7 due to Astrocytoma
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INTRAOPERATIVE FINDINGS• ♀/36 yo• D/ SOL intramedullary at spinal cord level vertebra C2‐C7 due to Astrocytoma
CASE 5• ♀/18 yo• Weakness all extremities• D/ SOL Intramedullary at cervicomedullary to conus medullaris (holocord) due to ependymoma
INTRAOPERATIVE FINDINGS• ♀/18 yo
• D/ SOL Intramedullary at cervicomedullary to conus medullaris (holocord) due to ependymoma
• D/ Foramen magnum decompression + laminoplasty tumor removal
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CASE 6• ♂/50 yo• Weakness both lower extremities• D/ SOL Intradural Extramedullary di level Vertebra Thoracal 8‐11 due to Spinal Lipoma
INTRAOPERATIVE FINDINGS• ♂/50 yo
• D/ SOL Intradural Extramedullary di level Vertebra Thoracal 8‐11 due to Spinal Lipoma
CASE 7 : 44 YO . Quadriparesis
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CASE 8 : 14 yo. Pain. Vegerative disturbance. Quadriplegic
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CASE 9 : 45, yo Male . Quadriplegic
PA RESULTS : Schwannoma Antoni A
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Case 10 : Female, 24 yo, G3P2A0 gravida 27 mgg + SOL Extradura e.c Langerhans cell hystiocitosis P
PA : Serpentine‐like meningioma
Case 11 :47 yo female with quadriparesis
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CASE 12 : Male, 55 YO, Quadriparesis
CAUDAL
ROSTRAL
LATERALMEDIAL
* N XII
PLATYSMA
CRICOID *ARTERI FASIALIS *
GLANDULA SUBMANDIBULARIS
ESOFAGUS *
* M.LONGUS COLLIM.LONGUS COLLI *C3
*TUMOR
MANAGEMENT• Surgery to establish definitive diagnosis, decompress the neuralelements, maintain the stability, cure the patient.
• Radiotherapy the dose that the spinal cord can tolerate vs local tumorcontrol.
• Chemotherapy has not been found to be beneficial in majority ofspinal tumors.
• Long term clinical and radiological follow up to evaluate the recurrencyrisk.
Benzel. Spine Surgery – Techniques, Complication Avoidanceand Management. 3rd edition. Elsevier, 2012.Mc Lain. Cancer in the Spine – Comprehensive Care. HumanaPress, 2006.