intraspinal tumor resection

Tumors in the spinal cord parenchyma account for 9% to 18% of myeloma, mostly gliomas (about 80% of intramedullary tumors), especially ependymoma, followed by astrocytoma Less common are hemangiomas, lipomas, etc. This kind of tumor grows up and down longer, and there are those who have the capsule and the boundary. Even if the tumor is very long, it is stressed that it should be completely removed and cured. The prognosis is good. Treatment of diseases: posterior fossa ependymoma astrocytoma glioma Indication Glioma, ependymoma, astrocytoma, hemangioma, lipoma. Contraindications The age is upset, the vital organs such as the heart and lungs are poor, and the limbs are completely paralyzed for more than 3 months. Preoperative preparation 1. Prepare microsurgical instruments. 2. The nature of intramedullary tumor of the spinal cord is difficult to estimate before surgery. The operation is invasive and the total rate of resection is low. Therefore, before the operation, the doctor must explain the various possibilities to the relatives of the patient and obtain their understanding and cooperation. Surgical procedure 1. Incision of the spinal cord: During the exploration of the spinal cord, a localized uplift of the spinal cord was found and the tumor in front of the spinal cord was excluded, and the puncture was performed with a fine needle. If it is cystic, do not exhaust it, otherwise the cyst wall will not be easily separated after collapse. Longitudinal incision is made in the median vein of the spinal cord, and the length of the incision should be exposed to the tumor [Fig. 1-1]. The incision is too short and it is easy to damage the spinal cord. After clamping the blood vessels on both sides of the incision with a silver clamp or bipolar coagulation, the spinal cord cortex was cut with a thin, sharp blade [Fig. 1-2]. 2. Separation of the tumor: it should be performed under a surgical microscope. After cutting the spinal cord, the edge of the tumor is found first, and most benign tumors (including gliomas) have a clear boundary with the spinal cord. If the tumor is invasive, it can not be reluctantly removed. It can only be resected partially in the tumor to avoid damage to the surrounding normal spinal tissue. Tumors with marginal or enveloped membranes should be separated from the junction of the tumor and the spinal cord and separated by strippers [Figure 1-3]. There are not many blood vessels around the tumor. Only one or two blood vessels are supplied. The tumor can be removed by bipolar electrocoagulation and burning (Fig. 1-4, 5). Longer tumors can be removed in fractions. The whole operation should be carried out in the absence of blood and clearness in the surgical field, otherwise it will easily damage the spinal cord parenchyma. 3. Stitching the dura mater: After the tumor is resected, there is an extended small hole at each end of the tumor cavity. This is the result of the tumor pushing the spine of the spinal cord. If the tumor-free tissue remains, it may not be treated. After the tumor cavity is stopped and rinsed, the dura mater is tightly sutured together with the arachnoid [Figure 1-6]. If the tumor is only partially removed, the dura mater is not sutured. complication 1. Epidural hematoma Paravertebral muscles, vertebrae and epidural venous plexus are not completely hemostasis. Hematoma can form after operation, resulting in aggravation of limb paralysis, which occurs within 72 hours after surgery. A hematoma can occur even when the drainage tube is placed. If this phenomenon occurs, it should be actively checked to remove the hematoma and completely stop bleeding. 2. Spinal cord edema: often caused by surgical operation to damage the spinal cord, clinical manifestations similar to hematoma. The treatment is mainly dehydration and hormones; in severe cases, the dura mater has been sutured, and the operation can be performed again to open the dura mater. 3. Cerebrospinal fluid leakage: mostly caused by loose suture of the dura mater and / or muscle layer. If there is drainage, it should be removed in advance. If the leakage is less, the dressing is observed. If it cannot be stopped or the fluid is leaked, the leak should be sutured in the operating room. 4. Incision infection, rupture: generally poor condition, poor wound healing ability or cerebrospinal fluid leakage is easy to occur. Intraoperative attention should be paid to aseptic operation. In addition to antibiotic treatment, it should actively improve the general condition, paying special attention to the supplement of protein and multivitamins. Special parts such as between the shoulder blades should be reinforced with muscle layer sutures. 5. Intraoperative spinal cord injury caused dysfunction.