32 Tumors of the Cervical Spine
KEY POINTS
Intramedullary Spinal Tumors
General Information, Clinical Presentation, and Imaging
Ependymomas
Intramedullary ependymomas most commonly occur in the cervical and cervicothoracic regions of the spinal cord. The mean age at presentation is 42 years, and there is a slight female predominance. The most common presenting symptom is neck pain localized to the region of the spine, but patients may also present with dysesthetic pain or numbness and, with larger tumors, with symptoms from neural compression. Given the slow growth and well-circumscribed quality of these tumors, symptoms generally progress slowly, and patients often have a long history prior to diagnosis.
Operative Techniques (See Figures 32-1 and 32-2)
Intramedullary Tumors
After tumor resection, we achieve hemostasis, avoiding the temptation to coagulate any of the surface vessels. The tacked sutures on the pia and dura are removed. The dura is closed primarily, in a watertight fashion. The subarachnoid space is irrigated to remove any blood prior to final closure, and a Valsalva maneuver confirms lack of CSF egress. Fibrin glue is placed over the dural closure. The wound is closed in the standard fashion and we leave a subfascial drain until there is limited output. We allow the patient to ambulate and sit up immediately after surgery.