Surgery is the first treatment for imSCT. At this point, most tumors have already grown to a significant size leading to a distortion of the regular anatomy of the spinal cord and its surface. Patients usually suffer from local pain or neurological deficits. Cervical and thoracic astrocytomas and ependymomas are most frequent, with young males predominating. Intramedullary spinal cord (imSCT) tumors are rare accounting for 5–10% of all spinal tumors. SCS evolved to be superior concerning applicability, cost-effectiveness, and time expenditure. ConclusionĭCM and SCS may help confirm and correct the AM for myelotomy in imSCT, leading to a favorable long-term neurological outcome in this cohort. Despite early postoperative worsening of DC function, long-term follow-up showed significant recovery and improvement in quality of life. After myelotomy, 3 patients experienced > 50% reduction in amplitude of SSEPs. In 92% of cases, the AM and neurophysiologic midlines were concordant. SCS was less time-consuming ( p = 0.001), cheaper, and easier to handle.

If baseline SSEPs were poor, both methods were limited. If both recordings could be acquired (6/13), concordance was 100%. SCS was applicable in all patients with determination of the midline in 9/13. The DCM electrode detected the midline in 9/13 patients with handling limitations in the remaining patients. Standardized neurological examinations were performed preoperatively, 1 week postoperatively and after more than 12 months. Procedural and technical aspects were compared. SSEPs at the DC after stimulation of tibial/median nerve with an 8-channel DCM electrode and cortical SSEP phase reversal at C3/C4 after SCS using a bipolar concentric probe were recorded. Patients with surgically treated imSCT were prospectively included between 04/2017 and 06/2019. We compare application and feasibility of both methods. Dorsal column mapping (DCM) and spinal cord stimulation (SCS) can identify DC neurophysiologically. In surgery for intramedullary spinal cord tumors (imSCT), distortion of the anatomy challenges the visual identification of dorsal columns (DC) for midline myelotomy.

Dorsal column stimulator