Microsurgical Techniques in Spinal Cord Tumours

The main goal in spinal cord surgery: to remove the tumour as completely as possible and to preserve neurological function. This balance is extremely delicate — it requires millimetre-level precision.

Intraoperative Neuromonitoring (IONM)

Throughout the surgery, the patient's nerve functions are monitored in real time:

• SEP (Somatosensory Evoked Potential): Monitors sensory pathways
• MEP (Motor Evoked Potential): Monitors motor pathways
• EMG: Monitors nerve root function

Technical Steps

Posterior approach: The most commonly used route. The canal is opened with a laminectomy or laminoplasty. The dura is opened to reach the tumour.

In intramedullary tumours: A myelotomy is performed from the posterior median sulcus or the dorsal root entry zone. The tumour is removed using an ultrasonic aspirator (CUSA) and microsurgical techniques. The tumour-spinal cord interface is carefully determined.

In extramedullary tumours: The tumour has usually pushed the spinal cord to the side. After removal from within the capsule (intracapsular debulking), the capsule is separated from the surrounding tissues.

Laminoplasty: Especially in children, the lamina is replaced to preserve the bone structure and prevent the development of deformity.

In extramedullary tumours (meningioma, schwannoma), the total removal rate is over 90%; recurrence is rare after total removal, but it can rise above 5% in long-term follow-up.^1,2

Outcomes

In extramedullary tumours (meningioma, schwannoma), the total removal rate is over 90%; recurrence is rare after total removal, but it can rise above 5% in long-term follow-up. In intramedullary ependymomas, total removal (resection) can be achieved when a dissection plane is found between the tumour and the spinal cord. In astrocytomas, subtotal removal is more common due to diffuse borders.^3,4

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